The perimenopause is a confusing time for women. The perimenopause is a distinct transition between the reproductive years and cessation of menses. This article will hopefully help to explain and offer treatment options for this often frustrating transition. The World Health Organization defines the onset of the perimenopause as the beginning of menstrual cycle changes. Early perimenopause changes include the first break in regular cycling of menses. Late perimenopause is classified after missing 3 to 11 months of menses, while menopause is reached after 12 months of no menstrual flow. Women usually notice the onset of perimenopause symptoms during their 40’s and irregularities usually persist for approximately 5 years.

The range of perimenopause symptom duration may be quite variable, from 2 to 8 years, or even longer. In general, the later in life that perimenopause symptoms begin, the shorter the transition to menopause. The hormonal changes taking place probably represent the major cause of symptoms experienced. These changes can produce many symptoms that are traditionally thought to only occur after menopause.

Contrary to popular belief, the perimenopause may be associated with elevations of estrogen levels. However, these elevations are generally followed by abrupt falls in estrogen levels. The constantly changing hormone levels of the perimenopause can precipitate significant hot flashes and night sweats. The ‘peaks and valleys’ of estrogen production during the hormonal ‘roller coaster’ invariably contribute to these symptoms. Other medical conditions commonly seen during the perimenopause years that can mimic these symptoms are thyroid irregularities and diabetes.

Other commonly described changes during this transition are related to changes in estrogen production. Vaginal thinning can lead to discomfort, itching and dryness, and pain with sexual relations. Urinary complaints include burning, urgency and frequent urination. Mood changes are very common during this transition and include irritability, anxiety, depression, fatigue, and frustration. Hormonal fluctuations may contribute to these symptoms, although many other reasons can be identified as a contributor to these symptoms. In numerous instances, balancing a career, marriage, elderly parents and adolescent children contribute to these hormonal fluctuations.

The average age of menopause in the United States is 51 to 52 years of age; therefore the perimenopause may start as early as 40 to 45 years of age. Clinically, many practitioners note a continuum in certain patients. Patients with significant premenstrual symptoms at 30 to 40 years of age often proceed to perimenopausal symptoms. Therefore, many of the treatments for premenstrual syndrome (PMS) are effective for the perimenopause. According to the Study of Women Across the Nation, irritability and fatigue are common features of the perimenopause. Diminished libido and hot flashes also occur with relative frequency. These hot flashes may be the classic, intense ones that leave women drenched afterwards…..or they may be milder with a sensation of warmth and minor sleep disturbances.

The diagnosis of the perimenopause is based upon a careful menstrual cycle history and symptom review. Maintaining a ‘menstrual calendar’ for 4-6 months will detect a pattern of changing cycle lengths and flow patterns. Evaluating for other conditions that are common during the perimenopause and may mimic symptoms of the perimenopause is also important. Therefore, thyroid and diabetes testing is prudent. The most prudent use of FSH testing and estrogen levels during the perimenopause has not been determined and should always be used in the context of a person’s menstrual history and symptoms. The transition to menopause can be diagnosed after no menses for a 12 month period of time and signifies cessation of ovarian function. Often associated with symptoms, this diagnosis does not routinely require laboratory testing.

There are a number of proposed treatment options for the perimenopause. These treatments in large part depend upon the symptom complex that is most troubling for the individual. There is no treatment that works well for every person. If your symptoms are dominated by vasomotor alterations, like hot flashes, certain natural herbal products work well.  Lifestyle changes can also be beneficial in the perimenopause. Proper diet with vitamin and mineral supplementation is vital for optimal health. Weight loss, tobacco cessation and moderation of alcohol intake will improve long term health prospects. Lastly, stress reduction is very important.

The perimenopause is a period when many changes are occurring in a women’s life. Changes in her family, career stressors, and hormonal fluctuations can wreak havoc on many women. Stress relief cannot be emphasized enough to help deal with these multiple factors. Keeping a detailed symptom log and discussing your specific symptoms with your health care provider will provide an opportunity for optimal evaluation and treatment options.