Perimenopause is a process — a gradual transition. No one test or sign is enough to determine if you've entered perimenopause. Your doctor takes many things into consideration, including your age, menstrual history, and what symptoms or body changes you're experiencing.
Some doctors may order tests to check your hormone levels. But other than checking thyroid function, which can affect hormone levels, hormone testing is rarely necessary or useful to evaluate perimenopause.
Medications are often used to treat perimenopausal symptoms.
Hormone therapy. Systemic estrogen therapy — which comes in pill, skin patch, spray, gel or cream form — remains the most effective treatment option for relieving perimenopausal and menopausal hot flashes and night sweats. Depending on your personal and family medical history, your doctor may recommend estrogen in the lowest dose needed to provide symptom relief for you. If you still have your uterus, you'll need progestin in addition to estrogen. Systemic estrogen can help prevent bone loss.
Vaginal estrogen. Estrogen can be administered directly to the vagina using a vaginal tablet, ring or cream. This treatment releases just a small amount of estrogen, which is absorbed by the vaginal tissue. It can help relieve vaginal dryness, discomfort with intercourse and some urinary symptoms.
Antidepressants. Certain antidepressants related to the class of drugs called selective serotonin reuptake inhibitors (SSRIs) may reduce menopausal hot flashes. An antidepressant for management of hot flashes may be useful for women who can't take estrogen for health reasons or for women who need an antidepressant for a mood disorder.
Gabapentin (Neurontin). Gabapentin is approved to treat seizures, but it has also been shown to help reduce hot flashes. This drug is useful for women who can't use estrogen therapy for health reasons and for those who also have migraines.
