Patient education: Perimenopause (The Basics)

What is perimenopause? — 

This is the time leading up to menopause, which is when a person stops having monthly periods. After menopause, the ovaries no longer release eggs or make the hormone estrogen. This does not happen all at once, but gradually.

Perimenopause usually starts about 4 years before a person has their last period. The average age for this is 47 years, but it can happen a bit earlier or later. During this time:

●Hormone levels change – This involves several different hormones. The most important change is that estrogen levels can be much higher than usual, then drop to very low levels. This is what causes symptoms.

●Periods become less regular.

People can also start to have other symptoms of menopause, like hot flashes.

Perimenopause is a normal and natural part of life. But for many people, the symptoms are hard to deal with. It can help to know what to expect. There are also treatments that can help.

What are the symptoms of perimenopause? — 

The main symptom is changes in the menstrual cycle. For example, your periods might happen more or less often than usual, or be shorter than before.

Hormone changes can also cause other symptoms. These might include:

●Hot flashes – These can feel different to different people. For some people, they feel like a wave of heat that starts in the chest and face and then moves through the body. When hot flashes happen during sleep, they are called "night sweats."

●Mood changes – Many people start having symptoms of depression or anxiety.

●Sleep problems – Some people have trouble falling or staying asleep. People with night sweats or mood changes are more likely to have sleep problems.

Other symptoms of menopause typically happen later, after monthly periods stop. For example, you might notice vaginal dryness. This can make sex uncomfortable or painful.

Will I need tests? — 

It depends. If you notice changes to your period, or other symptoms that could be related to perimenopause, tell your doctor or nurse.

If you are older than 45 years, it's normal to start having changes in your periods. Doctors do not usually recommend getting tests to check your hormone levels. This is because a single blood test does not give enough information about whether you are in perimenopause.

Doctors do recommend tests in certain situations:

●If there is a chance you could be pregnant, your doctor will probably do a pregnancy test.

●If your periods are very heavy or last a long time, your doctor can do different tests to look for the cause.

●If you have other symptoms that could be caused by a medical problem, such as thyroid disease, you might get other tests.

If you are younger than 45 years, your doctor might order blood tests. This can help them figure out if you are in perimenopause or if something else is causing your symptoms.

Can hormone therapy help with perimenopause symptoms? — 

In many cases, yes. The main goal of hormone therapy is to reduce hot flashes. But it might also help with other symptoms.

The hormone estrogen is the most effective treatment for menopause symptoms. Most people need to take estrogen with another hormone called progesterone. People who had a hysterectomy (surgery to remove the uterus) can take estrogen by itself.

Your doctor can talk to you about whether hormone therapy is an option for you. Experts think that hormone therapy is safe for most people younger than 60 years. But there are a few exceptions. Do not take hormones if you had breast cancer, a heart attack, a stroke, or a blood clot.

Some doctors are not used to prescribing hormone therapy. If you feel that you are not getting the help you need, you might choose to talk to a different doctor who is an expert in menopause treatment. You can ask your doctor or nurse to refer you to someone.

Are there other treatments that can help? — 

Depending on your symptoms, your doctor might prescribe other treatments. Examples include antidepressants or vaginal estrogen (to help with dryness or pain during sex). There are some things you can do on your own that might help (table 1).

Many people wonder about "natural remedies." Talk to your doctor before trying these, especially if you have a history of breast cancer. Things like herbs and supplements are not proven to help, and in some cases, could harm you.

You might have seen ads for companies selling products to treat menopause symptoms. These often include supplements or vitamins that claim to balance your hormones, improve your sex life, or cure other symptoms. Most of the time, there is no evidence that these products work. The companies and people selling these products do not always provide accurate information. The best way to learn about treatment options is to talk with a doctor who is an expert in women's health and menopause. In the US, the North American Menopause Society ("NAMS") has information on their web site: www.menopause.org/for-women.

More on this topic

Patient education: Menopause (The Basics)
Patient education: Hormone therapy for menopause (The Basics)
Patient education: Menstruation (The Basics)
Patient education: Vaginal dryness (The Basics)
Patient education: How to use vaginal medicines (The Basics)

Patient education: Menopause (Beyond the Basics)
Patient education: Menopausal hormone therapy (Beyond the Basics)
Patient education: Vaginal dryness (Beyond the Basics)