menstrual cycle

Perimenopause - Know about Symptoms, Tests, and Treatment

  • 4.7   (7 Votes)
Medically Reviewed by Dr. Deepika Tiwari - MBBS on 27 Apr 2018 - Written by Dr. Sheetal Pandey Tejwani - MBBS - Grammatically Approved by Dr. Kavita Jaggi Agrawal - MBBS

Perimenopause symptoms which occur in women in the middle age are irregular cycles, mood changes, vaginal dryness, sexual functional changes, and bone density reduction. Perimenopause tests are diagnosed with the assistance of blood tests. Perimenopause treatments include hormone therapy, vaginal estrogen, gabapentin, and antidepressants.

Perimenopause is a condition when a female body makes fewer hormones, which are responsible for controlling the menstrual cycle i.e. estrogen and progesterone. There are many reasons, which play a key role, and on the basis of it, your doctor will recommend hormone replacement therapy for estrogen or progesterone. And once you don't have periods for a year then it is possible that you have hit the menopause and so cannot get pregnant anymore.

What is a menopausal transition?

Perimenopauseliterally means around menopause. It implies the time during which female body starts making a natural transition to menopause and thus marking the end of female's reproductive years. It is also known as menopausal transition. The perimenopause period gets over when you don't have a menstrual cycle for a definite period of 12 months and post that you reach menopause.

When does perimenopause start?

It starts at different ages and one can notice the progression signs like irregular periods. Some notice it in their 40s while some women will notice the changes in early-mid 30s. Female hormone level i.e. estrogen in the body rises and falls unevenly during the period of perimenopause. The menstrual cycle can also lengthen or shorten and you also might start having periods where ovaries don't release the egg.

When does perimenopause start
You might also experience signs of menopause like hot flashes, vaginal dryness and sleeping troubles. There are treatments available for such symptoms. To check your symptoms in more detail please read our article on healthy periods.

What are the symptoms of Perimenopause?

During the menopausal transition, you will notice some subtle and unsubtle changes in the body like:

1- Irregular Cycles: As there is an unpredictable ovulation, the duration between periods might get longer and shorter, flow either gets heavy or light or there are chances of skipping some periods. You might be in your early perimenopause if you see a consistent change of 7 days or more in the average length of periods. The chances of late perimenopause are defined when you have a gap of 60 days or more between the cycles.

2- Hot flashes: This is a common sign of perimenopause. The frequency, intensity and length can vary. Some women may experience slightly warm while others can drench in sweat.

3- Sleeping problems: Sleeping issue arises due to changes in hormones including symptoms like hot flashes or night sweats.

4- Mood changes: Irritation, mood swings or increased risk of depression can happen during perimenopause. The reason behind this can be sleep disruption or hot flashes.

5- Vaginal dryness: Vaginal tissues might start losing the elasticity and lubrication when estrogen levels begin to diminish. It can further cause itching, pain and soreness while intercourse. Low estrogen levels can also leave you vulnerable to urinary or vaginal infections. Vaginal dryness
6- Decrease in fertility: The ability to conceive decreases, once ovulation becomes irregular.

7- Changes in sexual function: Sexual arousal as well as desire to have sex might change during the perimenopause.

8- Reduction in bone density: You may start losing bone density quickly due to declining estrogen levels. It increases the risk of osteoporosis, which is a disease leading to fragile bones.

Changing cholesterol levels: As estrogen levels start diminishing, it may cause unfavorable changes in blood cholesterol levels contributing to the risk of heart disease.

In case you are missing periods to frequently then does not always mean that you are are heading to menopause state. There may be other reasons to such irregularities. Please explore them with our article on causes of missed periods

What are the causes of Perimenopause?

Due to menopausal transition, the female body's estrogen and progesterone production rises and falls. Most of the changes are experienced during menopause because of diminishing estrogen.

How long does Perimenopause last?

The average duration of perimenopause is about 4 years but in some women, this might last only a few months or can continue for 10 years. It technically ends when the woman has gone without periods for 12 months.

Do Perimenopausal Symptoms Need Consideration?

One of the common and normal indications of perimenopause is irregular periods. But there are other reasons also which can cause changes in the menstrual bleeding. You must visit a doctor if you notice any of the following situations:

1- If your periods are very heavy or have blood clots.

2- Your period lasts longer than usual.

3- Spotting between menstrual cycles.

4- Spotting after intercourse.

5- Periods taking place close together.

Risk factors involved in Perimenopause

Though menopause is a normal phase but it might occur earlier in some females than others and there are certain factors which conclude that you may start perimenopause at an earlier age. Risks are:

1- Women who smoke may see the onset of menopause one or two years earlier than women who don't smoke.

2- Women who have a family history of early menopause may also experience early menopause.

3- One of the reasons that contribute to early menopause is cancer treatment with chemotherapy or pelvic radiation.

4- Uterus may be removed through hysterectomy but not the ovaries. This would not really mean menopause but ovaries would still continue producing estrogen.But the woman won't have their menstrual cycles. Such surgery can also cause menopause to occur early.

How to diagnose Perimenopause?

Perimenopause diagnosis is very much based on the woman’s age as well as symptoms. A blood test will help in determining the hormone levels. Doctor will advise to take several blood tests at different times for comparison due to hormone levels fluctuations caused due to perimenopause.Please note that other diseases can also mimic hormone levels changes as in case of perimenopause.

