Need help or have questions about your order? Call 510-991-8265Questions about your order? Call 510-991-8265

Sign InShop GLPs
Shop GLPs

Perimenopause Common Comorbidities and Overlap: What Clinicians and Patients Need to Know

By
Published Updated Last reviewed
10 linked public sourcesEditorial, sourcing, and corrections policy

At a glance

  • Definition / Perimenopause is the transition before menopause, usually starting in the 40s and lasting about 4 years on average, up to 10 years [1][2]
  • Staging / STRAW+10: early transition is a difference of 7 or more days between consecutive cycle lengths recurring within 10 cycles; late transition is 60 or more days without a period [4]
  • Vasomotor symptoms / Median total duration 7.4 years; 4.5 years after the final period [5]
  • Bone / Estrogen loss can cause bone density loss and osteoporosis [1]
  • Cardiovascular / Estrogen loss can raise cholesterol and increase risk of heart disease and stroke [1]
  • Weight / Fat mass rises faster and lean mass falls during the transition, but total weight does not accelerate at the start [3]
  • Genital and urinary symptoms / Vaginal dryness and bladder symptoms can occur; they may get worse over time without treatment [1][2]
  • Treatment / Hormone therapy is the most effective treatment for vasomotor symptoms; nonhormonal options include CBT, SSRIs/SNRIs, gabapentin and fezolinetant [6][7]

What perimenopause is

Perimenopause is the time before menopause when hormone levels change. Menopause is confirmed only after 12 months in a row with no period. Perimenopause usually begins in the 40s, lasts about 4 years on average, and can last up to 10 years. Pregnancy is still possible during perimenopause [1][2].

What overlaps with perimenopause

Sleep problems, mood changes, irregular periods and bladder symptoms can occur during perimenopause [1]. Waking at night to urinate (nocturia) can stem from increased nighttime urine production, reduced bladder storage, incomplete bladder emptying or a primary sleep disorder [8].

What the research shows

In SWAN, among 1,449 participants with frequent hot flashes or night sweats, the median total duration was 7.4 years. Among 881 with an observable final menstrual period, symptoms persisted a median of 4.5 years afterward [5].

Estrogen loss can cause bone density loss and osteoporosis, and can raise cholesterol and increase the risk of heart disease and stroke [1]. Menopause increases women's cardiometabolic risk profile [9].

In SWAN, fat gain doubled at the start of the transition and lean mass declined, but total weight did not accelerate at the start [3]. A Cochrane review of mostly small, older trials (searched to 1998) found no significant difference in weight change between hormone therapy users and non-users [10].

Vaginal dryness and bladder symptoms can occur during the transition [1]. The Office on Women's Health says genital and urinary symptoms may get worse over time without treatment [2]. For bothersome genitourinary symptoms that are not relieved by over-the-counter products, the Menopause Society recommends low-dose vaginal estrogen, vaginal DHEA or oral ospemifene [6].

Treatment for vasomotor symptoms

Hormone therapy is the most effective treatment for vasomotor symptoms and has been shown to prevent bone loss and fracture. For women younger than 60 or within 10 years of menopause onset with no contraindications, the benefit-risk ratio is favorable [6]. Nonhormonal options include CBT, SSRIs/SNRIs, gabapentin and fezolinetant [7].

Frequently asked questions

What is perimenopause and how long does it last?
Perimenopause is the transition before menopause, usually beginning in the 40s. It lasts about 4 years on average and can last up to 10 years. Pregnancy is still possible during perimenopause [1][2].
What symptoms can occur during perimenopause?
Sleep problems, mood changes, irregular periods and bladder symptoms can occur during perimenopause [1]. Waking at night to urinate can stem from increased nighttime urine production, reduced bladder storage, incomplete bladder emptying or a primary sleep disorder [8].
How long do hot flashes last?
In SWAN, among 1,449 participants with frequent hot flashes or night sweats, the median total duration was 7.4 years; among 881 with an observable final menstrual period, symptoms persisted a median of 4.5 years afterward [5].
Does hormone therapy prevent bone loss?
Hormone therapy has been shown to prevent bone loss and fracture. For women younger than 60 or within 10 years of menopause onset with no contraindications, the benefit-risk ratio is favorable for bothersome vasomotor symptoms and prevention of bone loss [6].

References

  1. Menopause | Menopause Symptoms | MedlinePlus. Menopause | Menopause Symptoms | MedlinePlus
  2. Menopause basics | Office on Women's Health. Menopause basics | Office on Women's Health
  3. Greendale GA, Sternfeld B, Huang M, Han W, Karvonen-Gutierrez C, Ruppert K, et al. Changes in body composition and weight during the menopause transition. JCI Insight. 2019;4(5). Changes in body composition and weight during the menopause transition
  4. Executive summary of the Stages of Reproductive Aging Workshop + 10: addressing the unfinished agenda of staging reproductive aging - PMC. Executive summary of the Stages of Reproductive Aging Workshop + 10: addressing the unfinished agenda of staging reproductive aging - PMC
  5. Avis NE, Crawford SL, Greendale G, Bromberger JT, Everson-Rose SA, Gold EB, et al. Duration of menopausal vasomotor symptoms over the menopause transition. JAMA Intern Med. 2015;175(4):531-9. Duration of menopausal vasomotor symptoms over the menopause transition
  6. “The 2022 Hormone Therapy Position Statement of The North American Menopause Society” Advisory Panel. The 2022 hormone therapy position statement of The North American Menopause Society. Menopause. 2022;29(7):767-794. The 2022 hormone therapy position statement of The North American Menopause Society
  7. New Collective Author. The 2023 nonhormone therapy position statement of The North American Menopause Society. Menopause. 2023;30(6):573-590. The 2023 nonhormone therapy position statement of The North American Menopause Society
  8. Getaneh FW, Sussman RD, Iglesia CB. Nocturia: Evaluation and Management. Am Fam Physician. 2025;111(6):515-523B. Nocturia: Evaluation and Management
  9. Kautzky-Willer A, Leutner M, Harreiter J. Sex differences in type 2 diabetes. Diabetologia. 2023;66(6):986-1002. Sex differences in type 2 diabetes
  10. Norman RJ, Flight IH, Rees MC. Oestrogen and progestogen hormone replacement therapy for peri-menopausal and post-menopausal women: weight and body fat distribution. Cochrane Database Syst Rev. 2000;1999(2):CD001018. Oestrogen and progestogen hormone replacement therapy for peri-menopausal and post-menopausal women: weight and body fat distribution
Evidence overview for conditions perimenopause: Perimenopause Common Comorbidities and Overlap: What Clinicians and Patients Need to Know