Perimenopause Symptoms & Treatments


Most women tend to look away from what’s coming – menopause. We may think that it’s something older women deal with, but actually, it starts earlier than you may think during the transitional period called “perimenopause.”

In this article we are going to fill you in on the details of perimenopause – the symptoms to look for and the treatments available to reduce the discomfort of perimenopause and improve your overall health.

First of All … What Is Perimenopause? 

Perimenopause is the gradual transition between the reproductive years and menopause. The word itself literally means, “around menopause,” indicating how varied this transition is for women.  For some, this transition is many years long and is associated with shorter menstrual intervals, irregular menses, night sweats, and other symptoms of perimenopause. For others, perimenopause may last only a few months, but, on average, the length of perimenopause for women is four years and ends when a woman has not had a period for twelve months.

And What Is Menopause?

Menopause is the natural decline in reproductive hormones, starting typically for most women in their 40s or 50s. A woman is diagnosed as being in menopause when 12 months have passed since her last menstruation.

Not certain you are in menopause? Sometimes a woman’s medical history may blur the certainty. In these cases, Dr. Fliedner will recommend some simple lab tests to confirm the diagnosis of menopause. Lab results indicating an elevated follicle stimulating hormone (FSH) and low estrogen (estradiol) are consistent with menopause. It is important to report any hormonal therapy, such as birth control pills before taking a lab test, as these alter hormone levels and will deliver an inaccurate result. You want to test your body’s hormone levels free from outside hormonal treatments.

What’s the Difference Between Perimenopause and Menopause?

To be clear, perimenopause is defined as a transitional phase that ends in menopause, which is the phase a woman enters when she has had no menstrual cycle for a full 12 months.

What Triggers Perimenopause?

As a woman ages, her body begins the natural progression from the fertile years to the non-fertile years. Her ovaries initiate this process by producing less estrogen in preparation to ending the release of eggs entirely. The body is preparing to transition to menopause when no more eggs are released and a woman loses the ability to get pregnant. It’s a natural and beautiful progression in a woman’s reproductive life.

At What Age Does Perimenopause Begin?

Most women begin perimenopause in their mid-40s, but some can start earlier. Entering menopause before age 40 is called premature menopause. Some medical conditions or procedures will trigger early menopause. If no medical or surgical cause exists, primary ovarian insufficiency will bring on premature menopause.

What are the Hormonal Changes during Perimenopause?

Two hormones, estrogen, and progesterone, are primarily responsible for ovulation, menstruation, and the maintenance of a balanced reproductive system. Declining levels of estrogen trigger most of the hormonal changes that women experience during perimenopause. Because these two hormones work together to keep a woman’s body in hormonal balance, the decrease in the production of estrogen causes an imbalance with its relationship to progesterone. The result is perimenopause can be likened to a hormonal roller coaster due to the rapidly fluctuating hormones. 

What Are The First Signs Of Perimenopause?

Generally, most women notice the first sign of perimenopause when they experience irregular periods. Menstrual cycles change from being fairly predictable to becoming unpredictable. Many women are awakened at night by night sweats or experience hot flashes and vaginal dryness (vaginal atrophy) fairly early into the menopause transition.

Symptoms Of Perimenopause

  • Hot flashes. Hot flashes are sudden feelings of heat, often accompanied by sudden sweating and a red, flushed face. The intensity, length, and frequency vary. When hot flashes occur at night, we refer to them as “night sweats.”
  • Breast tenderness. Hormonal fluctuations contribute to breast tenderness and soreness. 
  • Decreased libido. During perimenopause, sexual arousal and desire may change. Decreased estrogen levels dampen sexual arousal and decrease libido
  • Fatigue. Fluctuating hormones and sleepless nights during perimenopause contribute to fatigue.
  • Irregular periods. As ovulation becomes more unpredictable, a woman’s periods become irregular during perimenopause. The length of time between periods may be longer or shorter; the flow may be light to heavy; spotting may occur between periods, or periods may be skipped altogether. If you have a persistent change of seven days or more in the length of your menstrual cycle, you may be in early perimenopause. If you have a space of 60 days or more between periods, you’re likely in late perimenopause.
  • Vaginal dryness. Estrogen is responsible for maintaining a healthy vagina. When estrogen decreases, vaginal dryness occurs.
  • Urine leakage. When coughing or sneezing, a woman may experience urine leakage. This happens because the lining of a woman’s urethra, the tube that empties urine from the bladder, begins to thin, and the pelvic floor, the group of muscles that supports both the urethra and bladder, weakens.
  • Vaginal problems. When estrogen levels diminish, vaginal tissues lose lubrication and elasticity, making intercourse painful. Low estrogen may also lead to urinary or vaginal infections. 
  • Mood swings. Psychology Today reports that “23 percent of women will experience mood swings” during perimenopause.
  • Loss of bone density.  The National Institutes of Health reports, ”The loss of ovarian function during the menopausal transition has a profound impact on female skeletal health.”
  • Sleep disorders. Sleep disorders are often due to night sweats, but sometimes sleep becomes unpredictable due to depression and anxiety during the transition.

