Perimenopause (premenopause)

Perimenopause is the phase before menopause actually takes place, when ovarian hormone production is declining and fluctuating, causing a host of symptoms.

Some clinicians maintain that perimenopause can last for as long as 5 to 15 years, and refer to perimenopause as that period which is a 3 to 4 year span just before menopause. Either way, many women experience more symptoms during perimenopause than after menopause. Because this often happens at an age between 35 and 45, many women's symptoms are overlooked or ignored by their healthcare providers.

Most premenopausal women experience changes in their menstrual cycle. When estrogen levels begin to drop, the follicular phase of the cycle may be shortened, and this can shorten the total cycle from 28–30 days to 24–26 days, resulting in more frequent periods. On the other hand, some women begin having longer cycles because they are not ovulating as frequently. These changes can be quite different on an individual basis. Additionally, this declining/fluctuating estrogen level can produce a host of disturbing symptoms: hot flashes, increasing vaginal dryness, sleep problems, mood swings, breast tenderness and many other complications.

Many clinicians believe this is a perfect time to begin judicious estrogen/progesterone/testosterone therapy because then the hormone supplements do not create an excess, but are simply replacing a failing internal supply.

There is a relatively small number of women who hardly notice any changes before menopause. Their periods just stop overnight with few, if any, symptoms.

Another small percentage of women experience significant, dramatic symptoms that, when left untreated, ultimately lead to surgical intervention. Many women find at this time too many physicians strongly urging surgery and failing to provide information about the alternatives to, and consequences of, hysterectomy.