Perimenopause

Diagnosis

Perimenopause is a process — a gradual transition. No one test or sign is enough to determine if you've entered perimenopause. Your doctor takes many things into consideration, including your age, menstrual history, and what symptoms or body changes you're experiencing.

Some doctors may order tests to check your hormone levels. But other than checking thyroid function, which can affect hormone levels, hormone testing is rarely necessary or useful to evaluate perimenopause.

Treatment

Medications are often used to treat perimenopausal symptoms.

• Hormone therapy. Systemic estrogen therapy — which comes in pill, skin patch, spray, gel or cream form — remains the most effective treatment option for relieving perimenopausal and menopausal hot flashes and night sweats. Depending on your personal and family medical history, your doctor may recommend estrogen in the lowest dose needed to provide symptom relief for you. If you still have your uterus, you'll need progestin in addition to estrogen. Systemic estrogen can help prevent bone loss.
• Vaginal estrogen. Estrogen can be administered directly to the vagina using a vaginal tablet, ring or cream. This treatment releases just a small amount of estrogen, which is absorbed by the vaginal tissue. It can help relieve vaginal dryness, discomfort with intercourse and some urinary symptoms.
• Antidepressants. Certain antidepressants related to the class of drugs called selective serotonin reuptake inhibitors (SSRIs) may reduce menopausal hot flashes. An antidepressant for management of hot flashes may be useful for women who can't take estrogen for health reasons or for women who need an antidepressant for a mood disorder.
• Gabapentin (Neurontin). Gabapentin is approved to treat seizures, but it has also been shown to help reduce hot flashes. This drug is useful for women who can't use estrogen therapy for health reasons and for those who also have migraines.
• Fezolinetant (Veozah). This medicine is a hormone-free option for treating menopause hot flashes. It works by blocking a pathway in the brain that helps regulate body temperature.

Before deciding on any form of treatment, talk with your doctor about your options and the risks and benefits involved with each. Review your options yearly, as your needs and treatment options may change.

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.

Lifestyle and home remedies

Making these healthy lifestyle choices may help ease some symptoms of perimenopause and promote good health as you age:

• Ease vaginal discomfort. Use over-the-counter, water-based vaginal lubricants (Astroglide, K-Y Liquid, others) or moisturizers (Replens, Vagisil Prohydrate, others). Choose products that don't contain glycerin, which can cause burning or irritation in women who are sensitive to that chemical. Staying sexually active also helps by increasing blood flow to the vagina.
• Eat healthy. Because your risk of osteoporosis and heart disease increases at this time, a healthy diet is more important than ever. Adopt a low-fat, high-fiber diet that's rich in fruits, vegetables and whole grains. Add calcium-rich foods. Avoid alcohol and caffeine if they seem to trigger hot flashes. Ask your doctor if you should also take a calcium supplement and if so, what type and how much — also ask if you need more vitamin D, which helps your body absorb calcium.
• Be active. Regular exercise and physical activity helps prevent weight gain, improves your sleep and elevates your mood. Try to exercise for 30 minutes or more on most days of the week, although not right before bedtime. Regular exercise has been shown to reduce hip fracture risk in older women and to strengthen bone density.
• Get enough sleep. Try to keep a consistent sleep schedule. Avoid caffeine, which can make it hard to get to sleep, and avoid drinking too much alcohol, which can interrupt sleep.
• Practice stress-reduction techniques. Practiced regularly, stress-reduction techniques, such as meditation or yoga, can promote relaxation and good health throughout your lifetime, but they may be particularly helpful during the menopausal transition.

Alternative medicine

In addition to conventional therapies, many women transitioning toward menopause want to know more about complementary and alternative approaches to treating symptoms. Researchers are looking into these therapies to determine their safety and effectiveness, but evidence is still often lacking.

Some of the options studied include:

• Black cohosh. This herb extract is used by some women to treat hot flashes and other menopausal symptoms. There's not enough evidence to support its use. Experts also are unsure of what risks taking black cohosh poses. Some studies have suggested that black cohosh was harmful to the liver, but other studies found no evidence that this is true. Researchers also question whether the herb extract is safe for women with or at risk of breast cancer.

• Phytoestrogens. These estrogens occur naturally in certain foods. Two main type of phytoestrogens are isoflavones and lignans. Isoflavones are found in soybeans and other legumes and red clover. Lignans occur in flaxseed, whole grains, and some fruits and vegetables. There are also plant-derived compounds that have estrogen-like properties.

  Studies on phytoestrogens — whether from food or supplements — conflict on whether they help reduce menopausal symptoms. Studies also conflict on what beneficial impact, if any, phytoestrogens may have on breast cancer risk.

• Bioidentical hormones. The term "bioidentical" implies that the hormones in the product are chemically identical to those your body produces. However, compounded bioidentical hormones aren't regulated by the U.S. Food and Drug Administration (FDA), so quality and risks could vary. There's also no evidence that compounded bioidentical hormones are safer or more effective than conventional hormone therapy.
• Dehydroepiandrosterone (DHEA). This natural steroid produced by your adrenal gland is available as a dietary supplement and has been used by some to reduce pain during intercourse due to vaginal atrophy. But evidence on its effectiveness is mixed, and there are some concerns about possible harmful effects.

Talk with your doctor before taking any herbal or dietary supplements for perimenopausal or menopausal symptoms. The FDA does not regulate herbal products, and some can be dangerous or interact with other medications you take, putting your health at risk.

Low-risk complementary therapies that may help reduce stress and improve psychological well-being include:

• Acupuncture. Research on acupuncture for decreasing hot flashes is inconclusive, but promising.
• Relaxation techniques. Yoga and meditation, for example, can help reduce stress, which may in turn help improve menopausal symptoms.

Preparing for your appointment

You'll probably start by discussing your symptoms with your primary care provider. If you aren't already seeing a doctor who specializes in the female reproductive system (gynecologist), your primary care provider may refer you to one.

Consider taking a family member or friend along. Sometimes it can be difficult to remember all the information provided during an appointment. Someone who goes with you may remember something that you missed or forgot.

What you can do

To prepare for your appointment:

• Take along a record of your menstrual cycles. Keep a journal of your menstrual cycles for the past few months, including first and last date of bleeding for each cycle, and whether the flow was light, moderate or heavy.
• Make a list of any signs and symptoms you're experiencing. Include detailed descriptions. Include any symptoms that may seem unrelated.
• Make a note of key personal information. Include any major stresses or recent life changes.
• Make a list of all medications and the doses. Include prescription and nonprescription drugs, herbs, vitamins and supplements that you're taking.
• Prepare questions. Your time with your doctor may be limited, so prepare a list of questions to help you make the most of your time together.

Some basic questions to ask include:

• What is likely causing my symptoms?
• What are other possible causes for my symptoms?
• What kinds of tests do I need?
• Is my condition likely temporary or chronic?
• What is the best course of action?
• What are the alternatives to the primary approach that you're suggesting?
• I have some other health conditions. How can I best manage them together?
• Are there any restrictions that I need to follow?
• Should I see a specialist?
• Are there brochures or other printed materials that I can have? What websites do you recommend?
• What will determine whether I should plan for a follow-up visit?

Questions your doctor may ask

To start a discussion about your perimenopausal experience, your doctor may ask questions such as:

• Do you continue to have menstrual periods? If so, what are they like?
• What symptoms are you experiencing?
• How long have you experienced these symptoms?
• How much distress do your symptoms cause you?
• What medications, herbs, vitamins or other supplements do you take?