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Perimenopause is the normal time of a woman's life when the levels of estrogen, the female hormone produced by the ovaries, begin to decrease. This leads to changes in menstrual periods before they stop completely (menopause). Perimenopause can begin 2–8 years before menopause. During perimenopause, the ovaries may or may not produce an egg and a woman can still become pregnant.

What are the causes?

This condition is caused by a natural change in hormone levels that happens as you get older.

What increases the risk?

This condition is more likely to start at an earlier age if you have certain medical conditions or have undergone treatments, including:
  • A tumor of the pituitary gland in the brain.
  • A disease that affects the ovaries and hormone production.
  • Certain cancer treatments, such as chemotherapy or hormone therapy, or radiation therapy on the pelvis.
  • Heavy smoking and excessive alcohol use.
  • Family history of early menopause.

What are the signs or symptoms?

Perimenopausal changes affect each woman differently. Symptoms of this condition may include:
  • Hot flashes.
  • Irregular menstrual periods.
  • Night sweats.
  • Changes in feelings about sex. This could be a decrease in sex drive or an increased discomfort around your sexuality.
  • Vaginal dryness.
  • Headaches.
  • Mood swings.
  • Depression.
  • Problems sleeping (insomnia).
  • Memory problems or trouble concentrating.
  • Irritability.
  • Tiredness.
  • Weight gain.
  • Anxiety.
  • Trouble getting pregnant.

How is this diagnosed?

This condition is diagnosed based on your medical history, a physical exam, your age, your menstrual history, and your symptoms. Hormone tests may also be done.

How is this treated?

In some cases, no treatment is needed. You and your health care provider should make a decision together about whether treatment is necessary. Treatment will be based on your individual condition and preferences. Various treatments are available, such as:
  • Menopausal hormone therapy (MHT).
  • Medicines to treat specific symptoms.
  • Acupuncture.
  • Vitamin or herbal supplements.

Before starting treatment, make sure to let your health care provider know if you have a personal or family history of:
  • Heart disease.
  • Breast cancer.
  • Blood clots.
  • Diabetes.
  • Osteoporosis.

Follow these instructions at home:


  • Take over-the-counter and prescription medicines only as told by your health care provider.
  • Take vitamin supplements only as told by your health care provider.
  • Talk with your health care provider before starting any herbal supplements.


  • Do not use any products that contain nicotine or tobacco, such as cigarettes, e-cigarettes, and chewing tobacco. If you need help quitting, ask your health care provider.
  • Get at least 30 minutes of physical activity on 5 or more days each week.
  • Eat a balanced diet that includes fresh fruits and vegetables, whole grains, soybeans, eggs, lean meat, and low-fat dairy.
  • Avoid alcoholic and caffeinated beverages, as well as spicy foods. This may help prevent hot flashes.
  • Get 7–8 hours of sleep each night.
  • Dress in layers that can be removed to help you manage hot flashes.
  • Find ways to manage stress, such as deep breathing, meditation, or journaling.

General instructions

  • Keep track of your menstrual periods, including:
    • When they occur.
    • How heavy they are and how long they last.
    • How much time passes between periods.
  • Keep track of your symptoms, noting when they start, how often you have them, and how long they last.
  • Use vaginal lubricants or moisturizers to help with vaginal dryness and improve comfort during sex.
  • You can still become pregnant if you are having irregular periods. Make sure you use contraception during perimenopause if you do not want to get pregnant.
  • Keep all follow-up visits. This is important. This includes any group therapy or counseling.

Contact a health care provider if:

  • You have heavy vaginal bleeding or pass blood clots.
  • Your period lasts more than 2 days longer than normal.
  • Your periods are recurring sooner than 21 days.
  • You bleed after having sex.
  • You have pain during sex.

Get help right away if you have:

  • Chest pain, trouble breathing, or trouble talking.
  • Severe depression.
  • Pain when you urinate.
  • Severe headaches.
  • Vision problems.


  • Perimenopause is the time when a woman's body begins to move into menopause. This may happen naturally or as a result of other health problems or medical treatments.
  • Perimenopause can begin 2–8 years before menopause, and it can last for several years.
  • Perimenopausal symptoms can be managed through medicines, lifestyle changes, and complementary therapies such as acupuncture.

This information is not intended to replace advice given to you by your health care provider. Make sure you discuss any questions you have with your health care provider.