Understanding Perimenopause

  • Perimenopause begins while women continue to have regular periods
  • Estradiol levels are erratically higher and poorly suppressible, rather than dropping
  • Ovulation may occur but is often inadequate, with low progesterone levels
  • Prospective clinical observations indicate that cyclic oral micronized progesterone is effective for many symptoms, but controlled trials are needed

Of all perimenopausal women, 80 to 85% will be fine with information and reassurance; however, vocational and social support and appropriate medical therapy are needed for the 15 to 20% of women who have the highest estrogen levels and are very symptomatic.

Any three of the following can be used to define perimenopause:

  • New heavy and/or longer menstrual flow
  • Shorter menstrual cycle length (less than or equal to 25 days)
  • New sore, swollen, and/or lumpy breasts
  • New or increased menstrual cramps
  • New mid-sleep wakenings
  • Onset of night sweats, especially around flow
  • New or markedly increased migraine headaches
  • New or increased premenstrual mood swings
  • Notable weight gain without changes in exercise or food intake
Taken from “Estrogen Errors” by Jerilynn C. Prior, MD