How Is Perimenopause Treated?

Medically reviewed by Renita White, MDMedically reviewed by Renita White, MD

Perimenopause is the time leading up to your last period, or menopause. The word perimenopause means "around menopause." Most people enter perimenopause in their mid-40s. This transitionary time to menopause can last for years, with menopause usually starting around age 52.

During perimenopause, the ovaries shrink and produce less estrogen, leading to changes in hormone levels and menstrual cycle. Your periods become lighter or heavier, shorter or longer, or occur at different times during the month. It’s also common to skip periods.

Other common symptoms of perimenopause include hot flashes, trouble sleeping, vaginal dryness and discomfort, mood changes, low libido, and bone loss.

Perimenopause treatment focuses on reducing these symptoms so that your years spent in perimenopause are more manageable. Several treatment approaches can help with your symptoms, and a healthcare provider like an OB-GYN can help determine what might work best for you.

Medications

A few types of medications may be used to treat perimenopause symptoms. Some medications may target the cause of the symptoms (a decrease in hormones) while others may treat the symptoms themselves.

Hormone Therapy

The most common treatment for perimenopause is hormone replacement therapy (HRT). These are medications that typically contain a combination of estrogen and progesterone. Taking HRT can supplement the hormones you've had a decrease of due to perimenopause.

Your healthcare provider may prescribe HRT in the form of oral medications, creams, gels, intravaginal medication, or implants.

You can expect your symptoms to decrease by approximately 70% using HRT. It’s shown to be the most effective way to treat hot flashes and other symptoms of perimenopause. HRT can also prevent bone loss that leads to osteoporosis.

Not everyone should take the same type of HRT. If your uterus has been surgically removed (hysterectomy), you will likely be prescribed estrogen-only HRT as opposed to a combination therapy. And not everyone should take HRT. You should avoid HRT if you’ve had breast cancer, as the therapy can increase your risk of the cancer coming back.

Contraception

If you are sexually active during perimenopause, speak with your healthcare provider about contraceptive options. Because you can ovulate until menopause, you can still get pregnant during perimenopause. Getting pregnant during perimenopause has a higher risk of complications for you and the fetus. If you want to avoid pregnancy in perimenopause, you should use some form of birth control.

Hormonal contraceptives may help with perimenopause symptoms. They may reduce hot flashes, lighten your periods, maintain bone strength, and improve acne (which can form during perimenopause).

Antidepressants

Regardless of whether you have a history of depression, people in perimenopause have a three times greater risk of experiencing depression. Those with a history of depression are likelier to experience it again during the transition to menopause.

The increased risk of depression might be due to hormonal changes as well as an increase in life stressors during this time.

If perimenopause is causing or exacerbating anxiety or depression, your healthcare provider may recommend antidepressants to manage your mental health. For people whose depression or anxiety is due to hormonal fluctuations, hormone therapy alone may be effective in improving mood. Some people may take both treatments.

Therapies

Focusing on the health of both your mind and body through therapy may help manage perimenopause. Talk therapy and physical therapy may target certain symptoms you are experiencing.

Talk Therapy

You may find that talk therapy, or psychotherapy, helps alleviate your emotional and psychological symptoms associated with perimenopause. It might be particularly helpful in reducing symptoms of depression and anxiety.

If you are struggling with sexual intimacy as a result of your perimenopause symptoms, sex therapy might be helpful. You can participate in sex therapy as an individual or with your partner to work on communication, sexual arousal, and any other concerns.

Physical Therapy

Physical therapy, specifically pelvic floor physical therapy, can support pelvic floor health and reduce perimenopause symptoms like urinary incontinence and pelvic organ prolapse. During pelvic floor therapy, you will participate in exercises that strengthen the muscles under the uterus, bladder, and bowel (large intestine)—the muscles that control the bladder, rectum, and vagina.

Your physical therapist may also recommend using lubricants or vaginal moisturizers to address dryness and other concerns related to sexual health.

If sex is painful due to issues with your pelvic floor, your provider may suggest using a vaginal dilator. This is a specially designed product you insert into your vagina to help train your mind and body to become comfortable with insertion during sex.

Complementary and Alternative Medicine

There are homeopathic options for treating menopause, but evidence on how effective they are—as well as whether they would work in perimenopause—is limited.

Research suggests acupuncture may reduce hot flash severity and frequency compared to no treatment. However, evidence is scarce, and the treatment approach appears to be less effective than hormone therapy in reducing the frequency of hot flashes.

Hypnotherapy may be another effective way to reduce the frequency of hot flashes in menopause. The treatment approach has also been shown to improve sleep quality and quality of life in menopause.

Mindfulness meditation might improve anxiety, stress, sleep quality, and quality of life. The practice does not appear to reduce the severity of hot flashes.

Research also suggests that yoga can reduce physical and psychological symptoms of menopause and is as effective as other types of physical activity.

Lifestyle

Some lifestyle changes can improve your well-being during perimenopause.

Research shows that moderate or high levels of physical activity, such as being active for at least 20 minutes three days per week, can reduce both psychological and physical symptoms of perimenopause.

Many people find they cannot achieve their physical activity goals due to their sedentary work. If that's the case for you, try incorporating physical activity into your daily routine, such as taking walking breaks or using a standing desk.

Eating a balanced diet can also improve symptoms and sleep. Consider incorporating protein, carbohydrates, and fats into your diet. Staying hydrated, supplementing with probiotics, and consuming omega-3 fatty acids through foods like salmon may particularly help with perimenopause symptoms. Talk to your healthcare provider about your individual nutritional needs before making any changes or additions to your diet.

You might also want to limit foods and drinks that might worsen symptoms, such as alcohol, caffeine, and spicy foods.

You can also try preparing for any hot flashes you might experience. This can include dressing in layers so you can take off some clothes as you get hot and carrying a portable fan.

Related: Women Dealing with Perimenopause Swear These Products Provide Major Symptom Relief

Living With and Managing Perimenopause

Perimenopause is a normal but challenging phase of life before the onset of menopause. Perimenopause can last for years. On average, most people experience it for four years before their period completely stops.

It’s important to maintain consistency in taking care of yourself and prioritizing your well-being. Your healthcare provider may recommend a variety of treatment methods to address different symptoms as they arise. Make sure to be honest with them about your experiences.

You also may find support in talking with others who are experiencing or have recently experienced perimenopause. Although the physical symptoms can be challenging, social support may help to ease the burden and improve your mental and emotional well-being.

A Quick Review

Perimenopause is the transition into menopause. Although perimenopause may be challenging and uncomfortable, there is a wide range of treatments that can help alleviate your symptoms and improve your quality of life.

Talk with your healthcare provider about your options, including hormone therapy and other medications, talk therapy, physical therapy, complementary medicine, and lifestyle modifications.

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