Perimenopause: Age, Stages, Signs, Symptoms & Treatment

Potential causes of abnormal bleeding include perimenopausal hormonal imbalances, infection, pregnancy-related bleeding, fibroids, ... ThinkyoumayhaveCOVID-19? Findoutwhereyoucangettested Needavaccineorbooster? Nowschedulingforages6monthsandup ComingtoaClevelandCliniclocation? Visitationandmaskrequirements Home / HealthLibrary / Disease&Conditions Perimenopause Perimenopauseisthetransitionalperiodbeforemenopause.Duringperimenopause,levelsofestrogen,akeyfemalehormone,starttodecrease.Youmaybeginhavingmenopause-likesymptoms,suchashotflashesorirregularperiods.Perimenopausecanlastforyears.Whenyougoafull12monthswithoutaperiod,menopausehasbegun. Appointments216.444.6601 Appointments&Locations RequestanAppointment HaveMyBabyatClevelandClinic Overview SymptomsandCauses DiagnosisandTests ManagementandTreatment Prevention Outlook/Prognosis LivingWith Perimenopause Overview SymptomsandCauses DiagnosisandTests ManagementandTreatment Prevention Outlook/Prognosis LivingWith BackToTop Overview Whatisperimenopause? Perimenopause(alsoreferredtoasthemenopausetransition)iswhenyourbodystartstransitioningtomenopause.Duringthistransition,yourovariesbeginproducinglesshormones,causingyourmenstrualcycletobecomeerraticorirregular.Atthistime,yourbodyismovingtowardtheendofyourreproductiveyears. Perimenopausemaybeginasearlyasyourmid-30soraslateasyourmid-50s.Somepeopleareinperimenopauseforonlyashorttime.Butformany,itlastsfourtoeightyears.Thetermperimenopausesimplydescribesthetimewhenyourcyclesarenolongerpredictable. Otherphysicalchangesandsymptomscanoccurasyourbodyadjuststodifferenthormonelevels.Duringperimenopause,yourfertilityisdeclining,butyoustillcanbecomepregnant.Thesymptomsofperimenopause,theageitstartsandhowlongitlastswillvarybetweenwomen.You’reoutofperimenopauseandintomenopauseonceyou’vehad12consecutivemonthswithoutamenstrualperiod. Whatisthedifferencebetweenperimenopauseandmenopause? Perimenopauseisatransitionaltimethatendsinmenopause.Menopausemeansyourperiodshaveended.Whenyouhavenomenstrualcycleforafull12months,youhaveofficiallyreachedmenopause. Whydoesperimenopausehappen? Yourovariesbegintoproducelessestrogenasyouageinpreparationtostopreleasingeggsentirely.Ultimately,yourbodyispreparingtotransitiontomenopause,whenyoulosetheabilitytogetpregnant.It’sanaturalandnormalprogressioninawoman’sreproductivecycle. Atwhatagedoesperimenopausebegin? Perimenopausebeginsabouteightto10yearsbeforemenopause.Itusuallystartsinyourmid-40s,butitcanstartearlier.Completingmenopausebeforeage40iscalledprematuremenopause.Somemedicalconditionsorprocedurescauseearlymenopause.Ifthereisnomedicalorsurgicalcauseforprematuremenopause,it'scalledprimaryovarianinsufficiency. Howlongdoesperimenopauselast? Theaveragelengthofperimenopauseisaboutfouryears.Somepeoplemayonlybeinthisstageforafewmonths,whileotherswillbeinthistransitionphaseformorethanfouryears.Ifyou’vegonemorethan12monthswithouthavingaperiod,youarenolongerinperimenopause. Whatarethehormonalchangesduringperimenopause? Thehormonalchangesyouexperienceduringperimenopausearemostlycausedbydecliningestrogenlevels.Yourovariesmakeestrogen,whichplaysavitalroleinmaintainingthereproductivesystem.Onceyouenterperimenopause,yourestrogenlevelsstarttodecrease.Asestrogendecreases,itthrowsoffthebalancewithprogesterone,anotherhormoneproducesbytheovaries.Thesetwohormonestogetherareresponsibleforovulationandmenstruation.It’scommonforhormonelevelstofluctuateduringperimenopause—togoupanddownlikearollercoaster. Whenyoureachmenopause,yourbodymakessolittleestrogenthatyourovariesnolongerreleaseeggs.Atthispoint,youstophavingyourperiod. Whatarethefirstsignsofperimenopause? Generally,thefirstsignofperimenopauseisirregularperiods.Mostpeoplewillgofromhavingfairlypredictablemenstrualcyclestounpredictablecycles.Alotofpeoplealsoexperiencethemostcommonsignsofmenopauselikehotflashesandvaginaldryness(vaginalatrophy)fairlyearlyintothemenopausetransition. SymptomsandCauses Whatarethesymptomsofperimenopause? Yourbodyhasbeenproducingestrogensincepuberty.Onceyourestrogenlevelsbegintodecline,yourbodyhastoadjusttothechangesinhormones. Thesymptomsvary,butmostpeopleexperienceatleastoneofthefollowing: Irregularperiodsorskippingperiods. Periodsthatareheavierorlighterthanusual. Hotflashes(asuddenfeelingofwarmththatspreadsacrossyourbody). Vaginaldrynessanddiscomfortduringsex. Urinaryurgency(needingtourinatemorefrequently). Sleepproblems(insomnia). Changesinmoodlikeirritability,depressionormoodswings. Thelengthoftimeyouhavesymptomsofperimenopausecanvarybetweenafewmonthstomanyyears.Thedecreaseinestrogenalsocanleadtobonethinningorchangingcholesterollevels.Continuetohaveregularcheckupswithyourhealthcareprovidertokeepaneyeonyourhealth. Whatareperiodslikeduringperimenopause? Yourbodyisproducinglessofthehormonesthathelpyouovulate,soyourperiodscanbecomeirregular.Yourmenstrualcyclecouldbecomelongerorshorterthanusual.Yourbleedingcouldalsobeheavierorlighterthannormal.Somepeoplealsonoticeachangeintheirpremenstrualsyndrome(PMS)symptoms. HowdoIknowifchangesinmyperiodsarenormalperimenopausalsymptomsorsomethingtobeconcernedabout? Irregularperiodsarecommonandnormalduringperimenopause,butotherconditionscancauseabnormalitiesinmenstrualbleeding.Ifanyofthefollowingsituationsapplytoyou,seeahealthcareprovidertoruleoutothercauses. Yourperiodsarechangingtobecomeveryheavyoraccompaniedbybloodclots. Yourperiodslastseveraldayslongerthanusual. Youspotorbleedafteryourperiod. Youexperiencespottingaftersex. Yourperiodsoccurclosertogether. Potentialcausesofabnormalbleedingincludeperimenopausalhormonalimbalances,infection,pregnancy-relatedbleeding,fibroids,blood-clottingproblems,endometrialpolyps,miscarriage,takingbloodthinnersorcancer. Doyoustillovulateduringperimenopause? Ifyou’restillgettingaperiod,evenanirregularone,you'restillovulating.Untilyouhaven'tmenstruatedfor12consecutivemonths,youshouldassumeyourbodyisstillovulating(releasingeggs). DiagnosisandTests Howisperimenopausediagnosed? Youdon’talwaysneedtoseeahealthcareproviderforaperimenopausediagnosis.Manypeoplenoticeandtoleratethechangesintheirbodieswithoutaformaldiagnosis.Ifyouhavesymptomsthatinterferewithyourdailyactivities,seeahealthcareprovider. Youshouldreachouttoyourhealthcareproviderrightawayifyouhave: Bloodclotsinmenstrualdischarge. Spottingbetweenperiods. Vaginalbleedingaftersex. Emotionalsymptomsinterferingwithyourabilitytofunctiononadailybasis. WhatFSHlevelmeansperimenopause? FSH(folliclestimulatinghormone)isahormoneproducedbythepituitarygland—theglandlocatedatthebaseofyourbrain.Itstimulatestheovariestoreleaseaneggduringovulation.TestingyourFSHlevelcanhelpconfirmmenopausehasstarted.AconsistentlyhighlevelofFSHcanindicatemenopause.However,FSHtestscanbemisleadingbecauseduringperimenopauseyourhormonesriseandfallerratically.Certainmedications,likebirthcontrolpillsorhormonetherapy,interferewithhormonelevelsandwillaffecttheresultsofanyhormonetests.Overactivethyroidandhighprolactincanalsoalterthoseresults. ManagementandTreatment