Perimenopause describes the months or years leading up to menopause, when the body goes through vast changes. This transition can be more difficult for some than menopause.

Published: December 15, 2021

With your health provider as your co-pilot, you can navigate perimenopause and menopause.

Perimenopause, also called the menopausal transition, describes the months or years leading up to menopause, when the body goes through vast changes. This transition can be more difficult for some than menopause due to dramatic fluctuations in reproductive hormone levels. During perimenopause, these hormones are sometimes underproduced and sometimes overproduced. In menopause, reproductive hormones are at constantly low levels.

“We used to think perimenopause started only months before the onset of menopause. Now we know perimenopause can begin four or more years before menopause,” said Tamara L. Callahan, M.D., gynecologist with Norton Women’s Care.

Addressing perimenopause and menopause symptoms

Signs of perimenopause include menstrual irregularities, hot flashes, night sweats, mood swings, trouble sleeping and vaginal dryness.

You don’t have to live with these symptoms. Managing them is important for quality of life. For many, continuous low-dose birth control pills can provide steady estrogen that treats symptoms and provides contraception.

Menopause officially begins when there are no more periods for 12 consecutive months. This usually happens between ages 45 and 55, with the average age of 51.

“One thing we’ve learned about menopause is that lower estrogen levels mean more than vaginal dryness, decreased libido and painful intercourse,” Dr. Callahan said. “Less estrogen also can affect the bladder and urethra, potentially resulting in pain and burning with urination, urinary frequency, urgency and an increase in bladder and kidney infections. Patients often don’t associate these symptoms with menopause.”

Collectively, these vaginal and urinary symptoms are known as genitourinary syndrome of menopause (GSM).

Hypoactive sexual desire disorder (HSDD) can also happen during perimenopause and menopause. While there are some medications to help increase sex drive during perimenopause, options are limited for addressing libido during menopause.

“This is frustrating for patients and providers given that half of all patients experience at least one sexual symptom of menopause,” Dr. Callahan said.

Loss of estrogen during menopause also can result in “brain fog,” making concentration and finding words difficult.

Menopause can mean less time spent in deep sleep, too. As a result, quality of sleep becomes less restorative, which can be distressing and disruptive.

Then there’s the weight gain that comes from hormone changes and a decrease in metabolism. The extra weight is redistributed differently. Instead of added pounds accumulating on the hips and thighs as in younger women, the weight collects around the abdomen.

“Females typically live to age 75 and beyond, therefore they are living more than one-third of their lives in menopause,” Dr. Callahan said. “That’s a long time to live with distressing symptoms.”

Menopausal hormone therapy

Fortunately, menopausal hormone therapy (MHT) can help with most symptoms.

“When started within 10 years of the last menstrual period, in healthy women without contraindications, MHT is both safe and effective,” Dr. Callahan said. “In general, MHT can be used with minimal risk up to age 59. But transitioning off it needs to be done in conversation with the patient’s health provider.”

For those who cannot or choose not to use MHT, there are effective and safe non-estrogen therapies to treat hot flashes and night sweats. These include low-dose gabapentin and selective serotonin reuptake inhibitors (SSRIs), among others.

Low-dose vaginal estrogens can help with relieving the genital and urinary symptoms of menopause.

“Education is some of the most potent medicine we have — not just for the patient but for the partner, family and provider,” Dr. Callahan said. “We can work as a team to navigate this challenging time.”