Perimenopause means "around menopause" and refers to the time during which your body makes the natural transition to menopause, marking the end of the reproductive years. Perimenopause is also called the menopausal transition.
Women start perimenopause at different ages. You may notice signs of progression toward menopause, such as menstrual irregularity, sometime in your 40s. But some women notice changes as early as their mid-30s.
The level of estrogen — the main female hormone — in your body rises and falls unevenly during perimenopause. Your menstrual cycles may lengthen or shorten, and you may begin having menstrual cycles in which your ovaries don't release an egg (ovulate). You may also experience menopause-like symptoms, such as hot flashes, sleep problems and vaginal dryness. Treatments are available to help ease these symptoms.
Once you've gone through 12 consecutive months without a menstrual period, you've officially reached menopause, and the perimenopause period is over.
Throughout the menopausal transition, some subtle — and some not-so-subtle — changes in your body may take place. You might experience:
Some women seek medical attention for their perimenopausal symptoms. But others either tolerate the changes or simply don't experience symptoms severe enough to need attention. Because symptoms may be subtle and come on gradually, you may not realize at first that they're all connected to the same thing — rising and falling levels of estrogen and progesterone, another key female hormone.
If you have symptoms that interfere with your life or well-being, such as hot flashes, mood swings or changes in sexual function that concern you, see your doctor.
As you go through the menopausal transition, your body's production of estrogen and progesterone rises and falls. Many of the changes you experience during perimenopause are a result of decreasing estrogen.
Menopause is a normal phase in life. But it may occur earlier in some women than in others. Although not always conclusive, some evidence suggests that certain factors may make it more likely that you start perimenopause at an earlier age, including:
Irregular periods are a hallmark of perimenopause. Most of the time this is normal and nothing to be concerned about. However, see your doctor if:
Signs such as these may mean there's a problem with your reproductive system that requires diagnosis and treatment.
Perimenopause is a process — a gradual transition. No one test or sign is enough to determine if you've entered perimenopause. Your doctor takes many things into consideration, including your age, menstrual history, and what symptoms or body changes you're experiencing.
Some doctors may order tests to check your hormone levels. But other than checking thyroid function, which can affect hormone levels, hormone testing is rarely necessary or useful to evaluate perimenopause.
Drug therapy is often used to treat perimenopausal symptoms.
Before deciding on any form of treatment, talk with your doctor about your options and the risks and benefits involved with each. Review your options yearly, as your needs and treatment options may change.
Making these healthy lifestyle choices may help ease some symptoms of perimenopause and promote good health as you age:
In addition to conventional therapies, many women transitioning toward menopause want to know more about complementary and alternative approaches to treating symptoms. Researchers are looking into these therapies to determine their safety and effectiveness, but evidence is still often lacking.
Some of the options studied include:
Phytoestrogens. These estrogens occur naturally in certain foods. Two main types of phytoestrogens are isoflavones and lignans. Isoflavones are found in soybeans, chickpeas and other legumes. Lignans occur in flaxseed, whole grains, and some fruits and vegetables. There are also plant-derived compounds that have estrogen-like properties.
Isoflavone supplements generally come from soy or red clover. Lignans come mainly from flaxseed. Studies on phytoestrogens — whether from food or supplements — conflict on whether they help reduce menopausal symptoms. Studies also conflict on whether it's possible that phytoestrogens could increase the risk of breast cancer or interfere with the effectiveness of tamoxifen.
Low-risk complementary therapies, such as acupuncture, yoga and paced breathing may help reduce stress and improve psychological well-being. Research on acupuncture for decreasing hot flashes is inconclusive, but promising. Relaxation can help reduce stress, which may in turn help improve menopausal symptoms.
Talk with your doctor before taking any herbal or dietary supplements for perimenopausal or menopausal symptoms. The FDA does not regulate herbal products, and some can be dangerous or interact with other medications you take, putting your health at risk.
You'll probably start by discussing your symptoms with your primary care provider. If you aren't already seeing a doctor who specializes in the female reproductive system (gynecologist), your primary care provider may refer you to one.
To prepare for your appointment:
Some basic questions to ask include:
To start a discussion about your perimenopausal experience, your doctor may ask questions such as: