Perimenopause, or menopause transition, begins several years before menopause. It’s the time when the ovaries gradually begin to make less estrogen. It usually starts in a woman’s 40s, but can start in her 30s or even earlier.

Perimenopause lasts up until menopause, the point when the ovaries stop releasing eggs. In the last 1 to 2 years of perimenopause, this drop in estrogen speeds up. At this stage, many women have menopause symptoms.

How Long Does Perimenopause Last?

The average length of perimenopause is 4 years, but for some women this stage may last only a few months or continue for 10 years. Perimenopause ends when a woman has gone 12 months without having her period.

What Are the Signs of Perimenopause?

Women in perimenopause have at least some these symptoms:

  • Hot flashes
  • Breast tenderness
  • Worse premenstrual syndrome
  • Lower sex drive
  • Fatigue
  • Irregular periods
  • Vaginal dryness; discomfort during sex
  • Urine leakage when coughing or sneezing
  • Urinary urgency (an urgent need to urinate more frequently)
  • Mood swings
  • Trouble sleeping

Are My Perimenopausal Symptoms Normal or Something to Be Concerned About?

Irregular periods are common and normal during perimenopause. But other conditions can cause changes in menstrual bleeding. If any of the following situations apply to you, see a doctor to rule out other causes:

  • Your periods are very heavy, or they have blood clots.
  • Your periods last several days longer than usual.
  • You spot between periods.
  • You have spotting after sex.
  • Your periods happen closer together.

Causes of abnormal bleeding include hormone problems, birth control pills, pregnancy, fibroids, blood clotting problems or, rarely, cancer.

Are There Treatments That Can Ease the Symptoms of Perimenopause?

Many women get relief from hot flashes after taking low-dose birth control pills for a short time. Other options that may control hot flashes include the birth control skin patch, vaginal ring, and progesterone injections. Certain women should not use birth control hormones, so talk to your doctor to see if they are right for you.

You may also feel better if you do things that enhance your general well-being, such as:

  • Exercise.
  • Stop smoking.
  • Get more sleep and try going to sleep and waking up at the same time each day.
  • Drink less alcohol.
  • Get to a healthy weight and stay there.
  • Get enough calcium in your diet.
  • Ask your doctor if you should take a multivitamin.

Talk to your doctor if you are having problems with your sex drive. He or she may be able to recommend a counselor or therapist to help you and your partner work through this problem. Vaginal lubricants may also be recommended, if vaginal dryness is a problem.

Other treatments available to help with the various symptoms of perimenopause may include antidepressant medications for mood swings.

Talk to your doctor about your specific symptoms and goals of treatment. This will help him or her make a plan that is right for you.

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