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Health education · Hormonal healthSaint‑Hyacinthe
Perimenopause: symptoms, hormonal changes and treatment options in Saint-Hyacinthe
Do you still have your periods, but your cycle is changing? Hot flashes, disrupted sleep, fatigue, brain fog, irritability, palpitations or changes in libido can appear several years before menopause.
Perimenopause is a normal period of hormonal transition. At the Clinique IPS du Palais in Saint-Hyacinthe, our team can support you in reviewing your symptoms, ruling out other possible causes and discussing the different management options when these changes affect your quality of life.
Perimenopause is the period leading up to menopause. During this transition, ovarian function gradually changes and hormone levels, notably estrogen and progesterone, can fluctuate significantly.
Unlike menopause, it is entirely possible to be in perimenopause and still have your periods.
Cycles can become less predictable and various symptoms can appear well before the last menstrual periods. Perimenopause can last several years, and up to about ten years in some people.3
Perimenopause or menopause: what is the difference?
Perimenopause is the transition that precedes menopause.
Menopause is reached when a person has had no menstruation for 12 consecutive months, when no other cause explains this absence.1,2 After that point begins the period called postmenopause.
Many of the symptoms commonly associated with menopause can therefore begin during perimenopause.
The transition generally occurs in a person’s forties, but it can begin earlier or later. This is why age alone is not enough to determine whether a person is in perimenopause: changes in the menstrual cycle, symptoms and the clinical context are particularly important.
Menopause occurring before age 45 (early menopause) warrants particular attention, and loss of ovarian function before age 40 (premature ovarian insufficiency) requires a specific assessment.1
What changes can occur in menstrual periods?
Menstrual changes are among the common manifestations of perimenopause. Periods can become:
closer together or further apart;
longer or shorter;
heavier or lighter;
less predictable;
absent during some cycles.
A change in periods, however, is not automatically attributable to perimenopause. Some bleeding requires an assessment.
Possible symptoms
What are the symptoms of perimenopause?
Symptoms can vary greatly from one person to another. Some people go through this period with few manifestations, while others find their sleep, energy, mood, sexuality or daily functioning considerably affected.
Hot flashes and night sweats
Less restorative sleep and fatigue
Irritability or mood changes
Concentration and brain fog
Changes in menstrual periods
Vaginal dryness, libido and urinary symptoms
Palpitations are also reported by some people. Symptoms can fluctuate over time, just like hormones during this period.
Hot flashes and night sweats
Hot flashes are also called vasomotor symptoms. They can cause a sudden sensation of heat, often in the face, neck or upper body, sometimes accompanied by sweating.
When they occur at night, night sweats can fragment sleep and lead to:
fatigue upon waking;
difficulty concentrating;
irritability;
reduced energy during the day.
Frequency and intensity vary considerably from one person to another.
Why am I not sleeping as well?
Sleep problems are common during the menopausal transition. Hot flashes and night sweats can wake a person several times, but they are not the only possible explanations.
Sleep can also be influenced by stress, anxiety, mood, sleep habits or another disorder such as sleep apnea.
An assessment therefore makes it possible to determine whether the symptoms are consistent with perimenopause or whether another cause should be investigated.
Libido is complex and can be influenced by hormones, but also by sleep, stress, mood, medications, your relationship with your partner and overall health.
Genitourinary health
Vaginal dryness and urinary symptoms
Reduced exposure of tissues to estrogen can gradually lead to what is called genitourinary syndrome of menopause. These symptoms can begin during perimenopause and persist after menopause.
Different options exist, ranging from vaginal moisturizers and lubricants to local hormonal treatments when appropriate.1,2
It may show up, for example, as:
dryness;
irritation;
a burning sensation;
discomfort during sexual intercourse;
urinary urgency;
urinary pain or discomfort;
recurrent urinary tract infections in some people.
Can you still get pregnant during perimenopause?
Yes.
As long as ovulation is still possible, pregnancy remains possible, even when periods are irregular.1 Perimenopause therefore does not automatically mean that contraception can be stopped.
