What the Generalist Should Know About REIWhat Every Gynecologist Should Know About PerimenopauseVERRILLI, LAUREN MD*; BERGA, SARAH L. MD†Author Information *Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, University of Utah School of Medicine, Salt Lake City, Utah †Department of Obstetrics and Gynecology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York The authors declare that they have nothing to disclose. Correspondence: Lauren Verrilli, MD, 50 North Medical Drive, Salt Lake City, UT. E-mail: [email protected] Clinical Obstetrics and Gynecology: December 2020 - Volume 63 - Issue 4 - p 720-734 doi: 10.1097/GRF.0000000000000578 Buy Metrics Abstract Perimenopause often represents a physiologically challenging phase in women’s lives. The clinical presentation of the perimenopause includes infertility, irregular menstrual cycles, menorrhagia, and new onset of or worsening of mood disorders. Unlike menopause, which is characterized by low levels of estradiol and progesterone, the hallmark of perimenopause is highly variable levels of estradiol and progesterone with abrupt increases and decreases that are often described as a hormonal roller coaster. This chapter invites general gynecologists to understand the hormonal basis of the common complaints of perimenopause and offers information about the physiology of these issues and helpful treatment options. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.