Perimenopause

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Kudzai Dombo, MD

Kudzai Dombo

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Perimenopause isn’t one story—it’s thousands. Discover real voices, expert advice, and personalized care options for your unique experience with Alloy.

Perimenopause Symptoms Are Different for Every Woman | Alloy

Perimenopause Isn’t One Story: Here’s Why Every Voice Matters

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Monica Molenaar

Sharon Malone, MD

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Signs that perimenopause is ending include increasingly irregular periods, fewer headaches, more stabilized mood, intensified hot flashes, and worsening sleep disturbances. Understanding these changes helps women anticipate the onset of menopause and explore effective treatments such as hormonal therapies and non-hormonal options for symptom relief.

How Long Does Perimenopause Last? Signs That It's Ending - Alloy

How Long Does Perimenopause Last?  4 Signs Perimenopause Is Ending

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Low-Dose Birth Control Pill

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Sharon D. Malone, MD

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Opill is a progestin only birth control pill that can be safely used for perimenopausal women who are asymptomatic, in need of birth control and have contraindications to the use of combination oral contraceptives. Progestin only pills are over 90% effective, making them the most effective over the counter contraceptive on the market

Progestin-Only Birth Control Pill & Perimenopause | Alloy

Here’s What You Need to Know About the New OTC Birth Control Pill & Perimenopause

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Vivian Manning-Schaffel

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Estrogen Alone and Joint Symptoms in the Women’s Health Initiative Randomized Trial

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Is the scale moving despite no changes to your diet? Learn the real causes of perimenopausal weight gain and discover expert-backed strategies to take control.

Perimenopause Weight Gain - How to Put a Pause on It | Alloy

Perimenopausal Weight Gain: What You Need to Know

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Start an Online Consult

Mayo Clinic. “Perimenopause.

Cleveland Clinic. “Perimenopause.

Johns Hopkins Medicine. “Introduction to Menopause.”

Camila Hirotsu,⁎ Sergio Tufik, and Monica Levy Andersen. “Interactions between sleep, stress, and metabolism: 

Juan Pablo Del Río, María I. Alliende, Natalia Molina, Felipe G. Serrano, Santiago Molina and Pilar Vigil.

Harvard Medical School. “How does exercise reduce stress? Surprising answers to this question and more.” Harvard Health Publishing.

Qi X, Yun C, Pang Y, Qiao J. “The impact of the gut microbiota on the reproductive and metabolic endocrine system.” Gut Microbes. 2021;13(1):1-21. doi:10.1080/19490976.2021.1894070. 

Paweł Milart,corresponding author Ewa Woźniakowska, and Wojciech Wrona. 

Medical (clinical)

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If you are experiencing irregular periods in your 40s, you may be in perimenopause. Find out how you can relieve perimenopause symptoms with Alloy.

What Causes Irregular Periods in Your 40s? Perimenopause

In My 40s & Having Irregular Periods: Am I in Perimenopause?

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Discover how birth control may help ease menopausal symptoms. Get the facts on how it works and whether it’s a good fit for you.

Low-Dose Birth Control & Menopause: Managing Your Symptoms

Low-Dose Birth Control

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Find Your Skin Solution

Anna Johnson

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Menopause and Common Dermatoses: A Systematic Review.

Intradermal injection of botulinum toxin for erythema in rosacea: A scoping review and meta-analysis.

Disorders of flushing.

MANAGEMENT OF ENDOCRINE DISEASE: Flushing: current concepts.

Skin aging and menopause : implications for treatment.

Androgen deficiency, Meibomian gland dysfunction, and evaporative dry eye.

Sheila R. Boyle

Sheila Boyle

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Discover why rosacea frequently flares up during perimenopause, how to tell it apart from hot flashes or acne, and the best ways to treat midlife redness.

Rosacea in Midlife: Hormonal Triggers & Menopause Skin Care

How to tell rosacea from menopause flushing—and what treatments actually help

What Causes Rosacea in Midlife?  What Are the Triggers and Best Treatments Options?

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Hadley Mendelsohn

Epidemiology of melasma in Brazilian patients: a multicenter study.

Extra-facial melasma: clinical, histopathological, and immunohistochemical case-control study.

Melasma and aspects of pigmentary disorders in Asians.

