Perimenopause - diagnosis and treatment (2023)


Perimenopause is a process - a gradual transition. No test or sign is enough to determine if you have entered perimenopause. Your doctor takes many things into account, including your age, your menstrual history, and what symptoms or physical changes you are experiencing.

Some doctors may order tests to check your hormone levels. But aside from checking thyroid function, which can affect hormone levels, hormone tests are rarely necessary or useful to assess perimenopause.

Nursing at the Mayo Clinic

Our caring team of Mayo Clinic experts can help you with your perimenopause related health issues. Start here


Medications are often used to treat perimenopausal symptoms.

(Video) Treating Perimenopause Symptoms

  • Hormone therapy.Systemic estrogen therapy — which comes in tablet, skin patch, spray, gel, or cream form — remains the most effective treatment option for relieving hot flashes and night sweats in the peri- and menopause. Depending on your personal and family medical history, your doctor may recommend estrogen at the lowest dose needed to relieve your symptoms. If you still have your uterus, you need progestin in addition to estrogen. Systemic estrogen can help prevent bone loss.
  • Vaginal Estrogen.Estrogen can be administered directly into the vagina using a vaginal tablet, vaginal ring, or vaginal cream. With this treatment, only a small amount of estrogen is released, which is absorbed by the vaginal tissue. It can help relieve vaginal dryness, discomfort during intercourse, and some urinary tract symptoms.
  • Antidepressants.Certain antidepressants from a class called selective serotonin reuptake inhibitors (SSRIs) can reduce hot flashes associated with menopause. An antidepressant to treat hot flashes may be useful for women who cannot 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 cannot use estrogen therapy for health reasons and those who also have migraines.

Before deciding on any form of treatment, talk to your doctor about your options and the associated risks and benefits. Review your options annually, as your needs and treatment options may change.

More information

  • Care of perimenopause at the Mayo Clinic
  • Ablation des Endometriums

Request an appointment at the Mayo Clinic

(Video) Perimenopause vs. Menopause: Signs, Symptoms & Treatments with Dr. Katrina Kelly | San Diego Health

Clinical Trials

Explore the Mayo Clinic studiesExperimenting with new treatments, interventions and tests as a means of preventing, detecting, treating or managing this condition.

lifestyle and home remedies

The following healthy lifestyle choices can help relieve some symptoms of perimenopause and promote good health as you age:

  • Relieves 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 this chemical. Staying sexually active also helps by increasing blood flow to the vagina.
  • Eat healthy.As your risk of osteoporosis and heart disease increases during this time, eating healthy is more important than ever. Adopt a low-fat, high-fiber diet 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 be taking a calcium supplement, and if so, what kind and how much — also ask if you need more vitamin D, which helps your body absorb calcium.
  • Be active.Regular exercise and physical activity prevent weight gain, improve your sleep, and elevate your mood. Aim to exercise 30 minutes or more most days of the week, but not right before bed. Regular exercise has been shown to reduce the risk of hip fractures in older women and increase bone density.
  • get enough sleepTry to keep a consistent sleep schedule. Avoid caffeine, which can make it difficult to fall asleep, and avoid drinking too much alcohol, which can disrupt sleep.
  • Practice stress reduction techniques.Regularly practiced stress reduction techniques like meditation or yoga can promote relaxation and health throughout your life, but they can be especially helpful during the transition to menopause.

alternative medicine

In addition to conventional therapies, many menopausal women want to learn about complementary and alternative approaches to managing symptoms. Researchers are studying these therapies to determine their safety and effectiveness, but evidence is often lacking.

Some of the options explored include:

  • black cohosh.This herbal extract is used by some women to treat hot flashes and other menopausal symptoms. There is insufficient evidence to support its use. Experts are also unsure of the risks of ingesting black cohosh. Some studies have shown that black cohosh is harmful to the liver, but other studies have found no evidence of this. Researchers are also wondering if the herbal extract is safe for women with or at risk of breast cancer.
  • phytoestrogens.These estrogens occur naturally in certain foods. Two main types of phytoestrogens are isoflavones and lignans. Isoflavones are found in soybeans and other legumes, as well as red clover. Lignans are found in flaxseeds, whole grains, and some fruits and vegetables. There are also herbal compounds that have estrogen-like properties.

    (Video) Perimenopause: Signs, Symptoms, and Solutions

    Studies on phytoestrogens — whether from foods or supplements — are conflicting about whether they help reduce menopausal symptoms. Studies are also conflicting about what beneficial effects phytoestrogens might 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, compound bioidentical hormones are not regulated by the U.S. Food and Drug Administration (FDA), so quality and risks may vary. There is also no evidence that compound bioidentical hormones are safer or more effective than traditional hormone therapy.
  • Dehydroepiandrosteron (DHEA).This natural steroid, produced by your adrenal gland, is available as a dietary supplement and has been used by some to relieve pain during intercourse due to vaginal atrophy. However, the evidence for its effectiveness is mixed, and there are some concerns about possible harmful effects.

