Perimenopause

Perimenopause is the transitional phase before menopause when ovarian hormone levels fluctuate and menstrual cycles become irregular.

It typically begins in the mid-to-late forties and lasts several years, ending twelve months after the final period. Estrogen and progesterone levels swing unpredictably rather than declining smoothly, which drives the hallmark symptoms: cycles that shorten, lengthen or skip, hot flashes and night sweats, sleep disruption, mood changes, breast tenderness and changes in libido. Pregnancy remains possible during this time.

Assessment is based on age, menstrual pattern and symptoms; hormone levels vary too much from day to day to be a reliable test on their own. Clinicians distinguish perimenopause from thyroid disease, pregnancy and other causes of irregular bleeding. Cannabinoids have been the subject of survey research among midlife women, but controlled trials on perimenopausal symptoms are lacking.