Perimenopause meaning "around menopause" refers a menopausal transition where a woman’s body moving towards permanent infertility (menopause). It is a period where the ovaries gradually begin to make less estrogen (main female hormone). Women start perimenopause at different ages, however, signs and symptoms such as menstrual irregularity may become noticeable during their 40s. Some women may notice changes as early as their mid-30s.

Perimenopause lasts up until menopause (12 months without a menstrual period), the point when the ovaries stop releasing eggs. Over the years, the drop in the levels of estrogen speeds up and women begin to experience menopause-like symptoms such as hot flashes, tiredness, low sex drive and vaginal dryness.

Treatment options are available to help ease discomfort associated with perimenopause symptoms.



During the perimenopausal period, signs and symptoms may include:

·         Menstrual irregularity: As ovulation becomes more unpredictable, the length of time between periods may be longer or shorter, flow may range between light and heavy at times, and skipping some periods may occur.

·         Hot flashes and sleep disturbances: Many women experience hot flashes during perimenopause and sleep disturbances are often due to these hot flashes.  

·         Mood swings: Some women experience mood swings, irritability or increased risk of depression during perimenopause.

·         Vaginal and bladder problems: As levels of estrogen begin to decrease, the vaginal tissues may lose lubrication and elasticity, making intercourse painful. Loss of tissue tone may contribute to urinary incontinence or even vaginal infections due to constant irritation of the area.

·         Decreasing fertility: As ovulation becomes irregular, a woman’s ability to conceive decreases. Avoiding possible pregnancy at the time can be done through the use of birth control.  

·         Lower sex drive: During perimenopause, sexual arousal and desire for most women may diminish and will likely continue through perimenopause and beyond.

·         Loss of bone. With decreasing estrogen levels, bone loss is most likely to occur. The inability to replace the bones as quickly as losing them increases the risk of osteoporosis (a condition where the bones become brittle and weak).

·         Cholesterol level changes:  The decrease in estrogen levels can cause an increase in low-density lipoprotein (LDL) cholesterol (the so called bad cholesterol) which can lead to an increased risk of heart disease. At the same time, high-density lipoprotein (HDL) cholesterol (the good cholesterol) decreases in many women as they age, which also increases the risk of heart disease.



As a woman goes through menopausal transition, the body’s production of estrogen and progesterone rises and falls. Perimenopause is caused by changes in the levels of estrogen and progesterone in a woman’s body.


Risk factors

Menopause is a normal stage in a woman's life; however it may occur earlier in some women than in others. Certain factors that can contribute to risk of starting perimenopause at an earlier age include the following:  

·         Being a smoker

·         Having a family history of early menopause

·         Recieving treatment for cancer with chemotherapy or pelvic radiation

·         Having had hysterectomy (surgical removal of the uterus)



Irregular periods are the most common factor of perimenopause. Most of the time, this is normal and nothing to be concerned about. The following signs may indicate the presence of an underlying problem with a woman’s reproductive system that requires further medical attention and treatment. Seeing a doctor is vital if:

·         Blood flow is extremely heavy

·         Blood flow lasts longer than seven days

·         Bleeding occurs between periods

·         Periods regularly occur less than 21 days apart




The main treatment option for perimenopause is drug therapy. Different types of drug therapy used include the following:  

  • Hormone therapy: The use of systemic estrogen therapy in the form of a pill, skin patch, gel or cream form to relieve perimenopausal and menopausal hot flashes and night sweats. Systemic estrogen can also help prevent bone loss.
  • Vaginal estrogen: The use of estrogen in the form of a vaginal tablet, ring, or cream to be absorbed by the vaginal tissue and provide relief of vaginal dryness, discomfort during sexual intercourse and some urinary symptoms.
  • Antidepressants: The use of a class of drugs called selective serotonin reuptake inhibitors (SSRIs) to help manage and reduce menopausal hot flashes.
  • Gabapentin (Neurontin): A drug used to treat seizures and help reduce hot flashes. It is most useful in women who can’t use estrogen therapy due to medical reasons and in those who also have migraines.