🌙 Perimenopause is the natural transitional phase leading up to menopause, marked by fluctuating hormone levels—especially estrogen and progesterone—as the ovaries gradually slow down their function. This phase can begin as early as the mid-30s and typically starts in the 40s, lasting anywhere from 4 to 8 years before menopause officially begins (defined as 12 consecutive months without a period). Common symptoms include irregular periods, hot flashes, mood swings, sleep disturbances, vaginal dryness, and brain fog. Because hormone levels fluctuate significantly during this time, lab testing is rarely helpful for diagnosis. According to the Mayo Clinic and the North American Menopause Society (NAMS), perimenopause is best identified through symptoms and menstrual history rather than blood tests, which can be misleading due to hormonal variability.
Treatment for perimenopause focuses on symptom relief and improving quality of life. Hormone therapy remains one of the most effective options, especially for hot flashes, night sweats, and vaginal dryness. Systemic estrogen (via pills, patches, or gels) may be recommended, often paired with progestin if the uterus is intact. For vaginal symptoms, low-dose vaginal estrogen (in creams, rings, or tablets) offers targeted relief with minimal systemic absorption. Non-hormonal options include SSRIs (selective serotonin reuptake inhibitors) for mood and hot flashes, gabapentin for vasomotor symptoms, and fezolinetant—a newer, hormone-free medication that regulates body temperature via neurokinin-3 receptor antagonism. Lifestyle changes such as regular exercise, a balanced diet, and stress-reduction techniques like yoga or meditation can also help manage symptoms.
Ultimately, perimenopause is a highly individual experience. While some women breeze through with minimal disruption, others may find the symptoms challenging. Recognizing the signs and exploring treatment options—both medical and lifestyle-based—can empower women to navigate this phase with confidence and clarity. And remember: if you’re in your late 30s or 40s and noticing changes in your cycle, mood, or sleep, you’re not “too young”—you may simply be entering perimenopause.
If you are experiencing any of these symptoms and would like a consultation, please call my office and I would be happy to meet with you.
📚 References
- Mayo Clinic. “Perimenopause: Symptoms and Causes.” https://www.mayoclinic.org
- North American Menopause Society (NAMS). “The Menopause Guidebook,” 9th Edition, 2021.
- Santoro, N. et al. “The Menopausal Transition: Signs, Symptoms, and Management.” Journal of Women’s Health, 2021.
- Joffe, H. et al. “Nonhormonal Management of Menopause-Associated Vasomotor Symptoms: 2023 Position Statement.” NAMS, 2023.
- Kaunitz, A. M. et al. “Fezolinetant for Vasomotor Symptoms: A Novel Nonhormonal Option.” Menopause, 2023.