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Draft:Perimenopause

From Wikipedia, the free encyclopedia
  • Comment: The bulk of the sourcing here is primary research, albeit off longitudinal databases, which is problematic under WP:MEDRS. Not all of it is primary, so Santoro (2016) is a meta review, whereas Reed 2014 is presenting the read out of data based on a survey conducted by the team. So this draft draws too heavily on primary research, and insufficent use made of secondary / meta / systematics / reviews of existing research. ChrysGalley (talk) 11:33, 3 June 2026 (UTC)



Perimenopause is the phase during which the ovaries gradually reduce their hormonal activity, a period of physical and psychological changes preceding menopause. It begins with a persistent difference of more than seven days in the length of consecutive menstrual cycles and it ends after the occurrence of one year of amenorrhea, when menopause is reached.[1][2] The fluctuating hormone levels, particularly variations in the level of circulating estrogen, can cause a wide range of symptoms, including heavy and irregular bleeding, mood and memory changes, decreased libido, vasomotor symptoms and genitourinary symptoms.[1][3] Perimenopause is a normal part of reproductive aging rather than a disease, although clinically significant symptoms may be coded under ICD-10 (N95.8) or ICD-11 (GA30).[4]

Signs and symptoms

[edit]

The most commonly reported symptoms include hot flashes, sleep changes, vaginal dryness, and adverse mood. While these are the most commonly discussed perimenopausal symptoms, women may experience many others, and the type and severity of symptoms vary widely among individuals.

Hot flashes and night sweats

[edit]

Hot flashes, also known as vasomotor symptoms, one of the most common symptoms of perimenopause, are experienced by 30%-70% of perimenopausal women.[5][2][6] Women who have experienced hot flashes in their earlier stage of perimenopause tend to have them for a longer total duration.[5][7]

Sleep changes

[edit]

Sleep changes are another perimenopausal symptom that can affect the quality of life of women in their early perimenopausal stage.[8][9] Studies indicate, that insomnia is more common during perimenopause than before it.[8] Although women begin to notice sleep changes in their 40s, it becomes worse with the menopausal transition.[2] However, there is no clear consensus on whether these changes in sleep pattern are directly related to menopause or due to estrogen withdrawal or other hormonal changes, or simply related to ageing.[2] The hot flashes at night are one cause of sleep disturbance.

Vaginal dryness

[edit]

Although vaginal dryness or dyspareunia is a common issue reported among postmenopausal women, women in their perimenopausal stage also experience vaginal dryness, even though the estrogen levels are not consistently low as in postmenopause.[10][11] Unlike hot flashes and adverse moods, vaginal dryness and sleep difficulties are less likely to get better without ongoing treatment.[2]

Adverse mood

[edit]

Adverse moods reported by women in the perimenopausal stage include depression (mood) and anxiety.[12][2][13] Studies show that anxiety symptoms mainly appear in the late phase of perimenopause[12] and may lead to the onset of depression.[14][12][15]

Several factors influence the prevalence of depressive symptoms among women in their perimenopausal stage. These factors include stressful life events, financial strain, low educational attainment, high BMI, and vasomotor symptoms.[15][13]

Further symptoms

[edit]
  • Reduced libido[1]
  • Cognitive complaints (e.g. "brain fog", memory lapses)[1]

Diagnosis

[edit]

Diagnosis is primarily clinical, based on age, symptom pattern, and changes in menstrual cyclicity. Hormonal blood tests (such as FSH or estradiol) are generally unreliable for diagnosis in women over 45 with typical symptoms, as hormone levels fluctuate substantially from day to day and even within a single cycle, limiting their diagnostic value.[4][1]

Management

[edit]

Menopausal hormone therapy is commonly used as a treatment for women who experience symptoms of perimenopause such as hot flashes, sleep disturbance, vaginal dryness and mood changes, and can improve the quality of life.[2][1][16] However, most evidence on hormone therapy derives from postmenopausal populations, and it has not been specifically optimised for perimenopause.[17] Women who experience irregular bleeding may benefit from oral contraceptives, which can also provide contraception, since pregnancy can occur during perimenopause.[1]

Non-hormonal pharmacological options

[edit]
  • SSRIs and SNRIs for mood symptoms and hot flashes
  • Gabapentin and clonidine for vasomotor symptoms
  • NK3 receptor antagonists (e.g. fezolinetant), a newer targeted class for hot flashes[18]

Non-pharmacological approaches

[edit]

Society and culture

[edit]

