What Is Perimenopause?

Perimenopause is the transition leading up to menopause, when ovarian hormone production begins to change and fluctuate. For some women, the first sign is an obvious change in their menstrual cycle. For others, it may begin with symptoms that don’t initially seem hormonal at all: difficulty sleeping, anxiety, brain fog, weight changes, decreased libido, or simply feeling different than they used to.

And yes: you can be in perimenopause while still having regular periods.

Perimenopause most commonly begins in the 40s, although some women notice changes in their late 30s.

The transition can last for several years. During this time, estrogen and progesterone production becomes less predictable as ovarian function changes. Eventually, menstrual periods stop completely. Menopause is officially reached after 12 consecutive months without a menstrual period, provided there is not another explanation for the absence of periods.

Perimenopause can look very different from one person to another. Symptoms may include:

You do not need to experience all—or even most—of these symptoms to be in perimenopause.

One reason is that many symptoms overlap with other health conditions. Fatigue, brain fog, weight changes, mood changes, and poor sleep can also occur with thyroid dysfunction, iron deficiency, sleep disorders, medication effects, depression, anxiety, and other medical conditions. That’s why good perimenopause care shouldn’t automatically attribute every symptom to hormones.

At NOVEL, we look at the whole clinical picture and evaluate other potential contributors when appropriate.

Not necessarily.

For many women over age 45 with typical symptoms and menstrual changes, perimenopause can be identified clinically based on age, symptoms, and menstrual history. A single hormone level can also be misleading during perimenopause because hormone levels can fluctuate considerably from one day—or one cycle—to another.

Laboratory testing can still be useful in certain situations, particularly when the diagnosis is unclear, menstrual patterns cannot be used reliably, symptoms are atypical, or another condition needs to be evaluated.

No.

You do not have to wait until your periods stop before discussing treatment for bothersome perimenopausal symptoms.

Treatment should be individualized based on your symptoms, health history, risk factors, preferences, need for contraception, and goals.

Depending on the individual, treatment may include:

There isn’t one hormone regimen that is right for every woman.

The goal is not simply to “balance your hormones.” It is to understand which symptoms are affecting you, what may be contributing to them, and which treatment options make sense for your individual health history.

If changes in your cycle, sleep, mood, cognition, sexual health, energy, or other symptoms are interfering with your quality of life, you don’t have to wait for them to become severe before asking for help.

Perimenopause is a normal biological transition, but that doesn’t mean bothersome symptoms have to be ignored.

Ready to talk about your symptoms?
Explore NOVEL’s Perimenopause + Menopause Care to learn more about individualized treatment options.