Posted on February 10, 2015

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Source: Annals of Internal Medicine

Physician Writers
Megan McNamara
Pelin Batur
Kristi Tough DeSapri


What is perimenopause?

Perimenopause is a transitional time late in a woman's reproductive life before the final menstrual period (FMP). Menopause is de-fined retrospectively by 12 months of amenorrhea and loss of ovarian follicular activity. The mean duration of perimenopause is 5 years, but symptoms may begin 8 years or more before the FMP (1). The average age at onset of menstrual irregularity is 47.5 years (2). "Perimenopause" is a lay term—the North American Menopause Society and most women's health providers use the term "menopause transition" to describe this time of hormonal flux. For simplicity, we use "perimenopause" in this review.

How is it diagnosed?

According to the Staging of Reproductive Aging workshop (STRAW+10), the menopause transition is divided into the early and late phases based on cycle length and ovarian endocrine function (2). Early perimenopause is characterized by variable cycle length (> 7 days different from the normal cycle), and late perimenopause is characterized by >2 missed cycles or > 60 days of amenorrhea. During both early and late perimenopause, ovarian function progressively decreases while folliclestimulating hormone (FSH) and to a lesser extent luteinizing hormone increase.

Perimenopause is not a disease and does not require diagnosis or treatment unless symptoms are present. For clinicians, awareness of symptoms and signs of perimenopause is essential for providing appropriate patient counseling. Hallmark symptoms include irregular menstrual bleeding in addition to hot flashes and night sweats, which are referred to as vasomotor symptoms. Perimenopausal women may also experience mood changes, sleep disturbances, and sexual dysfunction. Because perimenopause is a clinical diagnosis, an FSH test is usually not needed to help make treatment decisions, although a level > 30 mIU/mL is strongly suggestive of menopause (in combination with prolonged amenorrhea). Serum estradiol levels fluctuate throughout perimenopause and are thus not reliable for diagnosis.

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