Perimenopause is the time period before a woman experiences menopause. Menopause is when a woman's periods stop permanently. The term "perimenopause", which means "around the menopause", is the menopause transition years before the date of the final period.^[1][2] The Centre for Menstrual Cycle and Ovulation Research describes it as a six- to ten-year time ending 12 months after the last menstrual period.^[3] During this time of perimenopause, a women will have changes in her body. This time usually begins when the women is in her mid- to late 40s. Women can see perimenopause changes as early as their 30s or as late as their 50s.^[4] Women are in perimenopause for four to eight years before their periods stop.^[5] Once a woman has gone 12 months without a menstrual period, they have reached menopause and perimenopause is over.^[3] During perimenopause, hormone levels of estrogen and progesterone rise and fall.^[6] A woman in perimenopause can have symptoms like vaginal dryness, hot flashes, and trouble sleeping. ^[4] As estrogen levels lower, a woman may start to lose bone tissue. Weak bones is called osteoporosis. People with osteoporosis are at risk of breaking bones.^[4]

Symptoms of perimenopause include changes in periods.^[5] Some changes are small and other changes can be more noticeable. Periods can become longer or shorter. Periods can be irregular.^[4] Menstrual flow may be a little bit or it can be a lot. A woman may skip some periods.^[5] If periods become far apart the woman is probably in perimenopause. If the menstrual period changes by seven or more days, this may be perimenopause. If the woman experiences 60 days or more between periods she is probably in late perimenopause.^[4] Some changes are hot flashes, night sweats, trouble sleeping, mood swings, vaginal dryness or atrophy, incontinence, osteoporosis, and heart disease.^[3]

Many people may feel very hot during perimenopause. These are called hot flashes. Some hot flashes can be very strong. Hot flashes can be for a long time or a short time. A woman may have a hard time sleeping because of hot flashes or night sweats. Sleeping can change even when there are no hot flashes or night sweats. A woman may have mood swings. She can experience, irritability or depression. Depression can happen for other reasons, not just perimenopause. If a woman has had mood disorders in the past, she is at risk for having these problems during perimenopause.^[4]

A woman can have vaginal dryness during perimenopause. She may also have pain during sex. It can feel like burning when she pees. Perimenopause can make a woman feel like she needs to pee right away. Perimenopause makes a woman likely to have urinary or vaginal infections. She might leak pee, need to pee more often or she feels like she has a strong urge to pee.^[4]

Perimenopause affects a woman's ability to have babies. It is harder to become pregnant. If a woman is still having periods, she may be able to still have a baby. If she doesn't want to get pregnant she can use birth control until she has gone 12 months without a period.^[4]

Women who are in perimenopause may have other conditions such as thyroid dysfunction, mental diseases, cardiovascular and cerebrovascular disease, and bone and joint system disease. Doctors will look for these diseases while assessing for perimenopause.^[7] The major cause of perimenopause is changing hormone levels. The ovaries make changing amounts of the hormones estrogen and progesterone. If the levels of these two hormones goes down, then the changes of perimenopause appear.^[5] These fluctuations cause many of the physical changes during perimenopause as well as menopause, especially during the last 1–2 years of perimenopause (before menopause).^[1][8] As estrogen levels lower, a woman may start to lose bone tissue. Weak bones is called osteoporosis. People with osteoporosis are at risk of breaking bones.^[4] Perimenopause is also associated with a higher likelihood of depression (affecting from 45 percent to 68 percent of perimenopausal women), which is twice as likely to affect those with a history of depression.^[9]

The treatment for perimenopause is to treat the symptoms. A doctor or other health care worker may want to test the amount of hormones that are in the blood. This is even more important if periods stop at an early age. This test is not given unless there a reason to have it. Another reason why this blood test may not given is because a women may have hormone levels change and go up and down.^[5] Treatment is sometimes with medication. Hormone replacement therapy can make women’s perimenpause symptoms less severe and it is the most successful medical treatment.^[7] Some doctors treat perimenopause with hormonal birth control. This treatment may help reduce hot flashes, vaginal dryness, and mood swings.^[6] Topical estrogen therapy cream and topical hormone treatment is used to treat perimenopause.^[10]

• Menstruation
• Menopause