What is perimenopause?
Perimenopause often begins years before the last period (average age 45 – 51) and lasts several years. Hormones fluctuate strongly — hence the varied symptoms. Menopause itself is defined retrospectively: 12 months without a period.
Common symptoms
- Hot flashes, night sweats
- Sleep disturbances, fatigue, “brain fog”
- Mood swings, irritability, depressive episodes
- Vaginal dryness, painful intercourse
- Weight gain, hair thinning
- Joint pain
- Cycle changes (shorter, longer, heavier, lighter)
Diagnostics
In a 45-minute visit we record symptoms, history, risks (breast cancer, thrombosis, cardiovascular) and conduct targeted hormone diagnostics — when medically meaningful. We discuss your treatment goals.
Hormone therapy (HRT)
For many women hormone replacement therapy is the most effective treatment. We follow current Swiss and international guidelines (SGGG, NAMS):
- Oestrogen ± progesterone — transdermal (patch, gel) or oral
- Local therapy — for mucosal symptoms alone often sufficient
- Bioidentical hormones — possible, with clear discussion of evidence
We discuss risk/benefit honestly — the evidence is much better understood today than 20 years ago.
Non-hormonal options
- Lifestyle (sleep hygiene, exercise, nutrition, stress management)
- Phytotherapy (cimicifuga, soy isoflavones) — moderate effect, well tolerated
- SSRIs/SNRIs for severe hot flashes or co-existing mood issues
- Vaginal laser for urogenital atrophy
Follow-up
With HRT: first follow-up at 3 months, then yearly. Mammography and gynaecological check-ups as usual, with small adjustments.
Costs
Whether compulsory insurance covers counselling, diagnostics and hormone preparations depends on the specific medical service. For medicines, the product, authorised indication, Specialities List entry and any limitations must in particular be satisfied; a diagnosis alone does not guarantee cover. Uncertain cover should be clarified before treatment. Deductible and co-payment apply to covered services.