Management of the Perimenopause

Clin Obstet Gynecol. 2018 Sep;61(3):419-432. doi: 10.1097/GRF.0000000000000389.


Perimenopause, or the menopausal transition, represents a period of time during which newly arising symptoms can present complex management decisions for providers. Many women present to care with complaints of hot flashes, vaginal and sexual changes, altered mood and sleep, and changing bleeding patterns. The effect of these symptoms on quality of life, even before a woman enters menopause, can be significant. The appropriate evaluation and evidence-based management of women in this transition is reviewed in this article. Two case vignettes are used to highlight certain evaluation and treatment challenges.

Publication types

  • Review

MeSH terms

  • Affect / physiology
  • Androgens / blood
  • Anti-Mullerian Hormone / blood
  • Biomarkers / blood
  • Evidence-Based Practice
  • Female
  • Follicle Stimulating Hormone / blood
  • Hot Flashes / physiopathology
  • Hot Flashes / therapy
  • Humans
  • Menstruation Disturbances / physiopathology
  • Perimenopause / blood
  • Perimenopause / physiology*
  • Sexual Dysfunction, Physiological / physiopathology
  • Sexual Dysfunction, Physiological / therapy
  • Sleep Initiation and Maintenance Disorders / physiopathology
  • Sleep Initiation and Maintenance Disorders / therapy


  • Androgens
  • Biomarkers
  • Anti-Mullerian Hormone
  • Follicle Stimulating Hormone