What Is Perimenopause?

Perimenopause is the stage leading up to menopause (defined as no longer having your period for at least a year). Typically affecting women during their late 40s, perimenopause is caused by a gradual, natural decline in estrogen hormones. The stage lasts for about five to 10 years and cause a number of symptoms, including changes in your menstrual pattern, mood fluctuation, and vaginal dryness.

Perimenopause Symptoms

The average age of menopause is 51, and most women experience perimenopause in their 40s and early 50s. Symptoms can vary, and you may be prone to some of the effects more than others.

Even if it seems likely that your symptoms are due to perimenopause, it is important to see a healthcare provider. Medical illnesses such as thyroid disease, type 2 diabetes, and endometrial cancer can have similar effects.

Common symptoms of perimenopause include the following.

Period Changes

Changes in your usual menstrual pattern are among the most noticeable signs of perimenopause. You may have irregular bleeding, intermittent spotting, or changes in your premenstrual symptoms.

Hot Flashes and Night Sweats

Hot flashes can occur at any time, regardless of the environmental temperature. Some women also frequently feel warm and are prone to sweating during perimenopause.

Night sweats usually occur at night and can leave you and your blankets soaked.

Mood Changes

During perimenopause, you may be surprised by feelings of depression, anxiety, irritability, or mood swings, especially if you are usually emotionally stable.

Vaginal Dryness

You might feel pain or discomfort during sexual intercourse, and you may experience vaginal dryness, fragile vaginal skin, or even bleeding for a day or so after sex. Less vaginal lubrication also impedes fertilization of an egg by a sperm.

Sleep Problems

In addition to hot flashes, night sweats and anxiety can contribute to sleeping problems during perimenopause. Sleeping difficulties, in turn, can worsen mood changes. 

Weight Changes

During perimenopause, women often have slight to moderate weight gain and are prone to increasing fat around the waist area.

Urinary Problems

Urinary problems common in perimenopause include urinary tract infections (UTIs) and decreased bladder control or urinary incontinence. You may "leak" when laughing, exercising, or holding urine for long.

Lower Sex Drive

Many women have less interest in sex during the perimenopausal years, which can be distressing for women and their partners.

Skin Changes

You may notice skin dryness or a change in skin elasticity, which can make skin appear "saggy" or older.

Hair Problems

You may lose hair, resulting in thinning on your head. You may also get more hair on your face due to the shift in hormones.

Causes

Throughout the reproductive years, you produce several different estrogen hormones. These hormones help regulate the menstrual cycle and facilitate pregnancy through the action of complex feedback mechanisms.

During perimenopause, your body's production of estrogen hormones gradually declines. This is a normal part of a life and is what causes related symptoms.

Ovulation (ovaries releasing an egg) declines. The processes that accompany this, such as monthly production of the uterine lining, also decline during perimenopause. Menstruation, the release of the uterine lining when there is no pregnancy, gradually ceases as well.

Who Doesn't Experience Natural Perimenopause

If you have a total abdominal hysterectomy, with both of your fallopian tubes and ovaries removed, you can expect to experience surgical menopause (also called induced menopause).

There are also other causes for induced menopause, including pelvic radiation or chemotherapy. 

In these cases, women bypass the perimenopausal stage.

Diagnosis

Typically, perimenopause is diagnosed based on your medical history, physical examination, and possibly diagnostic testing as well.

Often, women seek medical attention for the more distressing effects of perimenopause. For example, irregular periods are usually a cause of concern. Similarly, mood changes, hot flashes, and UTIs often prompt a visit to the healthcare provider.

All of these issues could be solely caused by perimenopausal hormonal changes, but they could be the result of a medical illness, such as an infection or tumor, instead. For example, abnormal bleeding can be a sign of uterine fibroids, pituitary dysfunction, or cancer, even during the perimenopausal years.

To complicate matters, decreased estrogen in perimenopause can exacerbate many of the symptoms related to such conditions.

Given this, your healthcare provider will consider all possible causes of your symptoms—not just perimenopause, even if it seems likely.

Examination and Testing

Your healthcare provider may use any of the following to help form a diagnosis:

• Pelvic examination: During a pelvic exam, your healthcare provider will examine the cervix (birth canal), and can also examine the lower part of the uterus. This test can help your practitioner assess whether you have fibroids, a tumor, or infectious lesions.
• Pap smear: A Pap smear can help identify pre-cancerous lesions of the cervix. It is a relatively fast test during which your medical professional scrapes the inner lining of your cervix to collect a sample of cells that can be examined under a microscope.
• Imaging tests: If there is a concern that you may have a growth or an abnormality of your cervix, uterus, ovaries, or bladder, you may need an imaging test, such as computerized tomography (CT) or ultrasound.
• Biopsy: A biopsy is a sample of tissue that can be examined under a microscope. It involves a more invasive procedure than a Pap smear, and it may be guided by abnormalities seen on imaging studies.

Even if you don't have symptoms, your healthcare provider may also run tests to assess for osteoporosis and hypertension.

Treatment

Most women do not need to take medication to relieve perimenopausal effects. Often, lifestyle strategies can have a big impact on symptoms.

For some women, symptoms are especially bothersome and hormone replacement therapy (HRT) can be helpful. In other instances, symptomatic treatment aimed at controlling specific effects, such as depression, anxiety, or hair loss, are the best fit.

Lifestyle

Taking practical steps to ease your comfort may be all you need. This is especially true if your symptoms are mild and intermittent. You might not want to take a daily medication for a problem that only bothers you once every few weeks.

Some strategies to try:

• Dressing in layers, drinking cold drinks, and using a fan can cool you off.
• Exercise can help control your weight and can help you sleep better.
• Paying attention to your diet and hydration can help control weight and encourage healthy looking skin.

While not a treatment, absorbent liners can help catch bladder leaks and irregular vaginal bleeding, so they are worth having handy.

Symptomatic Treatment

Often, women opt to take treatment to help control the most bothersome symptoms of perimenopause. Treatments can range from simple over-the-counter (OTC) medication to prescription therapies.

For example, OTC vaginal lubricants can help relieve vaginal dryness.

Prescription medications may also be helpful: An antidepressant or antianxiety medication for mood, an anticholinergic for bladder control, or a sleep aid for insomnia, to name a few.

Hormone Replacement

Because a decline in estrogen is the main cause of perimenopausal symptoms, taking estrogen or a combination of estrogen with progestin (the synthetic form of the hormone progesterone) is often used to manage the effects.

HRT can be taken systemically (a skin patch or a pill) or locally (vaginal estrogen to treat dryness).

A Word From Verywell

To many, entering this new phase of life represents getting older, which may carry emotional challenges for some. Many of the symptoms of perimenopause are temporary and do not continue after menopause. However, some of the health effects of decreased estrogen, including the predisposition to heart disease and fragile bones, remain throughout a woman's life after menopause.

Be sure to get regular preventative health check-ups so that you can avoid health problems in the years to come.