Perimenopause

Perimenopause is a natural part of life, and also represents a point of transition that can last several years. For these reasons, perimenopause is not typically diagnosed unless its symptoms cause significant discomfort or inconvenience.

If your doctor suspects that another condition, such as a thyroid issue or hormonal imbalance, may be causing your symptoms (and not perimenopause), he or she may recommend hormone testing. Hormone testing is done through a hormone panel to test your levels of estrogen and other sex-linked hormones. This kind of testing can often show whether you are nearing or in menopause.

Treatment

In most cases, perimenopause does not require medical treatment. However, if symptoms are making you uncomfortable, your doctor can help you find relief. Treatment options include:

• Medication: Healthcare providers sometimes use antidepressants to treat persistent, troublesome hot flashes in women who do not have depression. A medication called gabapentin (Neurontin) is also sometimes prescribed to treat hot flashes.
• Hormone therapy: Hormone replacement therapy is the use of estrogen (and progesterone, in some women) to increase hormone levels and decrease uncomfortable symptoms. Hormone therapy artificially returns your body’s hormone levels to where they were before you began perimenopause. This may increase your risk of heart disease and some other conditions. Your provider will prescribe the lowest possible effective dose for only as long as necessary to treat symptoms. Women who have been diagnosed with breast cancer or who have a strong family history should not receive hormone replacement therapy. The same is true for women with specific blood clotting disorders.
• Vaginal estrogen: To relieve vaginal dryness, women can use prescription estrogen in pill, cream, or insertable ring form.
• Gabapentin: Gabapentin is usually used to prevent seizures, but can also reduce some of the symptoms of menopause and perimenopause, such as hot flashes.
• SSRI antidepressants: Selective serotonin reuptake inhibitors (SSRIs) are typically used to treat depression and other mood disorders. For women experiencing perimenopause, these drugs can also regulate hot flashes and other symptoms. These drugs are often prescribed for perimenopausal women with or without depression, especially if other treatments such as hormone therapy are not recommended due to health or family history.

It is important to remember that you can get pregnant while in perimenopause. Even if you frequently skip periods or have not had a period for a while, it is still possible to become pregnant during this phase, though pregnancy becomes less likely over time as you near menopause.

If you do not want to get pregnant, use a reliable form of birth control until one year has passed since the end of your last period.

When to see a doctor for perimenopause

Some women experience very few symptoms during perimenopause. While you should still see your doctor for regular physical checkups, it may not be necessary to seek specific care for perimenopause unless the symptoms cause significant discomfort.

If you begin noticing these symptoms before the age of 40, or if they are disrupting your daily life, you should also contact your doctor to see what options you have to ease your symptoms.

If you notice abnormal reproductive or menstrual symptoms like the following, see a doctor, since they might indicate a more serious condition:

• Having periods that repeatedly occur fewer than three weeks (21 days) apart
• Experiencing menstrual bleeding for more than seven days at a time
• Swelling or discomfort in your abdomen coupled with missed periods
• Frequent bleeding in between periods
• Excessive menstrual bleeding (changing pads or tampons more than every two hours)

Perimenopause lasts several years and may bring on new health concerns. You and your doctor can discuss strategies for managing perimenopause.

Dignity Health cares for women from adolescence through perimenopause and beyond. We’re here for you.

The information contained in this article is meant for educational purposes only and should not replace advice from your healthcare provider.