Menopause and Perimenopause

Menopause usually develops gradually over time. The months or years leading up to menopause are known as perimenopause, or the menopausal transition.

Hormonal fluctuations during this time may cause symptoms such as:

• Difficulty concentrating or remembering words, often called brain fog
• Hot flashes
• Irregular menstrual periods
• Mood changes
• Night sweats
• Sleep difficulties
• Vaginal dryness

Menopause symptoms vary from person to person. Changes in your menstrual cycle are common before periods stop completely.

Missing a period during perimenopause is normal. You might skip a month and then have a period again or miss several months before regular cycles briefly return. Early in perimenopause, cycles often become shorter, with periods closer together. As menopause approaches, periods typically occur farther apart before stopping altogether.

Pregnancy is still possible during this time. If you’ve missed a period and aren’t sure whether menopause is the cause, consider taking a pregnancy test.

Many people recognize the start of perimenopause based on their symptoms alone. Changes like irregular periods, hot flashes, or sleep issues are often enough to signal what’s happening. If you have questions or concerns about your symptoms, it’s a good idea to talk with your healthcare provider.

In most cases, tests aren’t needed to confirm menopause. Because hormone levels can fluctuate a lot during perimenopause, test results don’t always give a clear answer. Following menopause (12 consecutive months without a menstrual period), any vaginal bleeding should be discussed with your healthcare provider.

Perimenopause and menopause can lead to a broad and variable range of symptoms. The shift in hormones can affect sleep, mood, cognition, sexual intimacy, and lead to hot flashes and bladder symptoms. One or more of the following may be recommended:

• Hormone therapy (HT) – can help relieve symptoms of perimenopause and menopause by providing estrogen to supplement hormone levels. HT can vary and may include pills, skin patches, gels or sprays applied to the skin. Consultation with your healthcare provider is recommended to determine the benefit-risk balance for HT and for individualized treatment recommendations.
• Non-hormonal treatments – medications, such as antidepressants and other newer medications (NK3 receptor antagonists), can help with menopause symptoms such as hot flashes and sleep disturbance.