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Perimenopause is the transition phase before menopause, which can last from 2 to 10 years. During this time, ovulation becomes irregular and the production of estrogen and progesterone decreases. Several processes occur within the body, including:

  • Infrequent release of eggs by the ovaries
  • Reduced production of estrogen and other hormones
  • Decreased fertility
  • Shorter menstrual cycles, fewer ovulations and more cycle irregularity
  • Reduced levels of hormones, including estrogen, progesterone, androgen (androstenedione) and testosterone

Causes of Perimenopause

Perimenopause is caused by the declining function of the ovaries which can cause ovulation to become erratic and cease completely. As a result, the menstrual cycle length and flow may become irregular before the last menstrual period.

Symptoms surface as a result of changing levels of estrogen and progesterone. For example, estrogen levels may be higher which can trigger symptoms similar to those associated with premenstrual syndrome (PMS). Or, estrogen levels may decrease, which can trigger hot flashes or night sweats. Varying estrogen levels may be combined with normal menstrual cycles during perimenopause. Studies show perimenopausal women have varying patterns of hormonal fluctuations; as a result, each woman may experience perimenopause in a different way.

Perimenopause Symptoms

The most common symptoms include:

  • Mood changes
  • Changes in sexual desire
  • Difficulty concentrating
  • Headaches
  • Night sweats
  • Hot flashes
  • Vaginal dryness
  • Sleep disturbances
  • Joint and muscle aches
  • Frequent urination

Treatment for Perimenopause Symptoms

Your doctor will determine the perimenopausal treatment that is best for you based on:

  • Your age, overall health, and medical history
  • Current symptoms
  • Your tolerance for specific medications, procedures or therapies

Your physician may recommend any of the following treatments:

  • Hormone therapy using estrogen or estrogen combined with progestin to keep hormone levels more constant
  • Antidepressants to stabilize mood swings

Your doctor may also suggest lifestyle changes such as:

  • Eating a healthy diet which includes whole grains, fruits and vegetables
  • Consuming at least 1,000-1,200 mg of calcium daily (either through diet or supplements)
  • Getting regular exercise
  • Keeping a diary or record to identify what triggers hot flashes; i.e., coffee or tea

Some of the same suggestions used for coping with hot flashes during menopause (see the following) may also be helpful for perimenopausal symptoms.


Menopause, often called the change of life, refers to the period of time when a woman's hormone levels change. Menopause is complete when menstrual periods have ceased for one continuous year; this marks the end of a woman’s ability to have children.

Although menopause can actually occur any time (between the 30s to mid-50s or later), the average age for most women is 51. Generally, a woman tends to experience menopause at about the same age as her mother experienced it. However, women who smoke and are underweight tend to experience an earlier menopause, and those women who are overweight often experience a later menopause.

Other than natural causes, menopause can occur as a result of any of the following reasons:

  • Premature menopause: This may occur when there is ovarian failure before the age of 40, and may be associated with smoking, radiation exposure, chemotherapeutic drugs or surgery that impairs the ovarian blood supply.
  • Surgical menopause: This may follow an oophorectomy (removal of an ovary or both ovaries), or radiation of the pelvis, including the ovaries. This results in an abrupt menopause with women often experiencing more severe menopausal symptoms than is experienced during “natural” menopause.

Treatment for Menopause Symptoms

Each woman experiences symptoms differently. Some have fewer and less severe symptoms, while other women experience more frequent and stressful symptoms. These symptoms may include any of the following:

  • Hot flashes: This is the most common symptom with about 75% of all women experiencing sudden, brief, periodic increases in their body temperature. Usually hot flashes start before a woman's last period. For 80% of women, hot flashes occur for 2 years or less, with a small percentage experiencing hot flashes for longer than 2 years. The flashes seem to be directly related to decreasing levels of estrogen, and vary in frequency and intensity for each woman.

In addition to the increase in skin temperature, an increased heart rate may be experienced. Sudden perspiration then occurs as the body tries to reduce its temperature. Also, heart palpitations and dizziness may be experienced.

  • Vaginal atrophy: This is the drying and thinning of the tissues of the vagina and urethra which can lead to pain during sexual intercourse, as well as vaginitis, cystitis, and urinary tract infections.
  • Relaxation of the pelvic muscles: This can lead to urinary incontinence and increase the risk of the uterus, bladder, urethra or rectum protruding into the vagina.
  • Cardiac effects: Intermittent dizziness, paresthesias (an abnormal sensation, such as numbness, prickling, tingling, and/or heightened sensitivity), cardiac palpitations, and a faster than normal heart rate known as tachycardia may occur.
  • Hair growth: Changing hormones can cause an increase in facial hair and/or a thinning of the hair on the scalp.
  • Mental health: Studies indicate that menopausal women suffer no more anxiety, depression, anger, nervousness or feelings of stress than women of the same age who are still menstruating. Psychological and emotional symptoms of fatigue, irritability, insomnia and nervousness may be related to lack of estrogen and the stress of aging.

Treatment for Perimenopause Symptoms

Specific treatment for menopausal symptoms will be determined by your healthcare provider based on the following:

  • Your age, overall health and medical history
  • Current symptoms
  • Your tolerance for specific medications, procedures or therapies

There are a few non-medical options that may help women better manage the effects of hot flashes, including:

  • Dressing in layers, so clothing can be removed when a hot flash begins
  • Avoiding foods and beverages that may cause hot flashes; i.e., spicy foods, alcohol, coffee, tea, and other hot beverages
  • Drinking a glass of cold water or fruit juice when a hot flash begins
  • Reducing your stress level, which may aggravate hot flashes
  • Keeping a container of ice water or an ice pack next to your bed during the night
  • Using cotton sheets, lingerie, and clothing that allows your skin to breathe.
  • Keeping a diary or record of your symptoms to determine what might trigger your hot flashes.

Therapies your health care professional may suggest to manage your symptoms may include:

  • Hormone therapy
  • Estrogen therapy
  • Non-hormonal treatment: The use of over-the-counter creams that do not contain estrogen.
  • Estrogen alternatives: "Synthetic estrogens," such as raloxifene, which may offer the bone-building benefits of estrogen without the possible coinciding risks.

When approaching menopause, it is important to discuss each option with your physician, taking into consideration the potential risks and benefits as it relates to your health history.

For more information or to schedule an appointment for a pelvic exam with a Summa physician, click or call (330) 237-8662.