Perimenopause

What is Perimenopause?

Perimenopause is the time before menopause when your ovaries make less estrogen and hormone levels fluctuate. During perimenopause, pregnancy is still possible, but fertility decreases.

Perimenopause vs. Menopause: What’s the Difference?

Menopause occurs after 12 consecutive months without a period, while perimenopause is the transition from typical reproductive cycles to menopause. The average length of perimenopause is about four years, but how long it lasts can vary greatly.

When Does Perimenopause Happen?

Perimenopause most commonly starts in the mid-to-late 40s, but it can begin in the 30s or 50s.

What Are the Symptoms of Perimenopause?

Common signs of perimenopause include:

Irregular periods or spotting
Hot flashes and night sweats
Sleep problems and fatigue
Mood changes, anxiety, or “brain fog”
Weight gain and slower metabolism
Vaginal dryness or itching
Changes in sexual comfort or desire
Bloating, heartburn, or constipation
Thinning skin and changes to bone density

Less common perimenopause symptoms include:

Nausea
Dizziness
Changes in blood pressure
Breast tenderness

If you’re concerned about any of these symptoms, talk with your OBGYN provider.

What Causes Perimenopause?

The main cause of perimenopause is the natural decline of reproductive hormones — especially estradiol (a form of estrogen) and progesterone — produced by the ovaries. These hormonal changes affect many body systems, including temperature control, mood regulation, bone and skin health, and digestion.

Risk factors that can impact perimenopause include:

Age (most common in 40s)
Smoking (can bring on earlier changes)
Certain surgeries (e.g., removal of ovaries) or cancer treatments that affect ovarian function

UR Medicine's Treatments for Perimenopause

Diagnosing Perimenopause

Your OBGYN provider will review your symptoms and your medical history and perform a physical exam. They will ask about:

Menstrual changes
Symptom timing
Effects on daily life

Blood tests may be used to check hormone levels, thyroid function, or other causes of symptoms. Other tests such as bone density scan, blood pressure checks, and additional labs may be recommended.

Treating Perimenopause

At UR Medicine, we offer personalized care that prioritizes symptom relief, long-term health, and your treatment preferences. There are many medications and lifestyle adjustments that can help you through this transition.

Medical Options

Your provider will discuss risks and benefits and whether medical treatments are right for you. Options include:

Hormone therapy (HT) — lowers hot flashes, prevents vaginal dryness, and can help sleep and mood
Non-hormonal prescription options — for hot flashes, mood, or sleep when hormones aren't appropriate
Topical vaginal treatments — lubricants or local estrogen for vaginal dryness and itch
Birth control — can relieve symptoms by regulating hormone levels

Lifestyle Options

Lifestyle strategies can help reduce symptoms and longer-term risks related to weight, blood pressure, and metabolic changes. These may include:

Regular physical activity
Sleep hygiene
Limiting caffeine/alcohol
Stopping smoking
Balanced diet
Cooling strategies for hot flashes
Supplements (i.e. calcium, vitamin D, iron, zinc, and magnesium)

What Sets Us Apart?

UR Medicine offers multidisciplinary, integrated support for our patients. For perimenopause, our experts use menopause-focused gynecology, nutrition counseling, and behavioral health to address the physical and emotional effects of the transition.

Our approach combines clinical experience, research-informed options, and supportive services to offer the best care possible. Our gynecologists and menopause specialists provide expert, patient-centered care supported by the resources of an academic medical center.