If you don’t know the signs of perimenopause, don’t worry. We’ve got everything you need to know in our handy guide. Find out more about how long it lasts, its symptoms, treatment options, and how you know it is ending.
Find what you need quickly
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What is perimenopause?
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At what age does perimenopause start?
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How long can perimenopause last?
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What are the first signs of perimenopause?
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How is perimenopause diagnosed?
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How do you manage perimenopause symptoms?
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What are the signs that perimenopause is ending?
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What kind of complications should you expect?
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Final word
Discover your personalized treatment options
What is perimenopause?
Your body has a natural life stage called perimenopause, which is when your ovaries gradually stop producing eggs and your periods become irregular before they stop. It can start up to 10 years before menopause (which is when your periods have stopped for more than 12 months) but more commonly lasts 4-7 years.
During perimenopause, your body produces less of the hormones estrogen and progesterone but levels can fluctuate wildly during your cycle. Erratic changes in hormone levels and gradual reduction in estrogen can cause menopause symptoms and your periods can become irregular, heavier, or lighter.
Be aware that certain medications (including hormonal contraceptives like the pill) can cause your periods to become less frequent or even stop, making it difficult to tell when you have reached menopause itself. If this is the case, speak to your healthcare provider for further advice.
What happens during perimenopause?
There are four main changes to your body, during perimenopause.
- Gradual loss of oocytes (your eggs)
- Fluctuations in hormone levels
- Irregular periods
- Significantly reduced fertility
The only one you can easily notice is the changes in your periods.
Even though it is very unlikely you will get pregnant in perimenopause, pregnancy is still a possibility and contraception is important – find out more about contraception during menopause.
Perimenopause phases
Perimenopause has two phases:
- Early transition. You might see a delay of more than seven days in your period or notice a skipped period. Your bleeding amount or pattern may also change.
- Late transition. Your period cycle may be as long as 60 days and become irregular. Your estrogen levels are still fluctuating but more consistently low.
Perimenopause ends when you reach menopause, at which point your ovaries are no longer producing eggs and your periods stop. The average age for menopause is 51 years old. Read more about the stages of menopause.
At what age does perimenopause start?
Perimenopause usually occurs between the ages of 45 and 55. Find out more about early menopause.
How long can perimenopause last?
Perimenopause starts up to 10 years before your menopause and lasts for four to eight years on average. Your menopause journey is unique to you and perimenopause can last just a few months or much longer for some.
Perimenopause symptoms and their duration differ from one person to another for many reasons, including:
- Medical history and family history
- The type of symptoms experienced
- Age
- Lifestyle, such as exercise, smoking, and drinking
- Cultural factors
What are the first signs of perimenopause?
One of the key signs of perimenopause is that your period changes and can become heavier, lighter, and/or irregular, even all of these but at different times! If your period is generally 28 days on the dot, but suddenly becomes all over the place – 25 days, 20 days, 35 days – it might be perimenopause. You might notice you feel mentally and emotionally off-kilter too.
When it comes to signs of perimenopause, there are around 34 symptoms. This isn’t an exhaustive list but some of the most commonly reported, including:
- Hot flashes or night sweats
- Vaginal dryness
- Mood swings
- Feeling anxious or depressed
- Poor concentration and brain fog
- Difficulty sleeping
- Weight gain
- Skin dryness and acne
- Skin sensations (tingling, crawling)
- Body aches and pain
Perimenopause symptoms
Every perimenopause is different in terms of the number, combination, duration, and severity of symptoms. Research has found:
- At least one-third experience hot flashes (Journal of Women’s Health)
- You are two to four times more likely to experience a major depressive episode when you are perimenopausal or just after menopause, according to one study of American women (Study of Women’s Health Across the Nation)
- In one study of 3,890 peri- to postmenopausal women screened, 67% experienced symptoms and 54% sought either medical input or some treatment concerning their symptoms. The decision to seek treatment was influenced by age, number, and severity of symptoms (source)
Discover your personalized treatment options
How is perimenopause diagnosed?
