Navigating the Perimenopause Transition

Perimenopause is often described as a "hormonal journey" that can feel unpredictable. While menopause is defined as one year without a menstrual period, and is a natural biological transition, the symptoms of perimenopause—which can last for five to ten years before menopause—can significantly impact a woman's quality of life.

For many, this phase brings changing periods, hot flashes, brain fog, weight gain around the midsection, altered sleep, and emotional changes like anxiety or irritability. The good news? You don't have to just "tough it out." If your symptoms are bothering you, it is time to have a conversation with your provider about a tailored treatment plan.

Understanding the shift

Perimenopause typically begins in the late 30s or 40s.  During this time, the ovaries' production of estrogen and progesterone begins to fluctuate. As a result, common symptoms of perimenopause include:

• Hot flashes
• Night sweats
• Difficulty sleeping
• Mood changes
• Vaginal dryness
• Not feeling like oneself 

Is there a test for perimenopause?

There is no one test or symptom to accurately rule in or rule out perimenopause. Your provider can diagnose perimenopause based on menstrual history, age, and symptoms. 

In early-stage perimenopause, there are subtle changes in the menstrual cycle. The number of days of bleeding may be fewer or greater than average and the blood flow may be heavier or lighter. Cycles also typically become shorter than usual, occurring every 21 days.

In late stage, there are longer gaps between periods, typically 60 days or more.

Do I still need birth control?

Yes. Fertility declines as the final menstrual cycle approaches, but ovulation (and pregnancy) can still occur until a woman reaches menopause.  A reliable method of birth control is recommended until menopause is reached to prevent unwanted pregnancies. 

What are treatment options?

• Oral Contraceptives: Often recommended to regulate hormones, reduce heavy or irregular periods, and manage hot flashes.
• Menopausal Hormone Therapy (MHT): Low-dose hormone therapy (estrogen and progesterone) can be a safe and effective way to alleviate severe symptoms, such as hot flashes and vaginal dryness.
• Progesterone IUD: Can be used in combination with estrogen to control menstrual cycles, prevent pregnancy and manage perimenopausal symptoms. 

When to see a provider

You should make an appointment if you are experiencing:

• Symptoms that disrupt your sleep or day to day activity.
• Periods that are consistently heavy or last longer than usual.
• Irritability, anxiety, or cognitive issues ("brain fog") that affect your daily life.

It is important to remember that perimenopause is a temporary, albeit challenging, phase. With proper care, you can manage the symptoms and maintain your quality of life.

Dr. Nicole Van De Velde is board-certified in Obstetrics & Gynecology. Clinical interests and special procedures include contraception counseling and management, abnormal uterine bleeding, infertility evaluation and treatment, menopausal and perimenopausal management, minimally invasive surgery, and robotic surgery.