Talk to your doctor before taking any herbal or dietary supplements for perimenopausal or menopausal symptoms. TheFDAdoes not regulate herbal products, and some may be dangerous or interact with other medications you are taking and put your health at risk.

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

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

Prepare for your appointment

You probably start by discussing your symptoms with your GP. If you do not already see a doctor who specializes in the female reproductive system (gynecologist), your GP can refer you to one.

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

(Video) Perimenopause & Perimenopausal Depression: Signs, Symptoms, and Treatment | Mass General Brigham

What you can do

How to prepare for your appointment:

  • Take a record of your menstrual cycles with you.Keep a journal of your menstrual cycles over the past few months, including the first and last dates of bleeding for each cycle and whether the bleeding was light, moderate, or heavy.
  • Make a list of all the signs and symptoms you have.Add detailed descriptions. Include any symptoms that appear unrelated.
  • Write down important personal information.Include major stresses or recent life changes.
  • Make a list of all medications and the dosages.Include prescription and non-prescription drugs, herbs, vitamins, and supplements you take.
  • Prepare questions.Your time with your doctor may be limited. Therefore, prepare a list of questions so that you can make the most of your time together.

Some basic questions to ask yourself are:

  • What is likely causing my symptoms?
  • What are other possible causes of my symptoms?
  • What types of tests do I need?
  • Is my condition likely transient or chronic?
  • What is the best course of action?
  • What are the alternatives to the primary approach you propose?
  • I have some other health problems. How can I best manage them together?
  • Are there any restrictions I need to follow?
  • Should I see a specialist?
  • Are there brochures or other printed materials I can have? Which websites do you recommend?
  • What determines if I should schedule a follow-up visit?

Questions your doctor may ask

To start a conversation about your perimenopause experience, your doctor may ask questions such as:

  • Are you still having menstrual bleeding? If yes, how are they?
  • What are your symptoms?
  • How long have you suffered from these symptoms?
  • How distressing are your symptoms?
  • What medications, herbs, vitamins, or other supplements do you take?

By Mayo Clinic staff

(Video) What to Expect During Perimenopause



What can perimenopause be confused with? ›

Medical conditions including endometriosis or cancer are sometimes confused with perimenopause in midlife women because they can alter your menstrual cycle.

How can I reset my hormones during perimenopause? ›

During perimenopause, a woman's estrogen and progesterone start to fluctuate.
What you can do now
  1. Quit smoking if you smoke cigarettes.
  2. Exercise regularly.
  3. Eat more protein, omega-3 fatty acids, fiber, and calcium.
  4. Limit saturated fats, highly refined carbs, and sugar.
  5. Limit caffeine and alcohol.

How does a doctor diagnose perimenopause? ›

Diagnosis of of perimenopause

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.

What is the best treatment for perimenopause? ›

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.

What is the most common symptoms seen during perimenopausal years? ›

You might experience:
  • Irregular periods. ...
  • Hot flashes and sleep problems. ...
  • Mood changes. ...
  • Vaginal and bladder problems. ...
  • Decreasing fertility. ...
  • Changes in sexual function. ...
  • Loss of bone. ...
  • Changing cholesterol levels.
Aug 7, 2021

Can bloodwork tell if you're in menopause? ›

Sometimes, elevated follicle-stimulating hormone (FSH) levels are measured to confirm menopause. When a woman's FSH blood level is consistently elevated to 30 mIU/mL or higher, and she has not had a menstrual period for a year, it is generally accepted that she has reached menopause.

What vitamins help perimenopause? ›

Vitamin E is known to dramatically reduce the severity and frequency of perimenopausal hot flashes. Its antioxidant properties also lower your chances for depression, heart disease, and weight gain while relieving stress. Up your dose of vitamin E by consuming nuts, seeds, wheat germ, broccoli, spinach, and shellfish.

What hormone is lacking during perimenopause? ›

During perimenopause, levels of estrogen, a key female hormone, start to decrease. You may begin having menopause-like symptoms, such as hot flashes or irregular periods. Perimenopause can last for years. When you go a full 12 months without a period, menopause has begun.

Can Obgyn test for perimenopause? ›

Your provider may perform a blood test to evaluate hormone levels to confirm that you are perimenopausal. But, because your hormone levels are constantly changing throughout perimenopause, you may need several blood tests to determine whether or not you've begun the transition to menopause.

When should I see a gynecologist for perimenopause? ›

However, you may want to talk to a perimenopause doctor if you experience any of the following symptoms: Your periods are very heavy or they include blood clots. Your periods last much longer than usual. You experience spotting either between periods or after sex.

How can I treat perimenopause naturally? ›

Here's a list of 11 natural ways to reduce the symptoms of menopause.
  1. Eat foods rich in calcium and vitamin D. ...
  2. Maintain a moderate weight. ...
  3. Eat lots of fruit and vegetables. ...
  4. Avoid trigger foods. ...
  5. Exercise regularly. ...
  6. Eat more foods that are high in phytoestrogens. ...
  7. Drink enough water. ...
  8. Reduce refined sugar and processed foods.

