Perimenopause is the transition period of five to seven years before a woman has her final menstrual period. During this time, she still has periods but begins to experience symptoms of menopause, such as hot flashes, night sweats, mood changes, and weight changes, according to board-certified OB-GYN Brandye Wilson-Manigat, M.D.
The term premenopause is sometimes used interchangeably with perimenopause, but they are not the same. Premenopause refers to any stage before menopause, while perimenopause is the specific hormonal transition that happens right before menopause.
Menopause itself is defined as the permanent end of menstruation. A woman is considered menopausal after she has gone 12 consecutive months without any bleeding. This designation is given on the day that marks 12 months after her last period. The terms menopausal and postmenopausal are often used to describe this period of a woman’s life, which continues for the rest of her life.
Two main factors trigger perimenopause: estrogen production and genetics. Fluctuations in ovarian estrogen production start the process, and genetics largely determine when a woman enters perimenopause and menopause. If a woman’s mother and older sister were still menstruating in their mid-50s, she likely will too.
Ethnicity may also play a role. Some research suggests that Hispanic American and Black-American women tend to enter menopause earlier than Caucasian-American and Japanese American women. Lifestyle and personal health history can also affect the timing. Menopause tends to occur earlier in smokers and women with autoimmune diseases such as hypothyroidism, rheumatoid arthritis, and Type 1 diabetes. Women who work the night shift may also experience menopause earlier.
Getting a first period at a younger age does not mean a woman will reach perimenopause younger. A 2018 study found that women who had their first period at a younger age actually had longer menopausal transitions.
Perimenopause lasts four years on average, but it can last as long as a decade. Symptoms typically appear in a woman’s mid-40s, but they can start anywhere from the late 30s to mid-50s.
There are over 30 physical indicators of perimenopause. Common symptoms include fatigue, hot flashes, night sweats, mood changes, changes in menstrual cycle length, skipped or missed periods, heavier periods, brain fog, sleep disturbances, dry skin, brittle hair, hair loss, body and muscle aches, vaginal dryness, increased urinary urgency and frequency, and weight gain. Fatigue, mood changes, and hot flashes or night sweats are often the first symptoms a woman notices.
To cope with symptoms, experts suggest layering clothing that is easy to remove and carrying a handheld fan for hot flashes. Staying hydrated with electrolyte-based drinks can help replenish fluids lost during hot flashes or night sweats and may reduce trips to the bathroom. Regular exercise can help with weight management and mood changes by releasing feel-good hormones and lowering stress levels.
Women should see a doctor when symptoms become bothersome. If a general practitioner is not helpful, switching to a more experienced expert is advised. One doctor noted that under 10% of women get appropriate treatment for perimenopause symptoms, leaving many to deal with symptoms that can increase the risk of cardiovascular disease, osteoporosis, cognitive issues, and sexual problems.
Even seemingly minor symptoms may require medical attention. Irregular, heavy menstrual bleeding can lead to anemia, which worsens fatigue and may require a blood transfusion. Poor sleep can worsen feelings of depression and fuel weight gain, increasing the risk of high blood pressure and diabetes. Speaking with a doctor can also help alleviate embarrassment or anxiety about symptoms.
