Perimenopause
Also known as: Menopausal Transition · Climacteric
Perimenopause is the multi-year hormonal transition before menopause, characterized by fluctuating estradiol and progesterone, irregular cycles, vasomotor symptoms, and metabolic shifts. It typically begins in the 40s and ends 12 months after the final menstrual period.
What you need to know
Perimenopause is defined by hormonal variability rather than deficiency — estradiol can swing from high to low within the same cycle, and progesterone declines steadily as ovulation becomes irregular. The transition can last 4–10 years and presents with hot flashes, sleep disruption, mood changes, cognitive symptoms, joint discomfort, and accelerated body-composition change. Biomarker interpretation is more nuanced than in menopause because single-point values fluctuate. Provider-reviewed optimization weighs symptoms alongside biomarkers and uses bioidentical hormone optimization (BHRT) where appropriate.
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