Historically, there has been limited public and clinical information about menopause and the perimenopausal transition, and awareness of perimenopause specifically remains low, although it is a life stage that all women who reach midlife will eventually go through.[20][21]

Public discussion has expanded in recent years, with growing attention to its impact on quality of life and on workplace participation.[22] Several countries and employers have begun introducing menopause-related workplace policies, including flexible working arrangements, and awareness training.[23]

References

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  1. ^ a b c d e f g Lega, Iliana C.; Jacobson, Michelle (2024-10-15). "Perimenopause". Canadian Medical Association Journal. 196 (34): E1169. doi:10.1503/cmaj.240337. ISSN 0820-3946. PMC 11482657. PMID 39406411.
  2. ^ a b c d e f g Santoro, Nanette (2016). "Perimenopause: From Research to Practice". Journal of Women's Health. 25 (4): 332–339. doi:10.1089/jwh.2015.5556. ISSN 1540-9996. PMC 4834516. PMID 26653408.
  3. ^ Davis, Susan R.; Lambrinoudaki, Irene; Lumsden, Maryann; Mishra, Gita D.; Pal, Lubna; Rees, Margaret; Santoro, Nanette; Simoncini, Tommaso (2015-04-23). "Menopause". Nature Reviews Disease Primers. 1 (1) 15004. doi:10.1038/nrdp.2015.4. ISSN 2056-676X. PMID 27188659.
  4. ^ a b "Menopause: identification and management". www.nice.org.uk. 2015-11-12. Retrieved 2026-06-02.
  5. ^ a b Avis, Nancy E.; Crawford, Sybil L.; Greendale, Gail; Bromberger, Joyce T.; Everson-Rose, Susan A.; Gold, Ellen B.; Hess, Rachel; Joffe, Hadine; Kravitz, Howard M.; Tepper, Ping G.; Thurston, Rebecca C. (2015-04-01). "Duration of Menopausal Vasomotor Symptoms Over the Menopause Transition". JAMA Internal Medicine. 175 (4): 531–539. doi:10.1001/jamainternmed.2014.8063. ISSN 2168-6106. PMC 4433164. PMID 25686030.
  6. ^ Sarri, G; Pedder, H; Dias, S; Guo, Y; Lumsden, Ma (2017-05-11). "Vasomotor symptoms resulting from natural menopause: a systematic review and network meta-analysis of treatment effects from the National Institute for Health and Care Excellence guideline on menopause". BJOG: An International Journal of Obstetrics & Gynaecology. 124 (10): 1514–1523. doi:10.1111/1471-0528.14619. ISSN 1470-0328. PMID 28276200.
  7. ^ Freeman, Ellen W.; Sammel, Mary D.; Lin, Hui; Liu, Ziyue; Gracia, Clarisa R. (2011). "Duration of Menopausal Hot Flushes and Associated Risk Factors". Obstetrics & Gynecology. 117 (5): 1095–1104. doi:10.1097/AOG.0b013e318214f0de. ISSN 0029-7844. PMC 3085137. PMID 21508748.
  8. ^ a b Crandall, Carolyn J.; Mehta, Jaya M.; Manson, JoAnn E. (2023-02-07). "Management of Menopausal Symptoms: A Review". JAMA. 329 (5): 405–420. doi:10.1001/jama.2022.24140. ISSN 1538-3598. PMID 36749328.
  9. ^ Troìa, Libera; Garassino, Martina; Volpicelli, Agnese Immacolata; Fornara, Arianna; Libretti, Alessandro; Surico, Daniela; Remorgida, Valentino (2025-02-23). "Sleep Disturbance and Perimenopause: A Narrative Review". Journal of Clinical Medicine. 14 (5): 1479. doi:10.3390/jcm14051479. ISSN 2077-0383. PMC 11901009. PMID 40094961.
  10. ^ Santoro, Nanette; Komi, Janne (2009-08-01). "Prevalence and Impact of Vaginal Symptoms Among Postmenopausal Women". The Journal of Sexual Medicine. 6 (8): 2133–2142. doi:10.1111/j.1743-6109.2009.01335.x. ISSN 1743-6109. PMID 19493278.
  11. ^ Mark, J. K. K.; Samsudin, S.; Looi, I.; Yuen, K. H. (2024-05-03). "Vaginal dryness: a review of current understanding and management strategies". Climacteric. 27 (3): 236–244. doi:10.1080/13697137.2024.2306892. ISSN 1369-7137. PMID 38318859.