Chances of conception during perimenopausal

Yes, there are chances of conceiving. The woman can still get pregnant even though fertility declines during perimenopause stage. While for some women, it gets difficult to achieve pregnancy once they are in their late 30s to early 40s because of the drop in fertility. But if you don’t want to conceive then do use some form of birth control until the time you reach menopause.

What are the treatments available for Perimenopause?

For treating perimenopausal symptoms, drug therapy is used.

1- Hormone Therapy: The most effective treatment for relieving premenopausal and menopausal night sweats and hot flashes is systemic estrogen therapy. It comes in pill, skin patch, cream and gel form. It also prevents bone loss.

2- Antidepressants: For reducing menopausal hot flashes there are several antidepressants related to SSRIs class of drugs. These antidepressants are useful for women who cannot take estrogen for health reasons or women who require antidepressant for mood disorders.

3- Vaginal estrogen: Estrogen can be used directly to the vagina by using ring, cream or tablet for relieving from vaginal dryness. A small amount of estrogen is released in this treatment and is absorbed by the vaginal tissue.

4- Gabapentin: It helps in reducing the hot flashes and is used for treating the seizures. This is useful those women who cannot use estrogen therapy due to migraines and health troubles.

Stay positive mentally and physically once you enter this new phase of life. Perimenopause should not be taken as a negative phase of life. Take this stage as a time to consider what changes we can make to look ourselves better. So, the sooner you accept you are perimenopausal, the better it will be.

If you are experiencing the symptoms of perimenopause before your 40s than infertility drugs may be the reason. Understand how infertility drugs cause premature menopause. You should also know that if you have irregular cycles, then you may face trouble in conceiving.

Dr. Sheetal Pandey Tejwani

Written by

Gynecologic Surgeon, Laparoscopic Surgeon

Dr. Sheetal Pandey Tejwani is an Infertility Specialist, Gynecologic Surgeon and Obstetrician, located in Mumbai and having an experience of almost a decade. Her alma mater is B J MEDICAL COLLEGE in Pune from where she completed her MBBS and MS in Obstetrics and Gynaecology in 2007 and 2009, respectively. In the following year, she pursued her DNB in Obstetrics and Gynecology. She received her Post Doctoral Fellowship in Reproductive Medicine from Krishna IVF Vizag and Nadkarni IVF Centre, Surat in 2013. She is the member of 3 different associations i.e. Indian Society of Assisted Reproduction (ISAR), Indian Medical Association (IMA), and Association of Medical Consultants. Her area of expertise includes Tubectomy/Tubal Ligation, Hysterectomy (Abdominal/Vaginal), Intrauterine Insemination (IUI), Caesarean Section and In-Vitro Fertilization (IVF). She is a consultant in Veda Fertility And Urology Care, Mira Road and is a visiting consultant in Wockhardt Hospital, Mira Road, Mumbai. You can get the contact details of Dr. Sheetal Pandey Tejwani at


1.  How to conceive - things to remember when you are thinking how to conceive  get pregnant, Elawoman - 2017
2.  Top 10 effective natural remedies to cure menstrual cramps  period, Elawoman - 2017
3.  What are the top 5 reasons for delayed periods or irregular periods?  menstrual cycle, Elawoman - 2017
4.  Effect of infertility drugs on premature menopause - when to worry, what to do  signs of menopause, Elawoman - 2017
5.  5 healthy periods symptoms in women which help signify good health  healthy periods, Elawoman - 2017
6.  Know the 5 basics of ovulation predictor kits - when to use? how does opk work?  ovulation, Elawoman - 2017
7.  Primary and secondary amenorrhea - what are the causes of missed periods?  causes of missed periods, Elawoman - 2017
8.  Vaginismus - what are the causes, symptoms, and treatments of vaginismus?  intercourse, Elawoman - 2017
9.  Effect of infertility drugs on premature menopause - when to worry, what to do  infertility drugs cause premature menopause, Elawoman - 2017



Meena Parker

Very informative article. I just need to ask though, is medication for perimenopause is available in homeopathy? Allopathy doesn't suit me.

Oct. 4, 2018, 11:01 p.m. 4.5



I am 35 years old with 2 children. I don't want to have any more child. I am facing some of the perimenopause symptoms like an irregular cycle, sleeping problems and vaginal dryness. Do I need to have treatment or can live with this as one day every woman has to face this?

Sept. 17, 2018, 1:46 p.m. 5.0


Nitya Rana

I have blood clots during my cycles, Is it perimenopause or something else?

Aug. 20, 2018, 5:43 p.m. 4.5


Sakshi Khanna

I had a hysterectomy surgery one month ago. How long would it take to have Perimenopause?

Aug. 14, 2018, 1:23 a.m. 5.0


Chitra Bajaj

A very informative piece, thank you so much for sharing. Could not have known about menopause without the article. Would love to share this.

Aug. 10, 2018, 2:34 p.m. 4.5



Helpful blog

June 30, 2018, 5:48 p.m. 5.0


Jaspal Virendra

I used to have irregular periods with 45 - 50 days cycle but this time I had already crossed 2 months but still no signs of periods. What may be the reason? Shall I consult a physician.

April 12, 2018, 9:54 p.m. 4.5

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