How Is Perimenopause Diagnosed?

An attentive ob-gyn can make the diagnosis of perimenopause based on a discussion of your health symptoms. He can also administer a blood test to check hormone levels.  Because hormone levels are constantly changing during perimenopause, taking a few blood tests at different times of the month may help for comparison. Contact our office to schedule an exam.

Treatments For The Symptoms Of Perimenopause

Many women begin finding relief by making simple changes in their lifestyles. The list below offers some practical suggestions that will immediately enhance your overall well-being and will help dampen the symptoms of perimenopause:

  • Begin exercising. This can start with walking in your neighborhood or joining a local yoga class.
  • Stop smoking. Many great resources exist to help individuals stop smoking.
  • Get more sleep. Practice going to sleep and waking up at the same time each day. Use your mobile phone to help you, or try an app such as Calm to help you fall asleep.
  • Drink less alcohol.
  • Get to a healthy weight and stay there. In her book, If You Ask Me, Betty White, who lived a couple of weeks shy of 100 years old said that she weighed herself daily to be sure she didn’t gain weight. Perhaps a key to longevity, too!
  • Add 1000 grams of calcium to your daily diet.
  • Ask your doctor to prescribe a multivitamin.

BHRT Treats The Symptoms Of Perimenopause

BHRT has been shown to restore hormonal balance and reverse the effects of perimenopause.

According to The North American Menopause Society, “Medical organizations devoted to the care of menopausal women agree that there is no question that hormone therapy has an important role in managing symptoms for healthy women during the menopause transition [perimenopause] and in early menopause.”

In addition to treating the symptoms of perimenopause, BHRT has been shown to support women’s health by preventing many resulting diseases which occur from hormonal imbalance, such as heart disease, diabetes, osteoporosis, post-traumatic stress disorder (PTSD), and thyroid disorders.

To learn more about the benefits of BHRT read Dr. Fliedner & BioTE Hormone Therapy,  and What Are Bioidentical Hormones? 

As a board-certified ob-gyn and bioidentical hormone specialist, Dr. Thomas Fliedner has spent his career successfully treating patients with BHRT to restore hormonal deficiencies and improve life during perimenopause and after.

North Texas Vitality Brings Hope

You don’t need to walk this journey alone, and we are here to help. 

Dr. Fliedner and his team will walk alongside you, as they have with so many other women who have faced perimenopause and hormonal imbalances.

A patient Heather writes, 

“Dr. Fliedner is absolutely wonderful! He is kind, gentle, and caring for his patients. We discussed pellets, and I tried a round and was able to tell within a few weeks that it was working. I have more energy, sleep better, and overall feel amazing! I highly recommend Dr. Fliedner to everyone!”

At North Texas Vitality, you will receive personal attention and customized hormone replacement therapy. Dr. Fliedner will review your medical history and run advanced lab tests to determine your hormone levels. Upon receiving lab results, Dr. Fliedner will develop a custom hormone therapy to replace just what your body is missing.

North Texas Vitality offers a variety of BHRT therapies, including creams, pills, injections, or BioTE pellets. Dr. Fliedner prescribes only natural bioidentical hormones, which are identical to those produced by your body and are more readily acceptable.  

Call North Texas Vitality at 469-455-1665 or schedule your appointment online

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