‘The Change’ Begins: Navigating through Perimenopause

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Menopause doesn’t happen all at once. There’s a transitional phase as your body moves into menopause called perimenopause. This phase can last anywhere from two to 10 years, with changes that range from barely noticeable to severe.

Amanda Fox,CNP, Dulan and Moore Dulan Family Wellness Center, talks about perimenopause and what to expect.

Click play to watch the video or read the transcript.

What is perimenopause and at what age does a women experience it?

Perimenopause is the transition between where a woman is going into menopause. The transition typically starts between the early 40s. Some women do experience it in the late 30s, so there's a lot of signs and symptoms involved to know if you're entering into perimenopause. The biggest sign that women tend to complain about is hot flashes, insomnia, irregular periods, low sex drive, that’s just to name a few. There's a lot of hormonal imbalances that women go through that time. So the way to know that you're going out of perimenopause is no periods or no menstrual cycles for one year and at that point you have considered to cross the finish line - you're in menopause at that point.


As you enter your 30s and 40s, the amount of estrogen your ovaries produce begins to fluctuate. Although you may not experience any signs of perimenopause, here are some common changes that occur during this phase of life:

  • Menstrual cycles may become irregular and bleeding may become lighter or heavier.
  • Hot flashes produce a rush of heat to your upper body and face. They may last a few seconds or several minutes and occur during the day or at night.
  • Vaginal dryness due to decreased levels of estrogen can cause pain during sex, and vaginal infections may occur more frequently. Creams or pills may help relieve this dryness.
  • Urinary tract changes also can occur from dropping estrogen levels. The urethra, the tube which carries urine from the bladder out of the body, may become irritated, dry or swollen. The result may be more frequent urination and increased risk of urinary tract infections.
  • Reduced bone density may occur from decreased estrogen and increase your risk of osteoporosis. Bone loss most frequently happens in your hips, wrists and spine.
  • Sleep issues may develop during perimenopause, including trouble falling asleep (insomnia) or staying asleep. Night sweats (hot flashes) may also interfere with sleep and leave you feeling tired and de-energized during the day.
  • Breast changes, including breast tenderness or fullness, may become unpredictable as your cycle changes.
  • Mood swings are not uncommon in men or women during mid-life. Generally, they are more connected to life transitions than to hormone changes.

What To Do for Your Good Health

Talk with your doctor about changes you are experiencing and concerns you have. Over-the-counter products, medications and natural remedies are available for many of these issues.

Your doctor may prescribe hormone therapy for hot flashes, night sweats, bone protection or other symptom relief. This can be taken as a pill, skin patch, or a gel or spray applied to your skin. Hormone therapy may increase your risk of certain types of cancer and other conditions, so you’ll want to discuss the potential benefits and risks with your health care provider.

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In addition, a well-balanced diet and regular exercise will help you sleep better and boost your mood and energy level. Relaxation techniques such as yoga and meditation also may be beneficial to your overall health and well-being.

Plants and herbs including black cohosh, soy and Chinese herbs are used by some women to relieve perimenopausal symptoms, but conclusive studies have not determined their effectiveness. Because these products are not closely regulated, there may be concern about their quality.

Birth Control Still Needed

Birth control is still necessary during perimenopause. Women in their early to mid-40s ovulate and may become pregnant despite erratic cycles. For some women, sexual desire may decrease during perimenopause. Often, this is not due to physical changes. If you do have physical changes such as vaginal dryness, there are effective treatments to relieve dryness.

Talk with your doctor about changes you are experiencing and concerns you have.

Heart disease is a concern during menopause as the protection estrogen provides against heart attacks and stroke diminishes. Risk factors for heart disease also increase with aging, such as high cholesterol, high blood pressure and a more sedentary lifestyle.

Perimenopause is a great time to pay attention to your body and make a renewed commitment to live well and take good care of yourself. Get regular health care checkups and ask about screenings such as mammograms that guard against breast cancer and DEXA scans that measure bone density.

It's easy to get the care you need.

See a Premier Physician Network provider near you.

Small Steps: Quit Smoking.
Smoking may trigger hot flashes, weakens bones, and can irritate your bladder, which may become more sensitive during menopause.