Perimenopause

• Perimenopause is the phase before actual menopause, in which you can notice irregularities in your menstrual cycle, mood changes, and other physical symptoms.
• The average age of perimenopause is 40 to 44, but it can also occur earlier or later in some women. 
• Perimenopause treatment is mainly focused on symptom relief.

Perimenopause is a stage in which women experience a transition from their reproductive age towards menopause. This shift is combined with symptoms of perimenopause and irregularities in the menstrual cycle. Perimenopause can last quite some time and can cause symptoms that can affect everyday activities. Treatment options exist to find relief. In this guide by Ada’s medical team, you can find more information on perimenopause, its stages, symptoms, and treatment options. 

Perimenopause is the period before menopause, in which you can already start to notice the symptoms of menopause, but you’re still having a period occasionally. As this is a transition time from your reproductive age into your menopause, it’s also often referred to as the menopausal transition. Perimenopause starts when your period first becomes irregular due to a decline in the function of your ovaries and ends a year after you’ve had your last period. 1

Perimenopause is the stage before menopause. Perimenopause itself can also be divided into different substages, each of which has its characteristics: 2

• Very early perimenopause: in this stage, your period is still regular, but you can start noticing some early symptoms such as anxiety, mood changes, and heavier periods 
• Early perimenopause: in this stage, your cycle starts to show some changes, and your period can be about a week later or earlier than usual. Your symptoms can get a bit more noticeable, as your estrogen levels start to fluctuate more. This can lead to perimenopause symptoms such as breast pain, migraines, weight gain, and fatigue.
• Late perimenopause: as your estrogen levels drop in this stage, you can notice symptoms such as weight gain, fatigue, hot flashes, vaginal dryness and brain fog. 

After these stages, you’ll reach the end of your perimenopause. Some signs your perimenopause is ending can be that you haven’t had your period for quite some time and that you notice symptoms of perimenopause. Your symptoms should decrease once a year has passed since you’ve last had your period.

The symptoms of perimenopause are caused by the hormonal changes in your body and can be noticed both physically and mentally. Some common signs of perimenopause are:  3 4

• Hot flushes: a feeling of sudden heat in the face, neck or chest
• Night sweats
• Palpitations
• Changes in menstruation 
• Vaginal dryness
• Painful breasts 
• Painful intercourse
• Reduced sex drive
• Painful joints and muscles
• Changes to your body composition
• Having dry and itchy skin
• Recurrent urinary tract infections
• Incontinence
• Difficulty sleeping
• Headaches
• Changes in mood
• Memory problems
• Depression 
• Anxiety

Perimenopause symptoms can vary in nature and intensity, making the transition something very personal. Some women almost do not experience any perimenopause signs, while others may experience severe symptoms that affect their quality of life. 

Perimenopause is a natural process that happens when women grow older, as the ovaries start to lose their function and stop releasing eggs that can be fertilized. This causes changes to your hormones, which can cause irregular menstrual cycles and eventually a complete stop of your menstruation. 5

The duration of perimenopause can vary from woman to woman. Perimenopause starts once the menstrual cycle of a woman becomes irregular and ends 1 year after the last menstruation. For most women, the average duration of perimenopause is between 3 to 4 years, although for some, it can only take a few months or it can last up to a decade. 1

The diagnosis of perimenopause can be made based on your age and the symptoms you’re experiencing. Perimenopause tests aren’t required for the diagnosis. However, blood and urine samples can help determine your levels of estradiol, follicle-stimulating hormone, and luteinizing hormone, which typically have different values during menopause. 6

Perimenopause treatment is focused on symptom relief and the prevention of complications. 

Systemic hormonal treatment can help reduce the severity and frequency of the symptoms of menopause. It can also help reduce the risk of complications such as osteoporosis. This therapy can be administered in various forms, such as tablets, sprays, gels, patches, or vaginal rings. Which hormones you need depends on your situation. Hormonal treatment should only be given for a limited amount of time, so it’s essential to follow the instructions of your healthcare provider. 5

Local estrogen therapy can help with urogenital symptoms such as recurrent urinary tract infections, vaginal dryness, and pain during intercourse. It can be used in addition to systemic hormonal treatment. 5

Non-hormonal treatment exists for the treatment of physical symptoms such as hot flashes. Some examples are: 5

• Paroxetine
• Escitalopram
• Gabapentin
• Neurokinin B
  

During perimenopause, vitamin supplements may help relieve your symptoms. Studies show that the best perimenopause supplements are: 5

• Vitamin E
• Omega-3
• Milk thistle

Perimenopause self-care can consist of making lifestyle changes such as: 5

• Maintaining a healthy weight
• Cognitive behavioral therapy
• Wearing breathable clothing 
• Doing exercise

Perimenopause is the stage that marks the shift between the reproductive years of a woman and menopause. During this stage, you can experience various symptoms such as anxiety, weight gain, and hot flashes. To relieve these symptoms, you can ask your healthcare provider for the appropriate treatment option.

Q: When does perimenopause start? 
A: Perimenopause usually starts at the age of 40 to 44, although it can also start earlier or later in life. 

Q: Can you get pregnant during perimenopause? 
A: Although it’s less common, and the chances of getting pregnant are lower than in your reproductive years, it’s still possible to get pregnant during perimenopause. 

Q: What does a hot flash feel like during perimenopause? 
A: A hot flash during perimenopause can feel like a sudden feeling of warmth in the face, neck, or chest area. You may feel sweaty, and your skin can redden as well.

Q: How do you know if you are in perimenopause? 
A: If you're in perimenopause, then your menstrual cycle will start being irregular. After that, you can also start noticing common symptoms of perimenopause, such as anxiety, hot flashes, and weight gain.