A lifetime of healthy skin: implications for women.

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Melasma is a common pigment disorder that causes symmetrical dark patches on sun‑exposed areas of the face. Hormonal shifts, ultraviolet exposure, and structural skin changes during perimenopause and menopause may influence how and where this hyperpigmentation appears. 

What Is Melasma? Menopause Skin Triggers & Treatments

Understanding midlife pigmentation changes and building a menopause‑aware skincare plan

What is Melasma and Does Tretinoin Help Treat it?

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Find Your Relief Plan - External - Small

Find Your Relief Plan

The 2022 hormone therapy position statement of The North American Menopause Society.

Management of Menopausal Symptoms: A Review.

Management of perimenopausal and menopausal symptoms.

Hormone Therapy in Menopause: Concepts, Controversies, and Approach to Treatment.

The Menopause Transition: Signs, Symptoms, and Management Options.

Menopausal hormone therapy and women's health: An umbrella review.

The Women's Health Initiative Randomized Trials and Clinical Practice: A Review.

Stephanie Culver

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Hormonal changes during perimenopause and menopause can trigger symptoms ranging from hot flashes and sleep disruption to vaginal dryness and mood changes. When these symptoms become frequent, persistent, or disruptive to daily life, menopausal hormone therapy (MHT) may be considered as a treatment option. 

Signs You Need Hormone Replacement Therapy from Perimenopause

Practical clues that menopause symptoms may be disruptive enough to consider treatment

6 Signs You Need Hormone Replacement Therapy

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Perimenopause: From Research to Practice.

Menopausal Symptoms and Their Management.

Effect of Whey Protein Supplementation in Postmenopausal Women: A Systematic Review and Meta-Analysis.

EMAS position statement: Thyroid disease and menopause.

Sleep disturbance and menopause.

Amy Hayes

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Yes. Perimenopause is the hormonal transition leading up to menopause, driven by fluctuating estrogen and progesterone levels. Although many women begin noticing changes in their 40s, symptoms can appear earlier, including in the late 30s. Early signs may include sleep disruption, mood shifts, irregular cycles, hot flashes, and vaginal dryness, often before obvious menstrual changes occur. Recognizing these patterns and tracking symptoms can help clarify when it may be time to discuss possible perimenopause and treatment options with a clinician

Can Perimenopause Start in Your 30? The 'Millennial Menopause

Why hormonal changes sometimes begin earlier than expected—and how to recognize the signs

Early Perimenopause in Your 30s: The 'Millennial Menopause

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Hormones and dry eye disease.

Sex-steroid imbalance in females and dry eye.

Dry eye in postmenopausal women: a hormonal disorder.

Oestrogen, ocular function and low-level vision: a review.

Efficacy of artificial tears containing trehalose and hyaluronic acid for dry eye disease in women aged 42-54 versus ≥ 55 years.

Efficacy of hyaluronic acid 0.3%, cyanocobalamin, electrolytes, and P-Plus in menopause patients with moderate dry eye disease.

Effects of estradiol-drospirenone on ocular and nasal functions in postmenopausal women.

Dr. Judith Barreiro

Dr. Judith Barreiro, MD, is a board-certified gynecologist with over two decades of experience providing high-level surgical and clinical care to women in the Tampa Bay area. 

Dr. Judith Barreiro - OBGYN

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Hormonal changes during perimenopause and menopause can affect the eyes as well as other tissues throughout the body. Declining levels of estrogen and androgens may alter tear production, oil gland function, and the stability of the tear film, leading to symptoms such as dryness, irritation, burning, or fluctuating vision. 

The Menopause Eye Shift: Vision Changes and Dry Eye - Alloy

Why hormonal shifts can affect eye comfort, tear production, and vision during perimenopause

The Menopause Eye Shift: Vision Changes and Dry Eye

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Blog - Find Relief Now

Find Relief Now

Perimenopause as a neurological transition state

Understanding the pathophysiology of vasomotor symptoms (hot flushes and night sweats) that occur in perimenopause, menopause, and postmenopause life stages

Symptoms of menopause - global prevalence, physiology and implications

Vasomotor symptoms of menopause, autonomic dysfunction, and cardiovascular disease

Hormonal Agents for the Treatment of Depression Associated with the Menopause

Does menopause elevate the risk for developing depression and anxiety? Results from a systematic review

Migraine, menopause and hormone replacement therapy

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Some women in perimenopause report a strange sensation described as internal buzzing, trembling, or vibration in the body. Fluctuating estrogen levels can affect the brain, autonomic nervous system, and sensory pathways, which may contribute to unusual neurological or autonomic sensations during the menopausal transition. 

