Perimenopause should be used to include the period immediately or prior to the menopause with endrocrinological, biological, and clinical features of approaching menopause, and at least the first year after the menopause. Most women are anovulatory 18 months to 5 years before menopause. Thus, these women have little to no progesterone production during this period of time, thus they have a state of unopposed estrogen.

Symptoms: Hot flashes; irritability; sleep problems; irregular bleeding and general psychological changes.
As the woman transitions through the 5 years, she is first progesterone deficient with normal estrogen level and regular cycle. Then, estrogen production slows, usually in estriol and then estrone and estradiol. Usually she has symptoms of sleep disturbance when the estrogen levels start to drop. At the same time dhea levels are also dropping.

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