Canperimenopausebetreated? Thereisn’tanytreatmenttostopperimenopause.Perimenopauseisanaturalpartoflife.The“cure”forperimenopauseoccurswhenyourperiodsstopandyouentermenopause. Butyourhealthcareprovidermayrecommendover-the-counterorprescriptionperimenopausetreatmenttohelpeasesymptoms.Yourprovidermayrecommend: Antidepressants:Thesemedicationshelpwithmoodswingsordepression. Birthcontrolpills.Thesemedicationsstabilizeyourhormonelevelsandtypicallyrelievesymptoms. Estrogentherapy:Thistreatmentstabilizesestrogenlevels.Youmaytakeestrogentherapyasacream,gel,patchorswallowablepill. Gabapentin(Neurontin®):Thismedicineisaseizuremedicationthatalsorelieveshotflashesforsomewomen. Vaginalcreams:Yourprovidercantellyouaboutprescriptionandover-the-counteroptions.Treatmentcandecreasepainrelatedtosexandrelievevaginaldryness. Yourhealthcareproviderwilldiscusstherisksandbenefitsofperimenopausetreatmentwithyouandrecommendthebestoptionbasedonyourneeds.Certainlifestylechangeslikeeatingahealthydiet,lightexerciseandavoidingfoodsoractivitiesthattriggerhotflashescanalsohelp. Whatishormonetherapy? Hormonetherapycanhelprelievesomesymptomsofperimenopause.Ingeneral,healthcareprovidersrecommendthatpeoplewhoopttousehormonetherapystartitwithin10yearsofbeginningmenopausesymptomsanduseitforlessthanfiveyears.Estrogenandhormoneshavebeenlinkedtoanincreasedriskofheartproblemsandsometypesofbreastcancer. Speakwithyourhealthcareprovidertomakesureyouunderstandtherisksandbenefitsofhormonetherapyasatreatmentforperimenopause. Whataretherisksofhormonetherapy? Treatingperimenopausewithhormonetherapycanincreaseyourriskforthefollowingconditions: Uterinecancer. Stroke. Heartattack. Bloodclots. Gallbladderdisease. WhatcanIdotomanagemyperimenopausesymptomsathome? Youmaychoosetomanageperimenopausesymptomsathome.Torelievesymptoms,youcan: Eatadietfulloffruits,vegetables,wholegrains,leanproteinandhealthyfats. Performweight-bearingexerciseslikewalking,hikingorstrengthtraining. Improvesleephygienebyavoidingscreensanddoingrelaxingactivitiesbeforebed. Limitalcoholandcaffeine. Practicemeditationorotherstressmanagementtechniques. Quitsmoking. Loseweightifindicated.Weightlossreduceshotflashesandnightsweatsandimprovesyourenergylevel. Prevention Whatcanputyouintoperimenopauseearly? Certainfactorsarelinkedtoearlyperimenopause.Theseinclude: Smokingorusingtobaccoproducts. Afamilyhistoryofearlymenopause. Ahistoryofcancertreatment. Ifyou’vehadyouruterusorovariesremoved. HowcanIreducemyriskofperimenopausecomplications? Irregularperiodsarethemostcommonsymptomofperimenopause.Butit’simportanttoknowwhentotalktoyourhealthcareprovideraboutyourperiods.Sometimes,irregularbleedingcanpointtoanunderlyingproblem. Youcanloweryourriskofcomplicationsbyseekingtreatmentwhennecessary.Talktoyourhealthcareproviderifyou: Bleedformorethansevendaysinarow. Bleedbetweenperiods. Changepadsortamponseveryonetotwohours. Haveperiodsmorefrequentlythanevery21days. Outlook/Prognosis