Perimenopauz

Perimenopauz, also known as perimenopause, is the transitional phase before menopause during which ovarian function declines and hormone levels fluctuate. It typically begins in a woman’s 40s but can start in the late 30s and may last several years, commonly two to eight years. Menopause is reached after 12 consecutive months without a menstrual period, and perimenopause ends when menopause begins.

During perimenopause, menstrual cycles often become irregular and unpredictable. Other common symptoms include hot flashes and night sweats, sleep disturbance, and mood changes such as irritability or anxiety. Women may notice vaginal dryness, changes in libido, and urinary symptoms. Some experience concentration or memory changes, and weight gain can occur. Symptoms vary widely in type and severity; some people have few or no noticeable symptoms.

Causes are related to aging and decreasing ovarian reserve, with estrogen and progesterone levels fluctuating and follicle-stimulating hormone (FSH) levels rising as the ovaries respond less to signals from the pituitary. Perimenopause is a natural lead-up to menopause and is not a disease.

Diagnosis is usually clinical, based on history and menstrual patterns. Blood tests such as FSH or estradiol are sometimes used but are not required to diagnose perimenopause. Pregnancy testing may be considered if relevant.

Management focuses on relieving symptoms and addressing risks. Lifestyle measures such as regular exercise, a balanced diet, sleep hygiene, and smoking cessation can help. Hormone therapy may be considered for vasomotor and genitourinary symptoms in eligible individuals after discussing risks and benefits. Non-hormonal medications, including certain antidepressants (SSRIs/SNRIs), gabapentin, or clonidine, can help some hot flashes. Local estrogen therapy or vaginal moisturizers can alleviate vaginal dryness. Fertility declines during this period, but pregnancy remains possible until menopause.