The most reliable way to be assessed for perimenopause is for your healthcare provider to review your symptoms. They may want to examine you or do some other tests to exclude other causes for your symptoms.
Hormone blood tests are not generally needed if you are over 45. This is because hormone levels fluctuate throughout menopause, and can be dramatically different from one day to the next. Blood tests taken in perimenopause do not give an accurate picture of where you are in your menopause journey and are therefore not particularly useful in most cases.
Current recommendations are for healthcare providers to assess your menopause status based on your age, menstrual cycle, and symptoms. Despite being seemingly lower-tech, this is the most accurate way of diagnosing perimenopause.
There are, however, certain exceptions to this. Blood tests may be useful if your symptoms are not typical, if you are under 45, or if you are using certain contraceptives.
Find out more about menopause tests.
How do you manage perimenopause symptoms?
The good news is there are practical things you can do to manage many menopause symptoms with simple lifestyle changes. It helps to:
- Manage stress with relaxation techniques, such as yoga and meditation
- Get quality sleep and practice proper sleep hygiene
- Managing weight and focus on menopause-friendly nutrition
- Be active with a mix of cardio exercise, stretching, and strength training
Can HT help with perimenopause?
If you are struggling with perimenopause symptoms, talk to your healthcare provider and find out what support or treatment is right for you. Hormone therapy (HT) is an effective treatment for many perimenopause symptoms and your healthcare provider can explain the risks and benefits to you.
What are the signs that perimenopause is ending?
Perimenopause ends when you reach menopause – when you haven’t had a period for a year and are not on hormonal contraception.
Many find that their symptoms ease around this time, although others may continue to struggle even after their periods have stopped.
What kind of complications should I expect?
Talk to your healthcare provider if you have:
- Severe hot flashes that make day-to-day life difficult
- Vaginal dryness and irritation that is interfering with your sex-life
- Heavy bleeding, blood clots and/or pain
- Bleeding after sex or outside your period
- Periods lasting much longer than usual
- Any other symptoms that are worrying or troublesome
Find out more about symptoms that need healthcare provider advice or heavy bleeding.
Final word
Knowing that perimenopause or menopause looks different for each person is essential.
If you’re feeling different – physically, emotionally, or mentally – make an appointment to see your healthcare provider for advice about treatment. Many hesitate to ask for support but talking to friends and family, even your colleagues and employer can really help.
Read more about menopause on our blog or in our symptoms library.
- Bromberger JT, Kravitz HM, Chang YF, Cyranowski JM, Brown C, Matthews KA. Major depression during and after the menopausal transition: Study of Women’s Health Across the Nation (SWAN). Psychol Med. 2011 Sep;41(9):1879-88. doi: 10.1017/S003329171100016X. Epub 2011 Feb 9. Erratum in: Psychol Med.2011 Oct;41(10):2238. PMID: 21306662; PMCID: PMC3584692.
- Constantine GD, Graham S, Clerinx C, Bernick BA, Krassan M, Mirkin S, Currie H. Behaviours and attitudes influencing treatment decisions for menopausal symptoms in five European countries. Post Reprod Health. 2016 Sep;22(3):112-22. doi: 10.1177/2053369116632439. Epub 2016 Feb 18. PMID: 26895640; PMCID: PMC5019289.
- Delamater L, Santoro N. Management of the Perimenopause. Clin Obstet Gynecol. 2018 Sep;61(3):419-432. doi: 10.1097/GRF.0000000000000389. PMID: 29952797; PMCID: PMC6082400.
- Menopause 101: A primer for the perimenopausal, The North American Menopause Society
- Santoro N. Perimenopause: From Research to Practice. J Womens Health (Larchmt). 2016 Apr;25(4):332-9. doi: 10.1089/jwh.2015.5556. Epub 2015 Dec 10. PMID: 26653408; PMCID: PMC4834516.
- Santoro N, Roeca C, Peters BA, Neal-Perry G. The Menopause Transition: Signs, Symptoms, and Management Options. J Clin Endocrinol Metab. 2021 Jan 1;106(1):1-15. doi: 10.1210/clinem/dgaa764. PMID: 33095879.
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