What are the Symptoms of Peri-menopause

What is the Peri-menopause?

As women, our bodies go through dramatic changes as we age, and these changes are caused by our hormones. Perimenopause is the time of a woman’s life when her hormonal cycle slows, her fertility reduces, and periods become less common as she heads toward menopause. It can be a very stressful time because it affects her physical and emotional state.

To understand what causes the peri-menopause and how to best reduce the symptoms, it is important to appreciate the changes that occur in the female body during aging. There are four main stages in a woman’s hormonal life:


Puberty is the process of sexual maturation; it normally begins around the age of 11 and lasts for several years. Generally, it begins with breast development, followed by the growth of pubic hair and finally menstruation.

The Reproductive Years

The reproductive years begin with the onset of menstruation and persist until peri-menopause. They are characterized by the menstrual cycle, which controls a woman’s fertility. The menstrual cycle is primarily governed by fluctuations in the levels of the hormones that control ovulation and regulate the thickness of the uterine lining to prepare for the implantation of a possible fertilized egg.

  • The hypothalamus secretes gonadotropin hormone-releasing hormone (GnRH), which stimulates the pituitary gland to release follicle-stimulating hormone (FSH) and luteinizing hormone (LH).
  • FSH stimulates follicles in the ovaries to prepare an egg for maturation and release, which includes the secretion of estrogen to prepare the uterus for implantation.
  • LH triggers ovulation, or the release of an egg from the ovaries, which results in the production and release of progesterone and additional estrogen to prepare the body for fertilization and pregnancy [1].



Perimenopause occurs when a woman’s hormonal cycle transitions toward menopause and infertility begin. It often starts in women in their late-40’s and can last for up to 11 years; the average duration is ~4 years. During the peri-menopause, menses become less common and the symptoms typically associated with menopause (discussed below) begin.

The changes that occur during menopause are caused by altered hormone levels. A woman remains fertile only as long as her ovaries produce and secrete eggs via a process known as ovulation. Since there are a finite number of eggs, female fertility essentially has an expiration date. The production of estrogen and progesterone relies upon ovulation, which means that hormone production is diminished significantly once eggs are no longer released.

Hormonally, the peri-menopause is defined by persistently increased LH and FSH levels and very low estrogen and progesterone levels. Testosterone secretion can also decline by approximately 50% during peri-menopause [2].


Menopause officially starts one year after a woman’s last period. Menopausal women produce very high levels of FSH but low levels of estrogen and progesterone. They are no longer fertile and are at a higher risk of diseases such as osteoporosis and cardiovascular disease because of the reduced hormone concentrations [3].perimenopause

What are the Symptoms of Peri-Menopause?

The most common symptoms of peri-menopause (http://www.webmd.com/menopause/guide-perimenopause#2) are:

  • Hot flashes
  • Reduced sex drive
  • Discomfort and dryness during sex
  • Fatigue
  • Problems sleeping
  • Mood swings
  • Migraines
  • Severe premenstrual syndrome
  • Irregular periods
  • Breast tenderness
  • An urgent need to urinate
  • Urine leakage, particularly when sneezing or coughing

Because some of these symptoms can be caused by other hormone-related conditions, we always recommend getting your hormone levels checked to ensure that you receive an accurate diagnosis. If you visit AAI Rejuvenation Clinic with the above symptoms, we will measure the levels of your sex hormones as part of our work up. This will allow us to develop a specific program to make you feel like your old self.

Alleviate Your Symptoms with Hormone-Replacement Therapy (HRT)

Unfortunately, the transition from fertility to menopause is part of natural aging and it happens to all women. Although the symptoms of perimenopause can be severe, it is possible to reduce their severity and be able to function fully.

For many years, HRT was used to alleviate the symptoms of peri-menopause and reduce the risk of mortality, dementia, cardiovascular disease, and osteoporosis in aging women. Although a now-revised link to an increased risk of breast cancer led to a temporary decline in the use of HRT, it is again the number one treatment and disease-prevention strategy used in peri-menopausal and menopausal women [4].

As the name suggests, the aim of HRT is to replace the hormones no longer being produced naturally. The hormones are often delivered in tablet form, although transdermal Testosterone Patches, creams, Testosterone Gels, and implants can also be used. There are four major forms of HRT:

  • Estrogen alone
  • Estrogen and progesterone
  • Gonadomimetics, which contain estrogen, progesterone, and testosterone; an example is a tibolone
  • SERMs (selective estrogen receptor modulators)

Because HRT can restore your hormone levels to those you experienced when you were young, it can relieve your symptoms and also reduce the risk of diseases associated with low hormone levels such as osteoporosis and cardiovascular disease. Although some studies have suggested that HRT could protect against stroke, diabetes, cognitive aging, and mood, these effects are more controversial [5]. Nevertheless, the clinical evidence supporting the beneficial effects of HRT in cardiovascular disease and osteoporosis is convincing:

  • HRT reduces the risk of cardiovascular diseases. An evidence-based study investigated the evidence from randomized clinical trials and concluded that HRT could reduce the risk of mortality and cardiovascular disease in women within 10 years of the menopause aged <60 years [5]. However, there is evidence that HRT should be avoided in older women because it might increase the risk of coronary events [6].
  • HRT reduces the risk of osteoporosis. One of the best-known benefits of HRT is its ability to inhibit bone loss and reduce the incidence of fractures in perimenopausal women; estrogen therapy might be more effective than combined estrogen-progesterone treatment [7].

In addition to these clinical effects, HRT alleviates the symptoms of peri-menopause including skin and hair complaints and sexual symptoms [8], as well as hot flashes [9].

Measure your hormone levels today and find out if HRT could improve your day-to-day life.


  • [1] R.E. Jones, K.H. Lopez, Human reproductive biology, Academic Press2006.
  • [2] S.J. Richardson, The biological basis of the menopause, Bailliere’s clinical endocrinology and metabolism, 7 (1993) 1-16.
  • [3] L. Jia, H. Jin, J. Zhou, L. Chen, Y. Lu, Y. Ming, Y. Yu, A potential anti-tumor herbal medicine, Corilagin, inhibits ovarian cancer cell growth through blocking the TGF-beta signaling pathways, BMC complementary, and alternative medicine, 13 (2013) 33.
  • [4] R.A. Lobo, J.H. Pickar, J.C. Stevenson, W.J. Mack, H.N. Hodis, Back to the future: Hormone replacement therapy as part of a prevention strategy for women at the onset of menopause, Atherosclerosis, 254 (2016) 282-290.
  • [5] R. Sood, S.S. Faubion, C.L. Kuhle, J.M. Thielen, L.T. Shuster, Prescribing menopausal hormone therapy: an evidence-based approach, International Journal of Women’s Health, 6 (2014) 47-57.
  • [6] R.A. Lobo, Where are we 10 years after the Women’s Health Initiative?, The Journal of clinical endocrinology and metabolism, 98 (2013) 1771-1780.
  • [7] The 2012 hormone therapy position statement of The North American Menopause Society, Menopause (New York, N.Y.), 19 (2012) 257-271.
  • [8] D. Rouskova, K. Mittmann, U. Schumacher, H. Dietrich, T. Zimmermann, Effectiveness, tolerability and acceptance of an oral estradiol/levonorgestrel formulation for the treatment of menopausal complaints: a non-interventional observational study over six cycles of 28 days, Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology, 30 (2014) 712-716.
  • [9] N. Santoro, C.N. Epperson, S.B. Mathews, Menopausal Symptoms and Their Management, Endocrinology and metabolism clinics of North America, 44 (2015) 497-515.

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