The choice of contraception during this period may also take into account menstrual changes, symptoms, cardiovascular risk factors, migraines, smoking and other medications or hormonal treatments.
In a person in the usual age range with characteristic symptoms and menstrual changes, the assessment is based mainly on the clinical history.
The goal is not only to determine whether the symptoms are consistent with perimenopause, but also to look for other explanations when necessary.
The professional will look at, among other things:
changes in your menstrual periods;
the nature, intensity and duration of symptoms;
their impact on quality of life;
the medications used;
medical and family history;
contraception;
cardiovascular risk factors;
gynecological health.
Is a blood test needed to confirm perimenopause?
Not necessarily.
Hormone levels can vary considerably from one day or one cycle to the next during perimenopause: a single hormone measurement can therefore be difficult to interpret.
Quebec and Canadian recommendations indicate that no blood test is needed to diagnose perimenopause or menopause in a typical clinical situation.1,2 Tests may nevertheless be ordered when:
the age is unusual;
the symptoms are not typical;
periods are absent for another possible reason;
pregnancy is possible;
a thyroid problem or another condition is being considered;
the professional wishes to assess other aspects of health.
Why look for other causes?
Several problems can sometimes produce symptoms similar to those of perimenopause: thyroid disorders, certain medications, sleep problems, mood disorders or other medical conditions.
This is why the assessment should cover the overall picture rather than a single symptom.
When do symptoms warrant treatment?
Perimenopause is a natural transition and does not automatically require treatment. However, symptoms that affect quality of life deserve to be taken seriously.
Management may be relevant when symptoms interfere with sleep, work, relationships, sexuality, physical activity, concentration or general well-being.
The goal of treatment is mainly to improve symptoms and quality of life.
What treatment options exist?
Management is personalized. Depending on the symptoms and medical profile, the options may include:
lifestyle adjustments;
non-hormonal treatments;
local treatments for vaginal symptoms;
hormone therapy when appropriate.
There is no single approach that suits everyone.
Before menopause
Can hormone therapy be used during perimenopause?
Yes.
It is not necessary to wait until menstruation stops completely before discussing hormone therapy. Treatment can be started based on the clinical presentation.2
Systemic hormone treatment may be considered for some people with hot flashes or night sweats significant enough to affect their quality of life, taking into account their history and any contraindications. The treatment regimen may be different for a person who still has menstrual periods.1,2
SymptomsHot flashes or night sweats that affect quality of life.
ProfileHistory and any contraindications taken into account.
Periods still presentThe regimen can be adapted, for example with a cyclic progestin.
Estrogen and progesterone: why both?
Systemic estrogen can help improve vasomotor symptoms such as hot flashes and night sweats.
When a person still has their uterus, endometrial protection with progesterone or a progestin is generally necessary when systemic estrogen is used.1,2
For a person in perimenopause who still has periods, the choice between different ways of administering these hormones depends on factors such as menstruation, symptoms, contraception and medical profile.
Transdermal hormone therapy
Estrogen can, for example, be administered through the skin as a patch or gel. Oral preparations also exist. The choice of route of administration is individualized.
Recommendations indicate that transdermal preparations are associated with a lower thrombotic risk than oral preparations, which may be relevant in certain situations.1,2
What if I don’t want to take hormones?
Non-hormonal strategies also exist.2,3 Their relevance depends on symptoms, personal preferences, history and any contraindications to hormone therapy.
An individualized discussion makes it possible to compare the different options.
Can contraception also help?
In some situations, hormonal contraception can be used during perimenopause. For example, it can meet a contraceptive need while helping to manage certain cycle changes.
Contraception and menopausal hormone therapy are not the same thing, however.
The choice depends on factors such as age, pregnancy risk, cardiovascular factors, migraines, smoking, bleeding pattern and symptoms.
The menopausal transition is also a good time to review cardiovascular health. It can be useful to monitor certain risk factors, including blood pressure, cholesterol and blood sugar.
It may therefore be relevant to take advantage of this period to review longer-term prevention.
Body composition can change gradually around the menopausal transition. Weight, however, is influenced by several factors: aging, muscle mass, sleep, physical activity, diet, stress, metabolism and certain medical conditions.
