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 also experiences 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 hormonal transition that comes right before menopause. Menopause itself is defined as the permanent end of menstruation, confirmed after 12 consecutive months without any bleeding. This stage lasts for the rest of a woman’s life, and the terms menopausal and postmenopausal are often used to describe this period.
Causes and timing
Perimenopause is triggered by changes in ovarian estrogen production. Genetics is the main factor that determines when someone enters perimenopause and menopause, said Lauren Streicher, M.D., medical director at Midi, a virtual care clinic for 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 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 also tend to reach menopause earlier.
Getting a first period at a younger age does not mean a woman will reach perimenopause younger or get through it faster. A 2018 study found that women who started menstruating at younger ages actually had longer menopausal transitions.
Duration and symptoms
Research shows 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 can start anywhere from her late 30s to mid-50s.
There are over 30 physical signs 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 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. To know if a symptom is due to perimenopause or something else, a doctor visit is needed. An experienced menopause expert can evaluate symptoms based on personal medical history, family history, and sometimes blood work.
Managing symptoms
For coping with hot flashes, experts suggest layering easy-to-remove clothing and carrying a handheld fan. Staying hydrated with electrolyte-based drinks can help replace fluids lost during hot flashes or night sweats and keep body temperature steady. 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 recommended. One doctor noted that under 10% of women get appropriate treatment for perimenopause symptoms. Untreated symptoms can increase the risk of cardiovascular disease, osteoporosis, cognitive issues, and sexual problems.
Irregular, heavy menstrual bleeding that is not treated can lead to anemia, which worsens fatigue and sometimes requires a blood transfusion. Poor sleep can worsen depression and fuel weight gain, which raises the risk of high blood pressure and diabetes. Speaking with a doctor can also help reduce embarrassment or anxiety about symptoms. More conversations about perimenopause can make the condition less mysterious and more manageable.
