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Many of us know about menopause; it marks the end of the reproductive journey for a woman. But do you know about the final leg towards it, the transition? Perimenopause is the transitory period of menopause. It is a milepost when the path towards the final menstrual period begins. This menopausal transition is marked by extreme changes in hormonal levels, changes that wreak havoc on the female body. The average age of menopause is between 45 to 52 years old; perimenopause can begin ten years before the final menstrual period.

Perimenopause is divided into two stages, early and late. During the early stage, there is an increase in Follicle Stimulating Hormones (FSH), which results in shorter intervals between the menstrual cycles. The rapid decline in estrogen marks the late stage. During this stage, the menstrual cycles become progressively irregular with longer intervals in between. The fall in estrogen levels is responsible for most of the symptoms experienced by women in perimenopause or menopause.

The symptoms of perimenopause are:

  • Changes in the menstrual cycle, heavier periods, longer intervals between cycles

  • Vasomotor symptoms: hot flashes and night sweats

  • Vaginal dryness and pain during sex

  • Fatigue, pain in muscles and joints

  • Dizziness, headache, palpitations

  • Changes in the skin: dryness, itchiness, hair loss or thinning

  • Depression and anxiety: perimenopausal women are more likely to experience depression than premenopausal women.

  • Insomnia: insomnia is more prevalent in women going through this transition

  • Worsening of Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD)

Most of the symptoms of perimenopause are that of menopause. However, owing to whatever estrogen remains, these symptoms are mild and less severe during the transitory period. Regardless of the inevitable fall of estrogen, there are ways to reduce the severity of symptoms or even deal with them before they manifest. Consuming a healthy balanced diet and maintaining a normal body weight reduces the severity of vasomotor symptoms. Avoiding or quitting cigarette smoking before perimenopause will lower the severity of symptoms. Vitamins also aid in easing the symptoms of perimenopause. Vitamin E reduces vasomotor symptoms and improves the quality of sleep. Vitamin D and calcium prevent bone loss and also reduce the risk of osteoporosis. Vitamins B, C, and zinc support healthy skin and hair. And magnesium lowers mood symptoms, especially in those women who experienced PMS in their earlier years.

Hormone Replacement Therapy (HRT) is commonly prescribed to manage the symptoms of perimenopause. Bioidentical hormones are a natural plant-derived alternative to HRT. These hormones contain naturally occurring hormones that mimic the action of endogenous hormones. They restore the levels of estrogen and decrease the symptoms of perimenopause and menopause. However, not every woman is well-suited for hormonal therapy; therefore, risk factors and contraindications should be assessed before initiating therapy.

Menopause is unavoidable, and the travels towards it is not an easy one either. What is within one's control is how we can reduce the rigors of this experience. It is necessary to be aware of the changes our bodies undergo when hormonal levels fluctuate. By being aware of the impending circumstances, one can reduce their risk of experiencing them and live a good quality of life.


1) Hoyt LT, Falconi AM. Puberty and perimenopause: reproductive transitions and their implications for women's health. Soc Sci Med. 2015 May;132:103-12. doi: 10.1016/j.socscimed.2015.03.031. Epub 2015 Mar 14. PMID: 25797100; PMCID: PMC4400253.

2) Delamater L, Santoro N. Management of the Perimenopause. Clin Obstet Gynecol. 2018 Sep;61(3):419-432. doi: 10.1097/GRF.0000000000000389. PMID: 29952797; PMCID: PMC6082400.

3) Santoro N. Perimenopause: From Research to Practice. J Womens Health (Larchmt). 2016 Apr;25(4):332-9. doi: 10.1089/jwh.2015.5556. Epub 2015 Dec 10. PMID: 26653408; PMCID: PMC4834516.

4) Li, R. X., Ma, M., Xiao, X. R., Xu, Y., Chen, X. Y., & Li, B. (2016). Perimenopausal syndrome and mood disorders in perimenopause: prevalence, severity, relationships, and risk factors. Medicine, 95(32), e4466.

5) Anderson DJ, Chung HF, Seib CA, Dobson AJ, Kuh D, Brunner EJ, Crawford SL, Avis NE, Gold EB, Greendale GA, Mitchell ES, Woods NF, Yoshizawa T, Mishra GD. Obesity, smoking, and risk of vasomotor menopausal symptoms: a pooled analysis of eight cohort studies. Am J Obstet Gynecol. 2020 May;222(5):478.e1-478.e17. doi: 10.1016/j.ajog.2019.10.103. Epub 2019 Nov 6. PMID: 31705884; PMCID: PMC7196035.


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