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  • Michael Frey, MD


Feel a sudden warmth in your body when you’re otherwise healthy? Wake up drenched in sweat but the room temperature is chilly? Welcome to perimenopause.

You’re probably familiar with the term menopause, but what exactly is perimenopause? As with all aspects of life, there is a natural progression in your reproductive cycle. As you get older, your estrogen and progesterone levels decrease and your ovaries slow the production of eggs

Perimenopause occurs over years of your life, often starting in the early forties. Think of perimenopause as a journey, not a destination.

Perimenopause Symptoms

  • hot flushes

  • night sweats

  • irregular periods

  • mood swings

  • low libido

  • headaches

  • vaginal dryness

  • tiredness and difficulty with concentration and memory

  • itchy or dry skin

  • insomnia

  • weight gain and slowed metabolism

  • thinning hair

  • dry skin

  • loss of breast fullness

What Happens During Perimenopause?

The ovaries don’t stop working suddenly. They gradually slow down over time as they begin to run out of eggs. This affects the level of hormones in your body, such as estrogen and progesterone. Changes in hormone levels can cause changes in your periods as well as other symptoms.

Some people don’t experience this gradual process because their ovaries stop working suddenly, for example because of surgery or cancer treatment.

What Is The Average Age For Perimenopause?

The average age for menopause is 51. Perimenopause typically begins between 4 and 10 years before menopause. Perimenopause is considered “normal” if it starts after age 42. Before then, is considered premature. Early menopause is estimated to occur in 1 out of 100 women.

Is There A Test For Perimenopause?

Most of the time, perimenopause is diagnosed based on symptoms. Because of menstrual cycle irregularity during the transition to menopause, levels can be challenging to assess in a single blood test but we can test the FSH level.

  • Follicle-stimulating hormones (FSH). A test for levels of follicle-stimulating hormones (FSH) is often used to determine if menopause has occurred.

How to Cope With Perimenopause

  • Hormone therapy: Helps reduce hot flashes and may prevent bone loss.

  • Vaginal estrogen: Relieves vaginal dryness, discomfort during sex, and some urinary symptoms.

  • Low-dose antidepressants: Help reduce hot flashes and mood disorders.

  • Gabapentin: Help reduce hot flashes.

  • Calcium and vitamin D supplements or other osteoporosis treatments: Aids in strengthening bones.

  • Vaginal lubricants: Increases comfort during sex.

  • Incontinence treatments: Various lifestyle changes and medical options for gaining bladder control.

  • Supplements: May relieve hot flashes and other menopausal symptoms.

-Black Cohosh may help reduce hot flashes.

-Maca to help calm hot flashes.

-Equelle is a soy product that can help with sleep and hot flashes.

-Magnesium can help with cramping.

  • Exercise: Stimulates heart and bone health and maintains healthy weight.

  • Diet: Helps manage healthy weight.


Perimenopausal women can ovulate twice within one cycle, and can still ovulate up to three months before their final period. Though fertility is much lower in your 40s and 50s, you can still become pregnant until you have had one year without your period.

Therefore, you need to keep using contraception and protection for safe sex. The chance of pregnancy in women aged 45-49 years is estimated to be 2-3% per year. After the age of 50, it is less than 1%. While this is low, every woman’s fertility is different.

"So many women I've talked to see menopause as a blessing. I've discovered that this is your moment to reinvent yourself after years of focusing on the needs of everyone else."

-Oprah Winfrey


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