Does perimenopause need treatment? ›

Perimenopause does not need to be treated unless symptoms are bothersome. Treatments may include: Hormone therapy using estrogen or estrogen and progestins to level out hormone levels. Antidepressants to stabilize moods.

What over the counter medicine is good for perimenopause? ›

Amberen and Estroven are two brands of over-the-counter supplement products. They are for people experiencing menopause or perimenopause. Both Amberen and Estroven claim that their products relieve various symptoms associated with menopause, such as hot flashes and mood changes.

How long would perimenopause usually last? ›

The years leading up to that point, when women may have changes in their monthly cycles, hot flashes, or other symptoms, are called the menopausal transition or perimenopause. The menopausal transition most often begins between ages 45 and 55. It usually lasts about seven years but can be as long as 14 years.

What are the symptoms of low estrogen? ›

Signs of low estrogen include:
  • Dry skin.
  • Tender breasts.
  • Weak or brittle bones.
  • Trouble concentrating.
  • Moodiness and irritability.
  • Vaginal dryness or atrophy.
  • Hot flashes and night sweats.
  • Irregular periods or no periods (amenorrhea).
Feb 8, 2022

What are the first signs of perimenopause starting? ›

The first sign of perimenopause typically a disruption of your menstrual cycle. For many women, your period starts earlier or later than normal. For example, if your menstrual cycle has always been 28 days, during perimenopause, your period could come as early as 21 or as late as 35 days.

What does the start of perimenopause feel like? ›

Common physical symptoms of menopause and perimenopause include: hot flushes, when you have sudden feelings of hot or cold in your face, neck and chest which can make you dizzy. difficulty sleeping, which may be a result of night sweats and make you feel tired and irritable during the day.

What labs to check for perimenopause? ›

When testing for menopause is warranted, doctors may order an FSH test to detect elevated levels of FSH in the blood. Measuring FSH can help determine if a woman is perimenopausal or has already gone through menopause.

What level of FSH indicates perimenopause? ›

FSH is sometimes used as a measure of whether a woman is peri or postmenopausal. An FSH level of > 30 IU/L is consistent with the perimenopause, although FSH levels of 70-90 IU/L are not uncommon for postmenopausal women.

Do I need to see a doctor to confirm menopause? ›

Signs and symptoms of menopause are usually enough to tell most women that they've started the menopausal transition. If you have concerns about irregular periods or hot flashes, talk with your doctor. In some cases, further evaluation may be recommended.

Can you be misdiagnosed with perimenopause? ›

While menopause and perimenopause are both natural, biological processes, they can pose a unique risk for women: misdiagnosis.

Is it perimenopause or something else? ›

A woman is in menopause when she has gone 12 straight months without a period. Perimenopause starts when a woman first has symptoms related to hormonal changes and ends one year after she stops getting her period. Perimenopause can last from four to eight years.

Can perimenopause symptoms mimic MS? ›

The effects of the menopause can feel similar to MS symptoms, and hot flushes and difficulty sleeping might make MS symptoms feel worse. Finding ways to manage the effects of the menopause could help with MS symptoms too. Many women feel that their MS changes around the time of menopause.

How do you know if it's perimenopause or menopause? ›

Perimenopause is when you have symptoms before your periods have stopped. You reach menopause when you have not had a period for 12 months. Menopause and perimenopause can cause symptoms like anxiety, mood swings, brain fog, hot flushes and irregular periods.


1. Menopause Symptoms & Treatment
(Sutter Health)
2. Menopause, Perimenopause, Symptoms and Management, Animation.
(Alila Medical Media)
3. 32 Perimenopause Symptoms (+ 5 Remedies) Women Over 40 Must Know!
(Rena Hedeman)
4. PERIMENOPAUSE: How To Tell If You Are In Early Or Late Perimenopause!
(Heather Hirsch MD, MS, NCMP)
5. Premenopausal Syndrome (PMS)
(UNTV News and Rescue)
6. What is Perimenopause ? | Symptoms & Treatment | Dr.Kaajal Mangukiya
(Dr. Kaajal Mangukiya, IVF , Surat)


Top Articles
Latest Posts
Article information

Author: Francesca Jacobs Ret

Last Updated: 08/30/2023

Views: 6051

Rating: 4.8 / 5 (68 voted)

Reviews: 91% of readers found this page helpful

Author information

Name: Francesca Jacobs Ret

Birthday: 1996-12-09

Address: Apt. 141 1406 Mitch Summit, New Teganshire, UT 82655-0699

Phone: +2296092334654

Job: Technology Architect

Hobby: Snowboarding, Scouting, Foreign language learning, Dowsing, Baton twirling, Sculpting, Cabaret

Introduction: My name is Francesca Jacobs Ret, I am a innocent, super, beautiful, charming, lucky, gentle, clever person who loves writing and wants to share my knowledge and understanding with you.