Perimenopause: Beginning of Menopause | Patient Information | JAMA | JAMA Network
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JAMA Patient Page
February 19, 2003

Perimenopause: Beginning of Menopause

JAMA. 2003;289(7):940. doi:10.1001/jama.289.7.940

Menopause (the change of life) is when women stop menstruating (having periods) and their ovaries gradually stop working. The time leading up to menopause is called perimenopause. Perimenopause is a transition period in a woman's life and signals the beginning of the loss of fertility (ability to become pregnant) because of the body's natural aging process. Perimenopause and menopause are not diseases. They are healthy and natural parts of a woman's life.

Sometimes menopause does not happen naturally but is a result of medical treatments for health problems. Cancer treatments, including chemotherapy, pelvic radiation, and surgery, can cause early menopause. Removal of both ovaries (bilateral oophorectomy) for any reason starts menopause. Having a hysterectomy alone (removal of only the uterus, not the ovaries) does not cause menopause but will stop a woman's menstrual periods. Medical studies have shown that having a hysterectomy may speed the start of natural menopause by 1 to 2 years. Menopause usually happens between the ages of 40 and 55 years. Earlier natural menopause is more common in women who smoke, women who have had a hysterectomy without ovary removal, and women whose mothers and sisters have had earlier menopause. Most women experience hot flashes, which can last for 1 to 30 minutes but are usually 2 or 3 minutes long. Some women may have hot flashes for several years, and other women only have them for a short time. The February 19, 2003, issue of JAMA includes an article about perimenopause and menopause.

Symptoms of perimenopause

  • Irregular menstrual periods

  • Hot flashes

  • Night sweats

  • Vaginal dryness

  • Difficulty sleeping

  • Mood swings

Health concerns during menopause

  • Abnormal vaginal bleeding—See your doctor if this occurs because there are other causes besides perimenopause

  • Heart disease—Control high blood pressure and diabetes, maintain a healthy weight, exercise regularly, and eat a low-fat diet rich in fruits and vegetables

  • Osteoporosis (brittle bones)—Take calcium supplements and exercise regularly

  • Pain during sexual intercourse due to thinning and dryness of the vaginal walls

  • Sleep disturbances

Ways to ease symptoms during perimenopause

Hormone replacement therapy (HRT) has been often prescribed to control menopausal symptoms such as hot flashes. Recent medical studies have shown that HRT does not prevent heart disease in postmenopausal women and may increase the risk of breast cancer. You should discuss your individual benefits and risks of HRT with your doctor.

  • Regular exercise may reduce the intensity of hot flashes

  • Eating food rich in soy proteins (isoflavones); legumes (beans and peanuts) may also help hot flashes

  • Vaginal lubricants may ease dryness and pain associated with sexual intercourse

  • Wearing clothing in layers and avoiding what triggers hot flashes (exposure to a hot environment, hot drinks, spicy food, alcohol, and stress)

  • Alternative treatments, such as phytoestrogens (plant-based substances) and black cohosh (an herb), should be discussed with your doctor because they may interfere with some medications

For more information

Inform yourself

To find this and previous JAMA Patient Pages, go to the Patient Page Index on JAMA's Web site at They are available in English and Spanish. A Patient Page on women and heart disease was published in the December 25, 2002, issue, and one on hormone replacement therapy was published in the August 28, 2002, issue.

The JAMA Patient Page is a public service of JAMA . The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, JAMA suggests that you consult your physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. Any other print or online reproduction is subject to AMA approval. To purchase bulk reprints, call 718/946-7424.

Sources: American College of Obstetricians and Gynecologists, National Women's Health Information Center, North American Menopause Society