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Perimenopause and Menopause

Perimenopause means “around menopause”.  It refers to the time period when a woman’s body naturally transitions toward permanent infertility, which is called menopause.  Perimenopause is also referred to as the menopausal transition.

Women begin to notice perimenopausal symptoms at different ages.  You may notice signs of progression toward menopause, such as menstrual irregularity, sometime in your 40s.  Some women notice changes as early as their mid-30s.

The level of your estrogen (the main female hormone) rises and falls unevenly during perimenopause.  Your menstrual cycles may lengthen or shorten, and you may begin having menstrual cycles in which your ovaries don’t release an egg.  You may also experience menopause-like symptoms, such as hot flashes, sleep problems and vaginal dryness.  Treatments are available to help ease these symptoms.

Once you’ve gone through 12 consecutive months without a menstrual period, you’ve officially reach menopause, and the perimenopause period is over.


Menopause is defined as the time in a woman’s life when the ovaries stop producing eggs and menstrual periods end.  This usually occurs between the ages of 45 and 55, with the average age of menopause being 51 years.

Menopause is a normal part of a woman’s life and does not always need to be treated.  However, the changes that happen before and after menopause can be disruptive.  If you have bothersome symptoms, effective treatments are available.

Am I going through menopause?

If you are 45 years or older and you have not had a menstrual period in 12 months, there is a good chance that you are menopausal.  Most women in this group do not need any testing to confirm menopause, especially if they are having menopausal symptoms such as hot flashes or vaginal dryness.

If you are less than 45 years old and you stop having periods or if you have questions about menopausal symptoms, talk to your healthcare provider.  You may need further testing to see if menopause, or another problem, is the cause of your symptoms.

After hysterectomy

If you do not have a uterus (you have had a hysterectomy) but you still have ovaries, it can be hard to know when you are menopausal because you will not have menstrual periods.  You may develop menopausal symptoms as your ovaries stop working and your blood levels of estrogen begin to fall.  If you are having bothersome symptoms of menopause after hysterectomy, talk with your healthcare provider.


As the ovaries stop working levels of estrogen fall, leading to the typical symptoms of menopause.  Some women have few or no menopausal symptoms while other women have bothersome symptoms that interfere with their life.  These symptoms often begin during the menopause transition, before you stop having periods.

The most common symptoms of menopause include:

Hot Flashes-Hot flashes typically begin as a sudden feeling of heat in the upper chest and face.  The hot feeling then spreads throughout the body and lasts for two to four minutes.  Some women sweat during the hot flash and then feel chills and shiver when the hot flash ends.  Some women have a feeling of anxiety or heart palpitations during the hot flash.  Hot flashes can occur once or twice each day or as often as once per hour during the day and night.  Hot flashes usually begin well before your last menstrual period.  It is not clear what causes hot flashes.  Most women who have hot flashes will continue to have them for about four years (on average).

●Night sweats-When hot flashes happen during sleep, they are called night sweats.  Night sweats may cause you to sweat through your clothes and wake you from sleep because you are hot or cold.  This can happen one or more times per night.  Waking frequently can make it hard to get a good night’s sleep.  As a result of interrupted sleep, many women develop other problems, such as fatigue, irritability, trouble concentrating or mood swings.

Sleep problems-During the transition to menopause, some women begin to have trouble falling asleep or staying asleep, even if night sweats are not a problem.  Sleep problems can cause you to feel tired and irritable the next day.  Effective treatments for sleep problems are available.

Vaginal dryness-As the levels of estrogen in the blood fall before and during menopause, the tissues inside the vagina and urethra (the tube from the bladder to the outside of the body) can become thin and dry.  This can cause you to have vaginal dryness or irritation or to have pain or dryness with sex.

Depression-During the menopausal transition, some women develop new problems with mood, such as sadness, difficulty concentrating, feeling uninterested in normal activities, and sleeping too much or having trouble staying asleep.  Women with a past history of depression can feel more blue moods during the menopause transition.  If you have any symptoms of depression or blues that will not go away, talk to your doctor or nurse.  There are a number of effective treatments available.


Not all women will need treatment for menopausal symptoms, especially if the symptoms are mild.  For women whose symptoms are really bothersome, there are several treatment options:

Postmenopausal hormone therapy

Women with bothersome hot flashes can usually get relief with postmenopausal hormone therapy.  For women with a uterus, this would be a combination of estrogen and progesterone-like medication.  Women who do not have a uterus (eg, after a hysterectomy) need only estrogen.  Hormone therapy is available in a pill that you take by mouth; a skin patch; a vaginal ring; and a skin gel, cream or spray.

Hormone therapy alternatives

If you are bothered by hot flashes but you cannot take or would prefer to avoid hormone therapy, there are alternatives.  Although hormone therapy is the most effective treatment for hot flashes, non-hormonal alternatives are an option for many women.

Vaginal treatments

There are several treatment options for women with vaginal dryness, including vaginal estrogen.

Where to get more information:

Your healthcare provider is the best source of information for questions and concerns related to your medical problem.

Additional Reading:

Bioidentical Hormones -  www.thebussonbios.com
New York Times Article – The Estrogen Dilemma



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