What is Perimenopause?

Perimenopause is the transition to menopause. Your estrogen levels may rise and fall, but they gradually go down, causing hot flashes, mood swings and other symptoms. Although many women do not need treatment for this natural condition, treatment can help others.

You may have read about a condition called estrogen dominance. This theory, proposed in a book called What Your Doctor May Not Tell You About Menopause, said that the symptoms before menopause are caused by too much estrogen. That theory has not been supported by research, and estrogen dominance is not a condition recognized by medical experts. [1] While there is no estrogen dominance treatment that medical experts can recommend, they can diagnose and treat perimenopause.

Symptoms | Treatment | Home Remedies

What is Estrogen Dominance?

Estrogen dominance is not recognized by medical experts. The high estrogen symptoms (and low estrogen symptoms) that you are experiencing are probably due to perimenopause, the period before full menopause.

The American College of Obstetricians and Gynecologists (ACOG) explains that perimenopause – the period before menopause – is caused by your ovaries shrinking and making less estrogen. Perimenopause symptoms can last for several years before full menopause, diagnosed when you have not had a period for one year. The average age of full menopause is 51. [2]

Johns Hopkins Medicine says that perimenopause occurs as your ovaries gradually shut down and stop producing eggs. Hormone levels that used to be balanced become irregular with periods of being too high and too low. As hormone levels rise, high estrogen level symptoms may be similar to premenstrual syndrome (PMS). As estrogen falls, your low estrogen symptoms may include night sweats and hot flashes.

How Long Does Perimenopause Last?

Mayo Clinic explains that perimenopause is a natural transition that all women go through, but they may experience it

differently. Most women start having perimenopause symptoms around their mid-forties, but for some women, symptoms start in their late 30s.  In the early stages, as estrogen rises and falls irregularly, your periods may become irregular, shorter or longer. As estrogen continues to fall, periods become less frequent. When you have gone one year without a period, you are officially in menopause. [4]

Harvard Medical School says the average length of perimenopause is three to four years.

stages of menopause what is perimenopause

Menopause can be broken out into three stages with different symptoms.

Perimenopause Symptoms

Some women will have symptoms that are very bothersome, while others will hardly be bothered at all. [3] These are the most common perimenopause symptoms: [1, 3-5]

  • Hot flashes and night sweats, probably the most common symptoms
  • Vaginal dryness and painful sexual intercourse
  • Trouble sleeping
  • Mood swings, including irritability and depression
  • Loss of interest in sex
  • Trouble concentrating

Low estrogen does not cause obvious symptoms, as a loss of estrogen can also contribute to fragile bones (osteoporosis) and high cholesterol. Loss of estrogen also causes irregular ovulation and loss of fertility. However, it is important to know that if you are still having your periods, it is possible to get pregnant, so you should continue to use birth control until you have gone a year without a period. [4]

Can You Get Pregnant During Perimenopause?

You can still get pregnant until you’ve reached full menopause, which is not having your menstrual period for one year. Taking a birth control pill can relieve some of the uncomfortable perimenopause symptoms while also preventing pregnancy.

Diagnosis and Treatment for Perimenopause Symptoms

There is no test to diagnose perimenopause. The diagnosis is made based on your age, symptoms, and menstrual history. Testing estrogen levels is rarely useful, says Mayo Clinic. [4] Perimenopause is a natural part of aging and does not need to be treated unless the symptoms are bothersome. The most effective treatment is estrogen replacement, called hormonal therapy. [4,5] These are some common treatments:

  • Estrogen replacement with a pill, patch or cream is the best treatment for hot flashes and night sweats. Your doctor will prescribe the lowest dose that controls your symptoms. You may also take a medication called progestin to balance the estrogen. [4]
  • For vaginal dryness, an estrogen cream or vaginal tablet may relieve dryness and pain during intercourse. A water-based lubricating jelly may also be used. [4,5]
  • If you want to avoid estrogen, a type of antidepressant called an SSRI may reduce hot flashes. Another option is a seizure medication called gabapentin. [4]
  • A low dose birth control pill is a good treatment for irregular periods, hot flashes, vaginal dryness, and bone loss. Taking a birth control pill will also prevent pregnancy and can be taken until you reach menopause. [5]

Although there are many over-the-counter supplements that claim to relieve perimenopause symptoms, both Johns Hopkins and Mayo Clinic say these products are not regulated by the FDA and they do not have any consistent research to support their use. [4,5] They include black cohosh, phytoestrogens, bioidentical hormones, and DHEA. Talk to your doctor before trying any of these supplements. [3,4]

Lifestyle and Home Remedies for Perimenopause Symptoms

Whether you need medications are not, there are some things you can do on your own to make perimenopause easier:

  • Don’t smoke. Smoking prolongs perimenopause and causes it to occur earlier. [4]
  • Learn your hot flash triggers. Hot flashes can be triggered by hot foods or spicy foods, getting overheated, alcohol, tea, or coffee. Keep a record of what triggers hot flashes to avoid them. [3,5]
  • Eat a low-fat, high fiber diet with plenty of fruits vegetables and whole grains. Include foods high in calcium and vitamin D. This diet will help prevent high cholesterol and osteoporosis. Ask your doctor if you need to take a calcium or vitamin D supplement. [2,4]
  • Get at least 30 minutes of exercise daily. Exercise will help keep your bones strong and may relieve mood swings and depression. [3,4]
  • Avoid caffeine later in the day and any overuse of alcohol. Both can make it harder to sleep. [5]
  • Reduce your stress with mind body exercises like yoga or tai chi. Try some meditation or guided relaxation exercises. [4]

Remember that perimenopause is a normal transition. You do not need to treat it, but if you have symptoms that bother you, work with your doctor to find the best treatment. Always let your doctor know if you have: [2,4]

  • Very heavy or prolonged menstrual periods
  • Vaginal bleeding between your periods
  • Vaginal bleeding after menopause.
  • Vaginal bleeding after sexual intercourse

These could be symptoms that are not natural and may require diagnosis and treatment.


  1. Chapel Hill Gynecology, Estrogen dominance – Chapel Hill Gynecology
  2. ACOG, Perimenopausal Bleeding and Bleeding After Menopause | ACOG
  3. Johns Hopkins, https://www.hopkinsmedicine.org/health/conditions-and-diseases/perimenopause
  4. Mayo Clinic, Perimenopause – Symptoms and causes – Mayo Clinic
  5. Harvard Health, Perimenopause: Rocky road to menopause – Harvard Health

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Chris Iliades, MD

Dr. Chris Iliades is board-certified in Ear, Nose and Throat and Head and Neck Surgery from the American Board of Otolaryngology and Head and Neck Surgery. He holds a medical … Read More

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