Perimenopause: Symptoms and Treatments

Jenna Hilton
May 19, 2022

Menopause is a significant turning point in a woman’s life and is characterized by an absence of menstrual bleeding. It is preceded by a period of several years, during which a series of symptoms affect a woman’s physical and emotional state. This transitional phase before menopause is called perimenopause.

In this article, we explain what perimenopause is, how long it lasts, and which treatments can alleviate the most unpleasant symptoms.

Perimenopause: symptoms and treatments.

What Is Perimenopause?

Perimenopause is a natural process that occurs in the years before menopause and is marked by changes in a woman’s menstrual cycle and hormonal levels, especially estrogen. These changes are manifested in a series of physical and emotional symptoms. During this phase, the functioning of the ovaries declines, periods become erratic, and chances of conception are lowered.

What Is the Age for Perimenopause?

Women usually enter perimenopause around the age of 45. In rare cases, women experience the first symptoms in their mid-30s, while some not until their 50s.

How Long Does Perimenopause Last?

Perimenopause usually lasts four years but can stretch to ten years for some women. When a woman does not have a period for 12 consecutive months, she has entered menopause.

Perimenopause Symptoms?

Hot flashes in perimenopause

Perimenopause symptoms are different for each woman, but most experience a combination of these conditions:

  • Fluctuating estrogen and progesterone levels
  • Longer or shorter periods
  • Heavier or lighter periods
  • Menstrual cycles without ovulation
  • Hot flashes
  • Heavy sweating
  • Sleep issues, mostly due to hot flashes
  • Mood changes
  • Urinary incontinence
  • Vaginal dryness
  • Lower sex drive
  • Higher LDL (bad) and lower HDL (good) cholesterol
  • Loss of bone mass
  • Joint and muscle pain
  • Dry skin and hair loss

What Causes Perimenopause?

Most perimenopause symptoms appear because of the decrease in estrogen production caused by the declining ovarian function. This hormonal imbalance is responsible for hot flashes, vaginal dryness, bone loss, mood swings, and other uncomfortable symptoms.

Some lifestyle and medical factors can increase the chance of entering perimenopause earlier in life.

  • Genetics. In some cases, women whose mothers and grandmothers experienced early perimenopause also enter perimenopause at an early age.
  • Smoking. Many women who smoke enter perimenopause one or two years earlier than their non-smoking peers.
  • Cancer. Patients who undergo chemotherapy or pelvic radiation may enter menopause earlier.
  • Ovary removal. Surgery that removes the ovaries speeds up the onset of menopause because the body dramatically reduces estrogen production.
  • Certain medical conditions. Chromosomal abnormalities like Turner’s syndrome, autoimmune diseases, mumps, and AIDS can also cause premature menopause.

Note: Read our article, and learn the differences between perimenopause and premenopause.

Perimenopause Treatments

Hormone therapy for perimenopause

Some women struggle with their perimenopause symptoms. Fortunately, there are treatments that help you go through this challenging period.

1. Hormone Replacement Therapy

Many women who enter perimenopause seek hormone replacement therapy to stabilize estrogen levels and relieve the symptoms caused by low estrogen. At Vibrant Vitality Clinic, we provide Female Hormone Replacement Therapy to help address the issues that arise during perimenopause and help patients smoothly transition to menopause.

2. Medication for Hot Flashes

The FDA has approved a low-dose form of paroxetine (an antidepressant) to treat hot flashes. Other antidepressants also help alleviate these symptoms (venlafaxine, citalopram, escitalopram).

3. Antidepressants for Mood Swings

A doctor can prescribe antidepressants if mood changes interfere with your daily functioning.

4. Vaginal Creams

Prescription or OTC vaginal creams can help reduce vaginal dryness and pain during sex caused by decreasing estrogen.

5. Diet Change

In many cases, a simple diet change can help alleviate perimenopause symptoms. Doctors recommend eating mostly fruits, vegetables, and grains, and eliminating foods high in sugar and unhealthy fats.

6. Calcium Supplements

Women in perimenopause who experience bone thinning need 1000-1200 mg of calcium per day taken through food or supplements. Medical providers also recommend 400-600 IU of vitamin D for better calcium absorption.

7. Regular Exercise

Health professionals recommend regular exercise for disease prevention to everyone, including women in perimenopause. Exercise helps maintain optimal weight and triggers the happiness hormone, helping to improve mood, sleep patterns, and overall wellbeing.

When Should You See a Doctor?

Common perimenopause symptoms are not a cause for concern. It is important to maintain regular check-ups with your gynecologist to keep track of any changes in your health and wellbeing.

If perimenopause symptoms cause pain, discomfort, or heavy bleeding, you should seek medical help. The medical provider will perform a blood test to ensure you have entered perimenopause and recommend proper treatment.

Conditions that require medical help include:

  • Heavy bleeding and blood clots during menstruation
  • Bleeding after menstruation
  • Bleeding after sex
  • Menstrual cycles shorter than 21 days
  • Menstrual cycles several days longer than usual
  • Sleep issues
  • Emotional issues that interfere with daily life


Though sometimes uncomfortable, perimenopause is a natural process that can’t be avoided. The best way to go through perimenopause is to be informed about the symptoms and the treatments and lifestyle changes that help mitigate the most unpleasant effects. This knowledge will facilitate a smoother transition to the next chapter in your life.

Jenna Hilton
Jenna Hilton has been a practicing PA since 2009, specializing in Family, Internal Medicine and Medical Aesthetics. She attended Arizona State University where she received her Bachelor's Degree and graduated magna cum laude. She received her Master of Science degree in Physician Assistant Studies from A.T. Still University.

Jenna has been injecting neurotoxin and dermal filler since 2013. She received certification as a Master Injector in 2017 through Empire Medical in Los Angeles, California. She is currently working on a Fellowship Program in Anti-Aging and Regenerative Medicine through the American Academy of Anti-Aging Medicine. Her special interests include use of PLLA, Ablative/Non ablative skin resurfacing, PDO threads, hormone therapy and nutritional therapies to improve cellular regeneration and medically supervised weight loss.

Jenna Hilton believes in a multi-factorial approach, considering internal factors that accelerate aging and disease development. She always enjoys teaching. She co-founded Vibrant EDU courses at Vibrant Skin Bar and regularly performs one-on-one training with fellow injectors. She teaches Aesthetic and Advanced Injectable Courses at National Laser Institute. She has been named Preceptor of the Year and is an Adjunct Faculty Member at Midwestern University. She was born in Iowa, and lives with her husband and three children in Phoenix, AZ.

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