Perimenopause Stopping Treatment Safely: A Clinical Guide

Where perimenopause ends

Perimenopause runs from stage -2 in the STRAW+10 staging system through the 12 months after the final menstrual period, and lasts about four years on average [6][5]. Menopause is reached after 12 months in a row with no period [8][6], and pregnancy is still possible before that point [6]. In STRAW+10, a random FSH above 25 IU/L suggests late transition (stage -1); AMH, inhibin B and antral follicle count are supportive markers only because the assays are not standardized [5]. The Office on Women's Health says blood hormone tests are not usually needed to tell whether you are in perimenopause [6].

What the label and the Menopause Society say about duration

The Premarin label says to use the lowest effective dose for the shortest duration consistent with treatment goals and to re-evaluate postmenopausal women periodically to determine whether treatment is still necessary [1]. The Menopause Society 2022 statement says treatment should be individualized with periodic reevaluation, and that for women younger than 60 or within 10 years of menopause onset without contraindications the benefit-risk ratio is favorable for bothersome vasomotor symptoms and prevention of bone loss [2]. Label wording is changing: FDA asked in November 2025 to remove the cardiovascular, breast cancer and probable dementia statements from the boxed warnings [9], and approved changes for six products in February 2026 [10], while the Premarin and Prempro labels still carry the older box [1][11].

How long hot flashes last

Hormone therapy remains the most effective treatment for vasomotor symptoms [2]. In the Study of Women's Health Across the Nation (SWAN), the duration analysis included 1,449 women with frequent vasomotor symptoms; their median total duration was 7.4 years. Among 881 women with an observable final menstrual period, frequent symptoms persisted a median of 4.5 years afterward [7].

Non-hormonal drugs with their own monitoring and stopping rules

Fezolinetant (Veozah) 45 mg once daily requires liver tests at baseline, monthly for the first three months, then at months 6 and 9. The label says to stop if ALT or AST exceeds 5 times the upper limit of normal, or 3 times that limit with bilirubin above 2 times the limit [3]. The drug carries a boxed warning for hepatotoxicity [3][12].

Elinzanetant (Lynkuet) 120 mg at bedtime requires baseline liver tests and a follow-up at 3 months. The label says to exclude pregnancy before starting and advises contraception during treatment and for 2 weeks after the last dose [4].

Paroxetine mesylate (Brisdelle) 7.5 mg at bedtime is an SSRI at a dose lower than that used for depression and is not approved for any psychiatric condition. The label contraindicates it with MAOIs and within 14 days [13].