Arethereanyhealthrisksassociatedwithperimenopause? Therearehealthrisksassociatedwithmenopause,whichhappensrightafterperimenopause. Estrogenplaysanimportantroleinpreservingyourbones.Osteoporosisisaconditionwheretheinsidesofyourbonesbecomelessdenseandmorefragile.Thisincreasesyourriskforbonefractures.Yourhealthcareprovidermayrecommendamultivitamin,calciumsupplement,extravitaminDormoreweight-bearingexercises. Peopleinmenopausearealsoatanincreasedriskforheartdiseaseandothercardiovascularhealthconditions. CanIgetpregnantifIaminperimenopause? Yes,youcanstillbecomepregnant.Youmaybelesslikelytogetpregnantduringperimenopause,butit'sstillpossible.Aslongasyouhaveaperiod,youcanstillgetpregnant.Ifyouwanttoexpandyourfamilyduringthistime,speakwithyourhealthcareprovideraboutyourhealth,fertilityandpossiblefertilitytreatmentoptions. Whenyourperiodsareirregular,youmaybemorelikelytogetpregnantunexpectedly.Ifyoudon’twanttoexpandyourfamilyatthisage,continueusingbirthcontroluntilyourhealthcareprovidertellsyouit’ssafetostop.Continuetopracticesafesextopreventsexuallytransmitteddiseases(STDs)throughoutyourlife. LivingWith WhatquestionsshouldIaskmydoctor? Discussyourperimenopausesymptomswithyourhealthcareprovider.Itmighthelptokeepajournalofyourmenstrualcyclesincludingwhentheystartandstopandtheamountofbleeding. Somequestionsyoushouldaskare: Arethesesymptomsofperimenopause? WhatcanIdotorelievemysymptoms? HowlongdoyouthinkIwillhavethesesymptoms? Wouldhormonetherapybeanoptionforme? DoIneedtostarttakingmedicationorvitamins? Arethereanyteststhatshouldbedone? CanIstillbecomepregnant? WhenshouldIcallmydoctor? Ifyourperimenopausalsymptomsareunbearableorinterferingwithyourqualityoflife,itmightbetimetocontactyourhealthcareprovider.Theymaybeabletooffersupportorrecommendatreatmenttoreducetheintensityofyoursymptoms. Canperimenopauseaffectmysexlife? Possibly.Certainsymptomsofperimenopauselikevaginaldrynessanddiscomfortduringsexcanmakehavingsexlessdesirable.Vaginallubricantscanbeusedtohelpdryness.Speakwithyourhealthcareproviderifyouhaveissueswithadecreasedsexdrivesotheycanrecommendwaystohelpyou. ShouldIbeonbirthcontrolduringperimenopause? Yes.Ifyoudonotwanttobecomepregnant,youshouldusebirthcontrolduringperimenopause.Evenifyouaregettingyourperiodeveryfewmonths,youarestillovulatingthosemonths.Sinceit’snotpossibletopredictwhenyouareovulating,youshouldusebirthcontroluntilyouhaven’tgottenaperiodforatleast12months. Doesperimenopauseaffectmysleep? Yes,perimenopausecanaffectyoursleep.Somewomeninperimenopauseexperienceinsomniaandinterruptedsleepduetonightsweatsorothermenopausalsymptoms. Whatdohotflashesfeellikeduringperimenopause? Ahotflashfeelslikeasuddenwarmthalloveryourbody.Itisoftenaccompaniedbysweatingandared,flushedface.Hotflashesarecausedbylowestrogenlevelsandcanlastmonthsoryears. WhyamIgainingweightduringperimenopause? Theshiftinhormonesslowsdownyourmetabolism.It’sverycommonforwomeninperimenopausetogainweightoncetheirestrogenlevelsstarttodecline.Maintainingahealthydietandregularexercisecanhelppreventweightgainduringthetransitiontomenopause. AnotefromClevelandClinic Perimenopauseisthetransitiontomenopause.Duringperimenopause,youmaystarthavingmenopause-likesymptoms,suchashotflashes,moodswingsorvaginaldryness.Mostperimenopausesymptomsaremanageable.Butifyouneedhelpmanagingsymptoms,medicationsandothertreatmentsareavailable.Perimenopauseendswhenyou’vehadnoperiodforafullyear.Atthatpoint,youentermenopause. Share Facebook Twitter LinkedIn Email Print Getuseful,helpfulandrelevanthealth+wellnessinformation enews ClevelandClinicisanon-profitacademicmedicalcenter.Advertisingonoursitehelpssupportourmission.Wedonotendorsenon-ClevelandClinicproductsorservices. 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