Perimenopause
Also known as:
Menopause transition
The years of shifting hormones before the final period, often bringing cycle changes, hot flashes, poor sleep and mood changes.
Written and reviewed by Farhan Tahir, MD · Last reviewed
VIDEO LESSON
What it is
Perimenopause is the transition from regular ovulatory cycles to the final menstrual period. As follicles run down, estradiol swings unpredictably, sometimes higher than before and sometimes very low, while progesterone falls as ovulation becomes less reliable. It usually starts in the 40s and lasts several years. Menopause is confirmed after 12 months without a period.
Symptoms
• Cycles that get shorter, then longer or skipped
• Heavier or unpredictable bleeding
• Hot flashes and night sweats
• Poor sleep, anxiety, irritability or low mood
• Brain fog, joint aches and, later, vaginal dryness
How it's diagnosed
After 45, the diagnosis is clinical: your age, your cycle pattern and your symptoms. Hormone levels swing from day to day, so a single FSH or estradiol result can mislead. Blood tests help when you are under 40 to 45 or when the picture is unusual, and to rule out thyroid disease, pregnancy or anemia from heavy bleeding.
Treatment
Care follows your goals. Hormone therapy is the most effective treatment for hot flashes and night sweats. If you also need cycle control or contraception, options include a levonorgestrel IUD with estrogen, or low-dose combined contraception in suitable people. Non-hormonal medicines and CBT help when hormones are not right for you.
Clinical pearls
• Contraception is still needed until menopause is confirmed: usually 1 year after the last period over 50, or 2 years under 50.
• New depression in midlife deserves screening and treatment, not dismissal.
• Bleeding after sex, between periods or that soaks through protection needs evaluation.
Key studies and references
Educational content only, written and reviewed by Farhan Tahir, MD. It does not replace individual medical advice. For sudden chest pain, trouble breathing or stroke symptoms, call 911.
AT A GLANCE
Category
Menopause & bone
Also known as
Menopause transition
Reviewed by
Farhan Tahir, MD
Questions about your own care?
Dr. Tahir’s team offers consults through Youthful Medicine.
Keep exploring
Menopause & bone
Perimenopause
The years of shifting hormones before the final period, often bringing cycle changes, hot flashes, poor sleep and mood changes.
Read the guide →
Menopause & bone
Menopause & hot flashes
Why falling estrogen switches on the brain's heat-loss alarm, and the treatments that switch it off.
Read the guide →
Menopause & bone
Genitourinary syndrome of menopause
Dryness, painful sex and urinary symptoms from low estrogen. Common, progressive and very treatable.
Read the guide →