  12. ^ a b c Bromberger, Joyce T.; Kravitz, Howard M.; Chang, Yuefang; Randolph, John F.; Avis, Nancy E.; Gold, Ellen B.; Matthews, Karen A. (2013). "Does risk for anxiety increase during the menopausal transition? Study of Women's Health Across the Nation". Menopause. 20 (5): 488–495. doi:10.1097/gme.0b013e3182730599. ISSN 1072-3714. PMC 3641149. PMID 23615639.
  13. ^ a b Hogervorst, Eef; Craig, Jen; O'Donnell, Emma (2021-11-30). "Cognition and mental health in menopause: A review". Best Practice & Research Clinical Obstetrics & Gynaecology. 81: 69–84. doi:10.1016/j.bpobgyn.2021.10.009. PMID 34969617.
  14. ^ Kravitz, H. M.; Schott, L. L.; Joffe, H.; Cyranowski, J. M.; Bromberger, J. T. (2014). "Do anxiety symptoms predict major depressive disorder in midlife women? The Study of Women's Health Across the Nation (SWAN) Mental Health Study (MHS)". Psychological Medicine. 44 (12): 2593–2602. doi:10.1017/S0033291714000075. ISSN 0033-2917. PMC 4135380. PMID 24467997.
  15. ^ a b Bromberger, Joyce T.; Kravitz, Howard M. (2011). "Mood and Menopause: Findings from the Study of Women's Health Across the Nation (SWAN) over 10 Years". Obstetrics and Gynecology Clinics of North America. 38 (3): 609–625. doi:10.1016/j.ogc.2011.05.011. PMC 3197240. PMID 21961723.
  16. ^ Hickey, Martha; Szabo, Rebecca A; Hunter, Myra S (2017-11-23). "Non-hormonal treatments for menopausal symptoms". BMJ. 359 j5101. doi:10.1136/bmj.j5101. ISSN 0959-8138. PMID 29170264.
  17. ^ Delamater, Lara; Santoro, Nanette (2019-09-01). "Management of the Perimenopause". Clinical Obstetrics and Gynecology. 61 (3): 419–432. doi:10.1097/GRF.0000000000000389. ISSN 1532-5520. PMC 6082400. PMID 29952797.
  18. ^ a b North American Menopause Society (2023-06-01). "The 2023 nonhormone therapy position statement of the North American Menopause Society". Menopause (New York, N.Y.). 30 (6): 573–590. doi:10.1097/GME.0000000000002200. ISSN 1530-0374. PMID 37252752.
  19. ^ Mohebbi, Ramin; Shojaa, Mahdieh; Kohl, Matthias; von Stengel, Simon; Jakob, Franz; Kerschan-Schindl, Katharina; Lange, Uwe; Peters, Stefan; Thomasius, Friederike; Uder, Michael; Kemmler, Wolfgang (2023-02-07). "Exercise training and bone mineral density in postmenopausal women: an updated systematic review and meta-analysis of intervention studies with emphasis on potential moderators". Osteoporosis International: A Journal Established as Result of Cooperation Between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. 34 (7): 1145–1178. doi:10.1007/s00198-023-06682-1. ISSN 1433-2965. PMC 10282053. PMID 36749350.
  20. ^ Ayers, Beverley; Forshaw, Mark; Hunter, Myra S. (2010). "The impact of attitudes towards the menopause on women's symptom experience: A systematic review". Maturitas. 65 (1): 28–36. doi:10.1016/j.maturitas.2009.10.016. PMID 19954900.
  21. ^ Wegrzynowicz, Andrea K.; Walls, Amanda C.; Godfrey, Myra; Beckley, Amy (2025-04-22). "Insights into Perimenopause: A Survey of Perceptions, Opinions on Treatment, and Potential Approaches". Women (Basel, Switzerland). 5 (1): 4. doi:10.3390/women5010004. ISSN 2673-4184. PMC 12014197. PMID 40264725.
  22. ^ Hickey, Martha; LaCroix, Andrea Z.; Doust, Jennifer; Mishra, Gita D.; Sivakami, Muthusamy; Garlick, Deborah; Hunter, Myra S. (2024-03-09). "An empowerment model for managing menopause". The Lancet. 403 (10430): 947–957. doi:10.1016/S0140-6736(23)02799-X. ISSN 0140-6736. PMID 38458214.
  23. ^ The Menopause Society (2024-09-01). "Menopause and the workplace: consensus recommendations". Menopause (New York, N.Y.). 31 (9): 741–749. doi:10.1097/GME.0000000000002415. ISSN 1530-0374. PMID 39186451.
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