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Perimenopause is the transition into menopause — which sounds simpler than it actually is. Because while menopause just means you’ve stopped having periods, perimenopause has a lot more layers. In fact, when most people talk about menopause symptoms, they’re actually describing what happens in perimenopause. If that seems confusing, you’re right! We’re here to help clarify.
Perimenopause comes with many physical and emotional changes — and everyone’s experience is different. But the more you know about perimenopause, the more confident and empowered you’ll feel on your path through it.
What is perimenopause?
Menopause isn’t an event. It’s a process, like puberty. Perimenopause is a part of that process — it’s the time leading up to menopause. Hormone levels start to fluctuate. Your menstrual cycle becomes less regular. And this is when symptoms commonly associated with menopause, like hot flashes, are the most intense.
Perimenopause is unpredictable — and often misunderstood. In fact, most people in perimenopause feel completely uninformed about it. It’s common to have a lot of questions: How long will it last? What can I do to feel better? Am I normal?
Unfortunately, there are no one-size-fits-all answers. “Perimenopause manifests in many, many different ways,” explains Dr. Aisha Redmond, an OB/GYN at Kaiser Permanente. There’s no “normal” way to experience it — and understanding that is an important first step on this journey.
When does perimenopause start? How long will it last?
Perimenopause doesn’t happen on a set timeline. It can start any time before menopause, usually in your mid to late 40s. However, ages vary — some people start having perimenopause symptoms in their 30s.
How long perimenopause lasts is also different for everyone. Typically it’s between 2 and 8 years. But it can be longer or shorter. When you’ve gone 12 months without a period, perimenopause is over. You’ve experienced menopause and transitioned into postmenopause.
Symptoms of perimenopause
Perimenopause affects both the body and the mind. According to Dr. Redmond, there are about 60 different potential symptoms of perimenopause.
Symptoms often come and go — and change over time. And they can range from mild to debilitating. For example, as Dr. Redmond shares, “Some people have hot flashes once a day. Others have them 5 times an hour.” Both of those experiences are completely normal. Understanding symptoms and how to manage them can help make it all a little easier.
Physical symptoms of perimenopause
So many changes happen to your body in the transition to menopause. Here are some of the most common:
- Irregular periods that may be longer, shorter, lighter, or heavier.
- Hot flashes and night sweats that can make you suddenly very hot and uncomfortable.
- Body changes including weight gain, thinning hair, and dry or irritated skin.
- Sleep problems that can make it harder to fall or stay asleep and make you feel tired throughout the day.
- Vaginal dryness which can cause discomfort or make having sex painful.
Mental and emotional symptoms of perimenopause
Perimenopause doesn’t just affect your body. It affects your emotions, too. Hormonal changes in perimenopause change the way your brain works. And this has a huge impact on your mood. For example, you might feel more sensitive, stressed, or irritable.
It’s important to know that these feelings are real and valid. And to reach out to your doctor if you need help dealing with them.
- Mood swings can make you experience more frequent ups and downs.
- Depression or anxiety symptoms can appear for the first time. Or they may become worse if you’ve experienced anxiety or depression before.
- Brain fog can make you forget things or have trouble focusing.
- Changes in sex drive can make you feel less interested in sex. You may find it more difficult to orgasm.
Is it perimenopause, or something else?
Part of what makes perimenopause so confusing is that many symptoms mirror other health conditions. And there’s no test to confirm perimenopause. At a certain age, pretty much any change in how you feel could potentially be related to perimenopause. Or it could be something else. For example:
- Weight gain and fatigue could be a sign of a thyroid condition.
- Sleep problems could mean you’ve developed sleep apnea.
- Heavy or painful periods could be caused by uterine fibroids.
- Brain fog can be confused with attention deficit hyperactivity disorder (ADHD) or early signs of dementia.
That’s why it’s so important to talk to your doctor about any of these changes. They can help you rule things out and get to the bottom of what’s causing your symptoms.
What can help with perimenopause?
If perimenopause symptoms are bothering you, you don’t need to just tough it out. Your doctor can support you. Healthy lifestyle choices can help you manage symptoms. And talking about what you’re going through with others can empower you along the way.
Talking to your doctor
Your doctor can recommend treatment based on your symptoms, health history, and preferences. Here are some of the most common options:
- Hormone therapy (HT) works by replacing the hormones your body loses during perimenopause. HT can help with hot flashes, vaginal dryness, mood swings, and more.
- Low-dose birth control can help regulate your periods. It can even reduce hot flashes, brain fog, and mood swings.
- Certain antidepressants can help balance brain chemicals affected by hormone changes.
“There’s no magic bullet,” explains Dr. Redmond. “It’s an ongoing conversation between you and your doctor. As your perimenopause symptoms change, we might try different things.”
Keeping track of your symptoms
Perimenopause is unpredictable. Writing down what you’re feeling and when can help you spot patterns — and even stay ahead of symptoms. For example, you can limit caffeine if you notice it triggers hot flashes. Tracking your symptoms also gives your doctor a deeper understanding of how to best support you. And it’s a great way to measure your own progress as you figure out what works for you.
Making simple, positive lifestyle changes
- Prioritize sleep — Try to go to bed at the same time every night. A consistent relaxation routine can help you sleep better. And keeping your bedroom cool can help with hot flashes and night sweats.
- Move your body — Exercise can help improve mood, sleep, and energy. You don’t need to work out hard — just consistently. Even a short walk a few times a week can help.
- Address stress — Take 10 minutes a day to unwind and reset. Deep breathing. Stretching. Spending time in nature. These are all simple ways to decompress.
- Be kind to yourself — Recognize that this transition isn’t easy. Give yourself permission to take breaks, ask for help, and not be perfect.
Finding comfort in community
Perimenopause can feel lonely — but it shouldn’t be. Chances are, you have at least one friend going through it. Or a family member who has been there, done that. Connecting with others through this shared experience can be uplifting and empowering.
“I’ve heard so many patients say, ‘I thought it was just me,’” emphasizes Dr. Redmond. But you’re not alone in this. “Be each other’s buddies. Share your experiences. Creating a community can help you get through these tough times.”
Talking with family can be especially helpful — since most people’s perimenopause experience mirrors what their moms, aunts, and other relatives went through. But even people you don’t know can offer valuable perspective and support. Local or online support groups can be a great resource. Podcasts and blogs can also offer insight — and much-needed humor. Just be sure to fact check any health advice with your doctor.
Do perimenopause supplements work?
There’s a multimillion-dollar market for supplements that claim to help with perimenopause symptoms. Some people swear by them — but there’s not a ton of evidence that they work. As Dr. Redmond advises, “If a friend tells you a supplement is helping with their symptoms, it’s OK to give it a try. But you should check with your doctor first, especially if you have a lot of other health issues.”
Perimenopause can be hard. Be easy on yourself.
Perimenopause comes with a lot of unknowns. And while everyone’s experience is unique, giving yourself grace through this natural transition is good advice for anybody. Just remember: It’s normal to have questions. It’s OK to have hard days. And you’re not alone.