Perimenopause

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Introduction

What is perimenopause?

Perimenopause is a naturally occurring condition in women and refers to the time around which a woman reaches menopause. Menopause is a naturally occurring condition in women and is the cessation of menstrual periods. It marks the end of a woman’s reproductive years and is defined medically as the absence of menstrual periods for 12 consecutive months. Menopause typically happens between the ages of 45 and 55. During menopause, a women’s reproductive system changes, resulting in a discontinuation of estrogen production, the menstrual cycle, and egg maturation.

Perimenopause develops when the female reproductive system begins slowing down, resulting in decreased production of the female hormones estrogen and progesterone. Decreased hormone levels cause a coinciding drop in the production of eggs and in the frequency of menstrual periods. Menopause creates changes in the vagina, vaginal secretions, and outer genitalia. It most commonly develops over a period of one to five years.

The symptoms of perimenopause are different for every woman. Symptoms of the menopausal transition commonly begin a few years prior to the cessation of menses. The most common symptom of the perimenopause is hot flashes, but a number of other symptoms can occur.

Perimenopause symptoms can occur frequently or only occasionally. Some women do not experience any symptoms of menopause while others have sweats, hot flashes, and emotional distress. The symptoms may range in intensity from mild to severe. Fortunately, the symptoms of perimenopause can be managed with hormone therapy, medications, and lifestyle changes.

Perimenopause is not a disease process. Seek prompt medical care if you are being treated for menopause but mild symptoms recur or are persistent.

Symptoms

What are the symptoms of perimenopause?

Perimenopause causes a reduction in the production of the female hormones that can result in a number of symptoms. The symptoms can vary in intensity among individuals.

Common symptoms of perimenopause

You may experience perimenopause symptoms daily or only occasionally. Any of these symptoms can be severe:

Other symptoms of perimenopause

Other symptoms that may occur with perimenopause include:

  • Aches and pains in the joints
  • Anxiety
  • Depression
  • Difficulty with memory
  • Hair loss
  • Headache
  • Inability to control urination (urinary incontinence)
  • Infections of the vagina
  • Irregular heart rate
  • Irritability and mood changes
  • Pain during sexual intercourse
  • Reduced interest in sex
  • Reduced sexual response
  • Thinning skin

Symptoms that might indicate a serious condition

Perimenopause alone is not a serious condition and is a normal aspect of life. Seek prompt medical care if you are being treated for symptoms of perimenopause but these recur or cause you concern.

Causes

What causes perimenopause?

Perimenopause is brought on by the decreased production of the female hormones estrogen and progesterone. As a result, the female reproductive system begins slowing down, producing fewer eggs in the ovaries and less menstruation. Perimenopause causes changes in the vagina, vaginal secretions, and outer genitalia. It most commonly develops over a period of one to five years.

What are the risk factors for perimenopause?

Because perimenopause is a normal function of the female reproductive system, it is not a preventable condition. There are no risk factors associated with perimenopause.

Treatments

How is perimenopause treated?

Treatment for perimenopause is not always necessary. It is a normal part of life and not a disease process. However, some of the symptoms may be uncomfortable, and treatment of these symptoms is possible. Some women with perimenopause may not have any troubling symptoms, but if symptoms do occur, there are several treatment options for reducing or eliminating them. Your health care provider will assess the best treatment options for you based on your age, the severity of your symptoms, and your individual risk for cardiovascular disease, blood clots, breast cancer and stroke.

Hormone replacement therapy

Hormone therapy with estrogen or, most commonly, with estrogen plus a progestin, may be considered for the short-term relief of symptoms. Hormone therapy may be taken in pill form or may be prescribed as a skin patch, cream, or vaginal suppository.

You and your health care provider should discuss hormone replacement therapy, carefully considering whether the benefits will outweigh the risks for you. If you fall in a low risk category and your symptoms are interfering with your quality of life, your health care provider may use the following guidelines for hormone replacement therapy:

  • Do not prescribe for longer than five years

  • Do not prescribe for women who began menopause several years ago. This does not apply to estrogen creams, which can be used at any stage of menopause.

  • Prescribe as low a dose as possible or use estrogen cream

  • Prescribe only for women who recently started menopause

  • Take baseline measurements before hormone therapy is prescribed. These ensure a low risk of breast cancer, heart disease, or blood clots and stroke.

Other perimenopause treatment options

If you and your health care provider decide that the risks of hormone replacement therapy are too great, your health care provider may prescribe medications that will decrease the effects of symptoms like mood disorders and hot flashes. Examples include:

  • Bupropion (Welbutrin)
  • Catapres (Clonidine)
  • Fluoxetine (Prozac)
  • Paroxetine (Paxil)
  • Venlafaxine (Effexor)

What you can do to improve your perimenopause

Symptoms of perimenopause may also be decreased by:

  • Avoiding spicy foods

  • Being physically active

  • Consuming soy products

  • Consuming the recommended amount of vitamin D and calcium for perimenopausal women

  • Meditating or taking deep breaths when a hot flash is coming

  • Practicing daily Kegel exercises to strengthen vaginal muscles

  • Using lubricants during sexual intercourse

  • Wear light, layered clothing

Complementary treatments

Some complementary treatments may help some people to better deal with perimenopausal symptoms. These treatments, sometimes referred to as alternative therapies, are used in conjunction with traditional medical treatments. Complementary treatments are not meant to substitute for traditional medical care. Be sure to notify your doctor if you are consuming nutritional supplements or homeopathic (nonprescription) remedies as they may interact with the prescribed medical therapy.

Complementary treatments may include:

  • Acupuncture
  • Biofeedback
  • Hypnosis
  • Massage therapy
  • Nutritional dietary supplements, herbal remedies, tea beverages, and similar products

  • Yoga

What are the potential complications of perimenopause?

You can help minimize your risk of serious complications by following the treatment plan you and your health care professional design specifically for you. Complications of perimenopause include:

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2019 Jan 4
  1. Menopause. WomensHealth.gov. https://www.womenshealth.gov/menopause/.
  2. Menopause. PubMed Health, a service of the NLM from the NIH. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001896/.
  3. Burger HG. Unpredictable endocrinology of the menopause transition: clinical, diagnostic and management implications. Menopause Int 2011; 17:153.
  4. Bope ET, Kellerman RD (Eds.) Conn’s Current Therapy. Philadelphia: Saunders, 2013.
  5. Domino FJ (Ed.) Five Minute Clinical Consult. Philadelphia: Lippincott Williams & Wilkins, 2013.
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