It is therefore preferable to approach these changes from an overall health perspective rather than attributing them solely to hormones.
Estrogen plays an important role in bone health. Bone loss accelerates particularly toward the end of the menopausal transition and in early postmenopause.1
Depending on risk factors, it may be relevant to discuss:
physical activity;
muscle health;
nutritional intake;
the risk of osteoporosis;
the possible need for screening.
Seeking care
When to seek care?
It may be a good idea to seek a consultation when you are wondering whether your symptoms are related to perimenopause or when they begin to affect your quality of life.
An assessment is particularly useful in the presence of:
significant hot flashes or night sweats;
disrupted sleep;
a significant change in your cycle;
persistent fatigue;
mood changes;
vaginal or urinary symptoms;
decreased or changed libido;
brain fog;
palpitations;
questions about hormone therapy;
questions about contraception during this period.
When should bleeding be assessed?
Periods can become irregular during perimenopause, but not all bleeding should automatically be attributed to hormones. An assessment may be needed, for example, in cases of:
very heavy bleeding;
prolonged bleeding;
unusual bleeding between periods;
bleeding after sexual intercourse;
a significant or unexplained change in menstrual pattern.
After menopause, any new vaginal bleeding warrants an assessment.
How can Clinique IPS du Palais support you?
Depending on your situation, our team can:
review your symptoms;
assess whether the picture is consistent with perimenopause;
review your menstrual cycles;
look for other causes when necessary;
review your contraception;
assess certain risk factors;
order tests when indicated;
discuss hormonal and non-hormonal treatments;
support you with genitourinary symptoms;
provide follow-up after starting treatment;
adjust management according to your progress.
A pathway dedicated to hormonal health
When hormone therapy is an option to consider, the Clinique IPS du Palais offers a pathway dedicated to hormonal assessment and follow-up.
Can I be in perimenopause if I still have my periods?
Yes. This is often precisely what distinguishes perimenopause from menopause. Periods can continue for several years while becoming more irregular.
Can you be in perimenopause at 40?
Yes. The transition can begin during your forties and sometimes earlier. A particularly early onset, however, warrants an appropriate assessment.
Do I need a blood test to know if I am in perimenopause?
Not routinely. In a typical situation, the clinical history and menstrual changes are often more useful than a single hormone measurement.
Can hormones vary a lot?
Yes. Hormonal fluctuations are characteristic of this period, which partly explains why symptoms and periods can be variable.
Is it normal to have hot flashes while still having my periods?
Yes. Vasomotor symptoms can begin during perimenopause.
Can brain fog be related to perimenopause?
It can be one of the reported symptoms, but sleep, stress and other health problems can also contribute to difficulty concentrating.
Can I take hormone therapy before reaching menopause?
Yes, for some people. It is not necessary to wait 12 months without periods to discuss treatment of significant symptoms.
Can I still get pregnant?
Yes. As long as ovulation is possible, pregnancy remains possible.
What is the difference between hormonal contraception and hormone therapy?
They may use certain related hormones, but they do not have the same goals, nor necessarily the same doses or formulations. Contraception aims, among other things, to prevent pregnancy, whereas menopausal hormone therapy mainly aims to treat the symptoms of the menopausal transition.
When are you officially in menopause?
Menopause is generally recognized after 12 consecutive months without menstruation when no other cause explains this absence.
Institut national d’excellence en santé et en services sociaux (INESSS). Prise en charge des manifestations cliniques liées à la ménopause par l’hormonothérapie (clinical management tool). September 2024, revised February 2026, accessed October 6, 2026. inesss.qc.ca (PDF)
Government of Canada (National Defence, Women’s and Diversity Health). Prise en charge des symptômes de la ménopause (information for clinicians). Modified May 12, 2026, accessed October 6, 2026. canada.ca
Government of Canada (National Defence). Guide de santé des femmes et de la diversité : la ménopause. Modified September 17, 2026, accessed October 6, 2026. canada.ca
This page provides general information and does not replace an individualized assessment by a health professional.
