What is perimenopause and when does it typically begin?

During the transition into menopause, women experience a natural shift in hormone levels that can bring about significant changes in their physical and emotional health. (For the purposes of this article, “women” refers to biological sex.)

But perimenopause — the phase that precedes menopause when these changes begin to occur — remains somewhat of a mystery to many, explains Lisa Larkin, MD, president of The Menopause Society.

“So many women in their 40s come to my office with new symptoms such as weight gain, fatigue, sleep disturbances or worsening migraines, and they don't correlate that with hormonal changes,” says Dr. Larkin. Unfortunately, many of these same people have had their complaints dismissed or downplayed, she adds, making them hesitant to speak up.

A health care provider is a great first stop when these symptoms begin. Read on to learn more about the basics, including when perimenopause occurs and managing what comes next.

In this article:

The basics of perimenopause

Many women have regular periods until perimenopause, the time when their body begins the change to menopause. Perimenopause, or transition to menopause, may take a few years. During perimenopause, people may not ovulate every month, thus making their periods irregular.

Think of perimenopause as a transitional time between two major phases of a person’s life: their reproductive years, when they can become pregnant, and menopause, when their menstrual cycle ends and pregnancy is no longer possible.

Beginning in a woman’s 30s and 40s, the amount of estrogen produced by their ovaries begins to fluctuate. A common sign of perimenopause is a change in the menstrual cycle. Cycles may become longer than usual for or become shorter, or someone may begin to skip periods.

“I tell women their ovaries are aging, just like everything else is starting to age, and that has physiological consequences,” says Dr. Larkin, who is also chief executive officer of Ms. Medicine, a nationwide network of clinics focused on women’s health.

The ovaries produce eggs, as well as estrogen and other hormones that regulate menstrual cycles and pregnancy. During perimenopause, the number and quality of eggs the ovaries produce is reduced, making it harder (though not impossible) to become pregnant.

When does perimenopause start?

Perimenopause usually begins in a woman’s mid 40s.

How long does perimenopause last?

While perimenopause typically lasts for between 5 and 10 years, some are in this hormonal stage for less time. Menopause happens after a person has not had a period for one year.

Signs and symptoms of perimenopause

Everyone experiences perimenopause in their own unique way. Some of the major signs and symptoms of perimenopause include the following:

• Hot flashes and night sweats
• Irregular periods, caused by fluctuating hormone levels
• Mood problems
• Sleep disturbances, which are often caused by night sweats
• Urinary incontinence
• Vaginal dryness, which can contribute to pain during sexual intercourse

Many of these symptoms may continue once menopause is reached.

Signs perimenopause is ending

The signs that perimenopause is coming to an end tend to vary depending on the individual. “Every woman’s journey is different,” says Dr. Larkin.

In someone’s 40s, as their body starts the transition to menopause, their menstrual cycles might become irregular. Their periods might stop for a month or a few months and then start again. These periods also might be shorter or last longer than usual or be lighter or heavier than normal.

Some people may also notice that symptoms they developed during perimenopause, such as hot flashes, become more persistent, explains Dr. Larkin — while others, such as mood fluctuations and headaches, may become more stable or milder.

There is no single test or symptom to tell if someone has started perimenopause. Their health care provider can look at many factors, including their age, menstrual history and what symptoms or body changes they’re noticing. Some health care providers may order tests to check hormone levels. But other than checking the thyroid (which can affect hormone levels), hormone testing isn't usually helpful to determine whether someone is in perimenopause. That's because hormone levels in perimenopause change unpredictably.

Factors that influence perimenopause

Many aspects of a person’s life will influence how they experience perimenopause. Various factors (such as smoking and obesity) can influence how a person experiences perimenopause.

Furthermore, depression and anxiety that a person may experience during perimenopause can be worsened by other events in their life, such as struggling with finances or dealing with the loss of a parent.

Coping strategies and management for perimenopause

The good news: “Women don’t have to suffer in silence,” says Bruce Dorr, MD, an obstetrician-gynecologist at Littleton Gynecology and Wellness Providers in Littleton, Colorado. He notes that simply following standard health advice — such as eating a balanced diet, avoiding unhealthy food and getting plenty of exercise — can go a long way toward improving some symptoms of perimenopause like mood swings and poor sleep.

People can also adopt a variety of home remedies for managing certain symptoms. Someone can combat hot flashes, for instance, by dressing in layers that can be removed to cool off or set up a fan in the bedroom to ease night sweats.

Some people going through perimenopause will benefit from a prescription. If someone has had a hysterectomy (the removal of their uterus), they may start on estrogen therapy, which may help relieve hot flashes and night sweats. Estrogen therapy is available as a cream, gel, patch, pill or spray. If a woman still has her uterus, she may start taking estrogen plus progestin, which is often called combined hormone therapy. Taking progestin helps reduce the risk of cancer of the uterus that occurs when estrogen is used alone.

Hormone replacement therapy levels out estrogen and progesterone, which prevents fluctuations in hormones that cause perimenopause symptoms.

Talk to a health care provider to discuss options, including whether supplements may be appropriate. Other supplements that may help include calcium supplements.

People can also try a few over-the-counter (OTC) aids to help with vaginal dryness and incontinence.

Support and resources for menopause

If someone thinks they are experiencing symptoms of perimenopause, it’s important that they talk to their health care provider.