Perimenopause

Diagnosis

Perimenopause is a gradual transition, and there is no single test or symptom that confirms its onset. Healthcare professionals evaluate several factors, including age, menstrual history, and the presence of symptoms or bodily changes.

Hormone tests may sometimes be ordered to check levels, but except for thyroid testing—which can affect hormone balance—these tests are generally not helpful because hormone levels fluctuate unpredictably during perimenopause.

Treatment

Treatment for perimenopausal symptoms often involves medicines to manage specific concerns.

• Hormone therapy. Systemic estrogen therapy treats the whole body and is effective for hot flashes and night sweats. It is available as pills, patches, sprays, gels, or creams. If you still have a uterus, progestogen is added to estrogen therapy. Systemic estrogen may help prevent bone loss but carries risks such as stroke, blood clots, and breast cancer.

• Vaginal estrogen. Delivered via a vaginal tablet, ring, or cream, it releases a small amount of estrogen locally. This helps relieve vaginal dryness, pain during sex, and some urinary symptoms, and may help prevent urinary tract infections.

• Antidepressants. Selective serotonin reuptake inhibitors (SSRIs) can reduce hot flashes and may be useful for women who cannot take estrogen or need treatment for mood disorders.

• Fezolinetant. A non-hormonal medicine that helps relieve hot flashes by blocking a brain pathway that regulates body temperature.

• Oxybutynin. Primarily used for overactive bladder and urinary leakage, it can also help manage hot flashes.

• Gabapentin. Typically used for seizures or pain, gabapentin may reduce hot flashes and is an option for women who cannot use estrogen or have issues with sleep, pain, or migraines.

Before starting any treatment, discuss options, benefits, and risks with your healthcare professional. Regular check-ins are important to ensure the treatment remains suitable as your symptoms and needs evolve.