Perimenopause For Dummies
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Perimenopause is the phase of woman's life when her body begins to make the natural transition to menopause, which marks the end of the reproductive years. This Cheat Sheet summarizes some important information about perimenopause, including hormonal changes and symptoms that could signal medical problems.

Hormone changes in perimenopause

You probably know that perimenopause includes some hormonal shifts (and if you are a woman in this phase of life, you may have already experienced some of them). These changes can lead to symptoms ranging from the mildly uncomfortable to the deeply frustrating (hello, brain fog — when you experience confusion, forgetfulness, and a lack of mental clarity).

Which hormones are doing what, exactly? Here’s a breakdown of what’s going on with a woman’s hormones during perimenopause.


During perimenopause, levels of the hormone estrogen fluctuate and become unpredictable. Eventually, production falls to a very low level. Estrogen is a key component of many functions. Estrogen
  • Stimulates growth of breast tissue
  • Maintains vaginal blood flow and lubrication
  • Causes the lining of the uterus to thicken during the menstrual cycle
  • Keeps the vaginal lining elastic
  • Helps with concentration and memory


Progesterone production decreases greatly during menstrual cycles when ovulation becomes irregular. Here’s what progesterone does when it’s present in its normal levels:
  • Prepares the lining of the uterus for a fertilized egg and helps maintain early pregnancy
  • Factors into moods and sleep
  • Stabilizes the lining of the uterus, keeping it from growing too thick


Although known as the “male” hormone, testosterone is also important to women’s sexual health. Levels of testosterone peak in a woman’s 20s and 30s, and they decline slowly thereafter. Ovaries continue to make testosterone, even after estrogen production stops. Testosterone production from adrenal glands also declines with aging, but it continues after menopause. This hormone
  • Plays a key role in women’s estrogen production prior to menopause
  • Contributes to libido
  • May help maintain bone and muscle mass

Symptoms to watch for in addition to irregular bleeding

Sometimes, changes in menstrual bleeding patterns can be a sign that you may have a medical problem. Look for other signs and symptoms that may signal health issues other than perimenopause:
  • Bleeding disorder: If you notice that you also bruise easily (knocking into a table edge or a dresser results in an unusually large bruise) or you have nosebleeds that you can’t stop easily, your doctor may evaluate you for a bleeding disorder.
  • Thyroid disorder or vitamin deficiency: If your irregular bleeding comes with fatigue, heart palpitations, hair loss, swelling, or shakiness, you may have a thyroid disorder or a vitamin deficiency. Your healthcare provider can easily diagnose these conditions by using blood tests.
  • Autoimmune disease: If you notice any swollen glands, skin rashes, joint pains, or recurrent fevers along with your irregular bleeding patterns, you may have an autoimmune disease, such as lupus or rheumatoid arthritis.

Irregular bleeding not caused by perimenopause

Most irregular bleeding in perimenopause is just that — irregular, expected perimenopausal bleeding, caused by the normal hormonal changes of midlife. But don’t ignore other symptoms that you may experience, even if they’re not typically associated with perimenopause. Irregular menstrual bleeding can be a symptom of some other medical conditions:
  • Polycystic ovary syndrome (PCOS): A hormonal disorder that can cause enlarged ovaries that have small cysts on their outer edges.
  • Uterine fibroids: Noncancerous growths of the uterus that often appear during childbearing years.
  • Endometriosis: A condition where tissue similar to the lining of the uterus grows outside the uterus.
  • Adenomyosis: A condition where the tissue that lines the uterus (the endometrium) grows into the muscular wall of the uterus (the myometrium).
  • Thyroid disorders: Both hypothyroidism (underactive thyroid) and hyperthyroidism (overactive thyroid) can disrupt menstrual cycles.
  • Pelvic inflammatory disease (PID): An infection of the female reproductive organs.
  • Ovarian cysts: Fluid-filled sacs that form on the ovaries, usually after ovulation.
  • Cervical or uterine cancer: Cancer or pre-cancers of the cervix or uterus can cause abnormal bleeding.
  • Medications and contraceptives: Certain medications, including hormonal contraceptives, can cause changes in menstrual bleeding patterns.
  • Stress and weight changes: Significant physical or emotional stress, as well as extreme changes in body weight, can disrupt hormonal balance and lead to irregular periods.

About This Article

This article is from the book:

About the book author:

Dr. Rebecca Levy-Gantt is an obste­trician and gynecologist with her own Ob/Gyn practice and over 30 years of experience. Dr. Levy-Gantt is a Nationally Certified Menopause Practitioner whose areas of expertise include menopause, perimenopause, and hormonal management. She is the author of Womb With A View.

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