Medically Reviewed by Traci C. Johnson, MD on September 02, 2020

What Is It?

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Perimenopause is when your body makes less and less of the hormones that control your period -- estrogen and progesterone. Many factors play a role in whether or not your provider will recommend hormone replacement therapy such as estrogen and/or progesterone. Once you've missed your period 12 months in a row, you've likely hit menopause and no longer can get pregnant. But how do you know when you're in perimenopause?

Changes in Your Period

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They may be light or very heavy, long or short. You may skip some altogether. If you go more than 60 days between periods, you may be near the end of perimenopause. Low-dose birth control pills can keep you more regular and may help with other symptoms too. 

Heavy Bleeding

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If your periods are heavier, it may be because the lining of your uterus is thicker before it's shed. This is caused by a drop in the hormone progesterone. It also may make other issues, such as fibroids (growths in the wall of your uterus), worse.

Hot Flashes

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You suddenly get flushed and sweat for 5 to 10 minutes. Some women get slightly warm while others are drenched in sweat. When they wake you in the wee hours of the morning, they're called night sweats. Deep-breathing exercises may help. You also can try to avoid triggers -- warm temperatures, hot drinks, spicy food. You can try black cohash or add soy to your diet, as a natural source of estrogen. Talk to your doctor about medications for moderate-severe symptoms. 

Vaginal Dryness

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Because you have less estrogen, your tissue may become thinner and drier. This can cause itching, soreness, and pain during sex -- all of which can make you less frisky. Regular sex can help keep that tissue toned and healthy. Talk to your doctor about other medication options.

Sleep Problems

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Changes in your hormones and night sweats can wreak havoc with your rest. Good habits, such as a regular schedule and giving yourself time to fall asleep, can help. Talk to your doctor for options for more severe symptoms. 

Mood Changes

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Some women swing from high highs to low lows during perimenopause thanks, at least in part, to their changing hormones. And it can be worse if you have trouble sleeping. Women who had severe PMS symptoms may have more serious mood changes during this time as well. Some suggestions: Set priorities, and get out and do things you enjoy.


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Changes in your hormones, along with other symptoms of perimenopause (mood swings and sleep problems), may make it a little harder to remember things. You might lose your keys more often, forget some appointments, or have trouble focusing. It probably will get better once you’re past menopause.  

Bone Loss

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If you're in perimenopause, your levels of estrogen are dropping, and that means you could lose bone more quickly. Your doctor can use a special kind of X-ray to check. To stay as strong as possible, get plenty of calcium and vitamin D, and walk or lift weights for 20 minutes a day. Your doctor also may prescribe medication.

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