Perimenopause: Symptoms, Causes & Treatment

Dr. Sheila Sedicias
Medical review: Dr. Sheila Sedicias Gynecologist CRM 17459-PE
Created by: Tua Saude editing team
Key points
  • Perimenopause usually begins in the 40s as estrogen and progesterone levels gradually decline.
  • Common symptoms include irregular periods, hot flashes, mood changes, sleep problems, low libido, and vaginal dryness.
  • Treatment depends on symptom severity and may include medications, dietary changes, exercise, and healthy sleep habits.

Perimenopause is the stage before menopause when the ovaries gradually produce less estrogen and progesterone. It usually begins during a woman's 40s and can cause physical and emotional changes as the body transitions out of the reproductive years.

Common perimenopause symptoms include irregular periods, hot flashes, mood changes, sleep problems, vaginal dryness, and low libido. These symptoms vary from person to person and may begin several years before menopause.

Perimenopause is diagnosed based on symptoms, medical history, and, in some cases, blood tests to measure hormone levels. Treatment is not always necessary but may include medications, healthy lifestyle changes, and dietary adjustments to help manage symptoms when they affect daily life.

middle-aged woman having a hot flash

Perimenopause symptoms

The main symptoms of perimenopause include:

  • Changes in the menstrual cycle, including longer or shorter cycles

  • Changes in menstrual flow, including heavy periods

  • Breast pain or tenderness, abdominal bloating, and headaches

  • Irritability and mood changes

  • Difficulty sleeping or insomnia

  • Low libido

  • Heart palpitations

  • Hot flashes

  • Vaginal dryness

A gynecologist should be consulted if perimenopause symptoms begin earlier than expected or significantly affect quality of life.

Symptom checker

If you think you may be entering menopause, select the symptoms you are experiencing in the following test:

  1. 1. Irregular menstruation
  2. 2. Absence of menstruation for 12 consecutive months
  3. 3. Heat waves that start suddenly and without an apparent cause
  4. 4. Intense night sweats that can interrupt sleep
  5. 5. Frequent fatigue
  6. 6. Mood changes such as irritability, anxiety or sadness
  7. 7. Difficulty sleeping or lower sleep quality
  8. 8. Vaginal dryness
  9. 9. Hair loss
  10. 10. Decreased libido

This symptom test is only a screening tool and does not replace an evaluation by a gynecologist or blood tests to measure hormone levels.

What causes perimenopause?

Perimenopause occurs as the ovaries gradually produce less estrogen and progesterone. According to the National Institute on Aging, this decline in hormone production can contribute to hot flashes and other symptoms during the menopausal transition.

Perimenopause usually begins during the 40s. However, smoking, a family history of early menopause, cancer treatment, or surgery to remove the ovaries may cause it to begin earlier.

When does perimenopause start?

Perimenopause normally begins between ages 40 and 45. The timing may vary depending on factors such as genetics, lifestyle, and overall health.

Factors that may lead to early perimenopause include smoking, a family history of early menopause, cancer treatment, or surgery to remove the ovaries or uterus.

Confirming a diagnosis

A gynecologist may diagnose perimenopause by reviewing a woman’s symptoms and medical history. Blood tests may also be used to check hormone levels, including follicle-stimulating hormone (FSH), estrogen, and progesterone.

Perimenopause treatment

Treatment for perimenopause should be recommended by a gynecologist and is intended to relieve symptoms. However, treatment is not always necessary.

1. Medications

A gynecologist may recommend medications such as birth control pills or menopausal hormone therapy. In some cases, antidepressants or other medications, such as gabapentin or clonidine, may be prescribed to help relieve hot flashes.

2. Natural remedies

Natural remedies that may be marketed for perimenopause symptoms include:

These products are not FDA-approved to treat perimenopause or menopause symptoms, and their effectiveness has not been clearly established. They may also cause side effects or interact with medications, so they should only be used with guidance from a healthcare professional.

According to the US Food and Drug Administration (FDA), dietary supplements are not approved for safety and effectiveness before they are marketed.

3. Dietary changes

During perimenopause, certain dietary changes may help relieve symptoms. These include adding flaxseed to the diet, increasing the intake of calcium-rich foods, and limiting caffeine and alcohol.

It is also important to drink enough fluids and reduce the intake of foods high in fat and added sugars.

Adequate amounts of vitamin D, vitamin B6, vitamin B12, vitamin E, folic acid, magnesium, and calcium should also be obtained through food or supplements recommended by a doctor or registered dietitian. This may help support hormone balance and relieve symptoms.

4. Lifestyle changes

Other activities can be performed at home to help relieve perimenopause symptoms. Getting about 30 minutes of physical activity per day can help maintain muscle tone, strengthen bones, and support a healthy weight.

Relaxation exercises or meditation may also help manage stress and mood changes.

Maintaining healthy sleep habits is also important. Avoiding screens before bedtime and doing relaxing activities in the evening may make it easier to fall asleep.

Update History
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References
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