Perimenopause and menopause

Menopause means you’ve stopped having periods for a full year. In the years leading up to menopause, you’re in perimenopause. It usually starts in your mid to late 40s but can begin earlier.  

During perimenopause, levels of estrogen and progesterone fluctuate. Your periods may become less regular — typically lighter and further apart. But some people’s periods get heavier and closer together, with bleeding in between periods. If this happens, talk to your doctor. It could be perimenopause, or it could be something else, so we need to rule out other reasons. 

Perimenopause is also when symptoms like hot flashes, brain fog, and mood swings can begin. Although fertility declines during perimenopause, it’s still possible to get pregnant. Most people are in perimenopause for 2 to 8 years, but it can be longer or shorter.

Toward the end of perimenopause, symptoms like hot flashes, sleep disturbances, brain fog, and vaginal dryness may increase. Levels of estrogen, and progesterone hormones start to decline. 

When you’ve gone 12 months without having a menstrual cycle, you’ve reached menopause. Your ovaries have slowed down their production of estrogen and progesterone. On average, menopause occurs around age 51, but it can range from early 40s to late 50s. Symptoms may worsen, decline, or stop once you’ve reached menopause. Your doctor can help manage any symptoms that don’t subside on their own. 

The first thing many people notice is that their periods become less regular. They might start having symptoms like hot flashes. But everyone experiences perimenopause differently. Symptoms can be mild or severe, and they often change over time.

While you can’t predict exactly what will happen or when, your experience may be similar to what your mother and other family members went through. So, it can be helpful to talk to them about your experience and ask them questions. And if you think you’re in perimenopause, keep a record of how you’re feeling to share with your doctor. They can answer your questions and help you manage your symptoms. 

The earlier the better! Talk with your doctor whenever you have questions or if you start to have symptoms or irregular periods. A lot is happening to your body during this transition. Your doctor can help you manage your symptoms as they come, and get you started on a healthy path forward through menopause and beyond. 

Here are some questions you may want to ask your doctor: 

• Are there lifestyle changes that can ease my transition into menopause?
• How do I know if my symptoms are caused by menopause or something else?
• What treatment options are available for managing my symptoms? 
• Is hormone therapy right for me? 

Your care path will depend on your symptoms, health history, and personal preferences. Your doctor might recommend lifestyle changes, mental health support, medication, or a combination, depending on your needs. 

Learn about common symptoms and available treatments here. 

All of our ob-gyns and women’s health care providers have training in menopause care to help support members through this transition. Your doctor can answer your questions and connect you to additional resources and support as needed. 

Doctors usually diagnose perimenopause or menopause based on clinical signs and symptoms, rather than lab tests. Your care team will ask about changes in your menstrual pattern and symptoms you’re experiencing, and go from there. Hormonal testing is not recommended because your hormones are always fluctuating, which is what causes your symptoms. A hormone test would only capture your levels at one moment in time and might not reflect ongoing changes. 

When you’ve gone a full year without having a period, you’ve reached menopause. If this happens between the ages of 40 and 45, it’s called early menopause. If it happens before age 40, it’s called premature menopause. Sometimes early or premature menopause happens naturally. But in most cases, it’s due to health conditions, surgeries, or medications.

Talk to your doctor if you think you’re experiencing early menopause, because it can increase risk for certain health issues like osteoporosis and heart disease. Your doctor may want to rule out other conditions, especially if you’re under 45 and your period has stopped. 

Yes. You may experience changes in your emotions and mental health during perimenopause and menopause. These might include: 

• Trouble sleeping
• Exhaustion
• Mood swings
• Irritability
• Depression
• Anxiety
• Trouble concentrating
• Forgetfulness
• Worsening premenstrual syndrome (PMS)

Talk to your doctor about mental health symptoms you may have. Kaiser Permanente offers a range of mental health resources that can support you through this challenging transition. 

Hormone therapy (HT) is safe for most people. It’s usually a combination of 2 hormones, estrogen and a progestin. HT can come as a pill, patch, gel, spray, or vaginal ring. HT works by increasing the estrogen and progesterone levels in your body. It’s an effective way to relieve physical symptoms like hot flashes and night sweats. HT can also help with mental and emotional symptoms like mood changes and sleeplessness. 

HT isn’t guaranteed to relieve every symptom, but it can help improve quality of life for some people. There are also non-hormonal options that can help with perimenopause symptoms. 

Though generally safe for most people, HT can potentially increase risk for certain health conditions. These include: 

• Uterine cancer
• Heart disease
• Blood clots or stroke
• Gallbladder disease
• Breast cancer

Your doctor might not recommend HT if you’ve had — or have high risk for:

• Blood clots 
• Heart disease 
• Stroke
• Liver disease
• Estrogen-sensitive cancer, including breast cancer