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 commonly associated with menopause, such as hot flashes, night sweats, mood changes, and weight changes, according to board-certified OB-GYN Brandye Wilson-Manigat, M.D.
The terms premenopause and perimenopause are sometimes used interchangeably, but they are not the same. Premenopause refers to any stage before menopause, while perimenopause specifically describes the hormonal transition that happens right before menopause. Menopause itself is defined as the permanent end of menstruation, confirmed after 12 consecutive months without any bleeding. Once a woman reaches that point, she is considered menopausal or postmenopausal for the rest of her life.
What triggers perimenopause
Perimenopause is triggered by changes in ovarian estrogen production, and the main factor that determines when a woman enters this stage is genetics, said Lauren Streicher, M.D., medical director of community education and outreach at Midi, a virtual care clinic. If a woman’s mother and older sisters had late menopause, 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 timing. Menopause tends to occur earlier in smokers and in women with autoimmune diseases such as hypothyroidism, rheumatoid arthritis, and Type 1 diabetes. Women who work night shifts also tend to reach menopause earlier.
One common belief that is not true is that getting a first period at a younger age leads to earlier perimenopause. A 2018 study found that women who started menstruating earlier actually had longer menopausal transitions.
How long perimenopause lasts
Research shows that perimenopause lasts four years on average, but in some cases it can last as long as a decade. Symptoms typically appear in a woman’s mid-40s, though they can start anywhere from the late 30s to mid-50s.
Perimenopause symptoms
There are over 30 physical signs of perimenopause, according to Streicher. 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, Manigat said. If a woman is unsure whether a symptom is due to perimenopause or another condition, the only way to find out is to visit a doctor. An experienced menopause expert can evaluate symptoms in the context of personal medical history, family history, and sometimes blood work.
How to cope with symptoms
For hot flashes, Manigat suggests wearing layers of easy-to-remove clothing and carrying a handheld fan. Staying hydrated with electrolyte-based drinks rather than plain water can help replenish fluids lost during hot flashes or night sweats and keep body temperature steady. Electrolyte drinks may also reduce the number of trips to the bathroom compared to plain water.
Regular exercise can help with weight management, mood changes, and stress levels by releasing feel-good hormones into the body.
When to see a doctor
Streicher advises seeing a clinician any time symptoms become bothersome. If a general practitioner is not helpful, switching to a more experienced expert is recommended. She noted that under 10% of women get appropriate treatment for perimenopause symptoms, and untreated women are at increased risk for cardiovascular disease, osteoporosis, cognitive issues, and sexual problems.
Manigat added that even seemingly minor symptoms may require medical attention. Irregular, heavy menstrual bleeding, if untreated, can lead to anemia, which worsens fatigue and sometimes requires 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.
