There are different definitions of perimenopause, but all of them are usually the same in the opinion that perimenopause begins at the time of irregular periods—due to the deterioration of ovarian function—and ends a year after the last menstruation.

Every woman has perimenopause, and it varies for each individual. The average duration of this period is three to four years, although sometimes it can be only a few months or last a decade.

Some women during this period complain of hot flashes and are exhausted by abundant periods; in many, perimenopause occurs without any obvious symptoms.

Some may end their period suddenly, while others may have irregular menstruation for several years.


Most women believe that hot flashes do not appear before menopause. The tide, the short-term failure of thermoregulation is a characteristic symptom of perimenopause. Sudden bouts of heat last from one to five minutes. The intensity of sudden tides can range from a mild sensation of heat to a feeling of heat coming from within.

At high tide, a woman blushes her face and the upper half of her body, which can include sweat, chills and sometimes confusion. Such manifestations of tides at the most inopportune time (during a performance, interview, or romantic meeting) can greatly annoy a woman. The frequency of hot flashes is also different: in some women they happen several times a week; others have hot flashes up to ten times a day and at night.

In most women, hot flashes occur when approaching menopause. But that’s not a universal feature.

Although the physiology of tides has been studied for more than thirty years, no one can say with certainty why and how they occur. The hormone estrogen is used in the process of hot flashes: it maintains a normal body temperature. If its level is reduced, it may be disrupted by thermoregulation. Estrogen therapy relieves the symptoms of hot flashes. But that’s not all!

For example, researchers found that women with this symptom and without it have no difference in estrogen levels. Better understanding of the causes of perimenopause can open the way to new, non-hormonal treatments. Also, hormone therapy relieves hot flashes, but it is not free from side effects.

In thirty-five to forty years, the female body reduces the production of progesterone. The number and quality of follicles is also reduced, which is the reason for the decrease in estrogen production and the amount of ovulation. As a result, by the age of forty, the duration of the cycle and the intensity of the monthly menstruation can vary and become irregular.

Estrogen levels can plummet, or they may rise dramatically. Over time, follicle-stimulating hormone (FSH) levels increase in a vain attempt to stimulate the ovaries to produce more estrogen.

Although high FSH rates can be a signal of the onset of perimenopause, it is impossible to focus only on the level of FSH. It is not a reliable indicator, as its level can change dramatically day by day.


It is difficult to distinguish between the symptoms of perimenopause caused by changes in hormonal background and symptoms of a more general nature, which are determined by age or life events, such as children leaving from home, changes in interpersonal relationships or professional careers, or death or illness of parents.

Given the full spectrum of perimenopause traits, it is unlikely that they depend only on hormonal changes.

  • hot flashes and night sweats: It is estimated that 35-50% of women during perimenopause suffer from sudden high tides, which are accompanied by sweating and a feeling of heat, which can last up to five to ten minutes, both at night and during the day. They usually start with the upper body: head, face, neck, chest.
  • By their nature, they can be significantly different: some women feel only a slight warmth, while others sweat heavily. Most often hot flashes continue for one to two years after the onset of menopause. Ten percent of women have hot flashes for many years to come.
  • vaginal dryness: At the end of perimenopause, a drop in estrogen levels may cause thinning and dryness of the vaginal mucosa. Dryness causes discomfort, which manifests itself in the form of itching and irritation, and pain during intimate relationships, which can reduce libido.
  • uterine bleeding: This is caused bythe decrease in the amount of progesterone involved in the transformation of the endometrium, the layer of the mucous uterus before rejection can thicken, which causes abundant periods.
  • Insomnia: About 40% of women during perimenopause have trouble sleeping. A number of studies have identified a link between night sweating and sleep disturbances.
  • The problem is too complex to know the cause of sleep disorders only in fluctuations of the hormonal background. With age, sleep cycles change, and insomnia becomes a typical age problem for both women and men.
  • mood swings: Approximately 10-20% of women complain of mood swings during the perimenopause period. Some researchers attribute this to a drop in estrogen levels, but this has not yet been scientifically confirmed. In addition, the level of depression in women after forty-five years old is low.
  • The unpredictability of perimenopause can cause stress and irritation. Also, some women are more sensitive to hormonal changes, which may cause mood swings. Mood in middle age is mainly determined by factors such as stress, poor health and the presence of depressive conditions in the past.
  • other problems: Many women complain of short-term memory problems and difficulty concentrating during the menopause transition. Although estrogen and progesterone play an important role in maintaining brain activity, there is too little data to separate the effects of aging and psychological factors from those caused by hormonal changes.

How can you relieve perimenopause?

Vasomotor signs

  1. Avoid possible factors that may trigger hot flashes, such as hot, poorly ventilated rooms, hot drinks, and spicy food. Try to make your clothes multi-layered, so you can remove clothes if necessary.
  2. Try rhythmic breathing; deep breathing techniques facilitate hot flashes.
  3. The most effective treatment for severe hot flashes and night sweating is estrogen. But the dosage is prescribed by a doctor.

In all other cases, such as endocrine failures, irregular (or too many) monthly menstruations, or vaginal dryness, seek support from a gynecologist.

Dr. Lydia

Dr. Bachurina Lydia was born in the Republic of Uzbekistan in 1971. Since childhood, she wanted to be a doctor. After school she graduated from the Tashkent Medical Institute, worked as a therapist for four years, and then worked in cardiology for three years. After moving to Russia, she was certified and worked as a geriatrician for four years. Dr. Lydia is married with two sons and maintains “Beauty and Health Blog from LiDea” dedicated to medicine. She currently lives and works in Russia.

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