 Estrogen and the 'Internal Tremors' of Perimenopause | Alloy

How estrogen fluctuations affect the nervous system—and when to get symptoms checked out

"Estrogen and the 'Internal Tremor'" : Causes of Vibrating and Buzzing Sensations

Surreal mood showing a womans hands with sensation of internal tremor, a symptom of estrogen level imbalance.

Blog - Find Relief - Get Estradiol

Find Relief - Get Estradiol

Schwartz BS, et al. Epidemiology of Tension-Type Headache. JAMA. 1998;279(5):381–383. doi:10.1001/jama.279.5.381

Lauritsen, C.G., et al., Current Treatment Options:

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Learn why headaches occur during perimenopause and explore proven treatments to alleviate pain and improve daily comfort.

Perimenopause Headaches vs. Regular Headaches: What’s the Difference?

Perimenopause Headaches vs. Regular Headaches

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Mayo Clinic — Perimenopause: Symptoms and causes.

The Menopause Society (formerly North American Menopause Society) — Perimenopause.

Harvard Health Publishing — Perimenopause: Rocky road to menopause.

Cleveland Clinic — Perimenopause: Age, Stages, Signs, Symptoms & Treatment.

American College of Obstetricians and Gynecologists (ACOG) — Perimenopausal Bleeding and Bleeding After Menopause.

ACOG — Management of Acute Abnormal Uterine Bleeding in Nonpregnant Reproductive-Aged Women (relevant for perimenopausal heavy bleeding).

Irene N. Wahba

Dr. Irene Wahba is a board-certified obstetrician-gynecologist with over 25 years of clinical experience.

Dr. Irene Wahba

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Yes, you may experience phantom periods or go 6 months or more without bleeding. Perimenopause cycles become irregular because estrogen and progesterone levels fluctuate and disrupt the normal menstrual cycle. 

Are Irregular & Phantom Periods Normal during Perimenopause?

The Ultimate Guide to Perimenopause Periods

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Mood swings disrupting your life? Find practical tips to manage emotional changes during menopause and restore balance to your daily routine.

Can Menopause Make You Feel "Crazy"? | Mood Swings Causes & Solutions

Menopause Crazy Behavior: Perimenopause Depression

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Breast pain, or mastalgia, is a common symptom affecting up to 70% of women during their lifetime, primarily caused by erratic hormone fluctuations during the menopause transition (perimenopause). Mastalgia is most common in late perimenopause, declining to 39% once the transition to menopause is complete.

Why Do My Breasts Hurt During Perimenopause and Menopause?

A Guide to Mastalgia Relief

Why Do My Breasts Hurt During Perimenopause and Menopause? 

perimenopause breast pain

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Changes in body odor during menopause are a common yet rarely discussed symptom driven by shifting hormone ratios. When estrogen declines, the resulting increase in androgen influence and cortisol levels alters your sweat composition and skin pH, leading to new or more intense scents.


Does Menopause Change Body Odor or Scent? Solutions & Relief

Why Does Menopause Change Body Odor? Causes and Solutions

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Darwana Ratleff Todd

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Perimenopause marks the transition to menopause with fluctuating estrogen, irregular periods, anxiety, fatigue, and mood changes. Learn about symptoms, hormone treatments like birth control pills, and how to manage this challenging phase.

What is Perimenopause | Alloy

Perimenopause: What Is it, and How Did We Get Here?

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When it comes to headaches during perimenopause and menopause, there is good news and bad news. Learn more in this hot take from Dr. Sharon Malone of Alloy.

Perimenopause & Headaches: Good & Bad News | Alloy

Perimenopause & Headaches

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Just like in puberty, perimenopausal skin is subject to periodic acne, even in women who never experienced outbreaks as a teenager. But there are solutions.

Perimenopausal Acne: What to Do About It

It’s Not Puberty, It’s Perimenopause. Let’s Talk About Acne.

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