What Is Perimenopause?

When you hear the word menopause, what’s the first thing you think of? For most folks, the answer is probably hot flashes. And while that word association is certainly true, there’s so much more to menopause than just that single infamous symptom! A whopping 1.3 million women in the U.S. become menopausal each year (1). But, how do they know they’re menopausal, how old are they when symptoms start, and what do they do about it?

Those are all valid questions to have–and they’re not talked about enough. That’s why we’re here to discuss all things (peri)menopause, including signs of perimenopause, early signs of menopause, and what it all means for you and your health. Let’s dive in.

Perimenopause vs. menopause

First things first, let’s clear up the difference between perimenopause and menopause. Perimenopause, sometimes called the menopausal transition, is the phase leading up to menopause.

During this phase, your ovaries gradually start producing less estrogen. Estrogen is one of the hormones responsible for regulating your menstrual cycle. So, as your hormone levels fluctuate, you might start having larger gaps between periods or missing periods altogether. If the opposite happens and your cycles are shorter than 21 days or you’re spotting in between, go ahead and reach out to a doctor! You might also start experiencing symptoms often associated with menopause, even though you’re still having periods. More on these symptoms in a bit.

Everyone’s experience with this transitional phase is different. You might deal with the signs of perimenopause for just a few months, but many people have symptoms for years. But that doesn’t mean you have to suffer through them! Treatments are available to make sure your symptoms don’t interrupt your daily life.

Perimenopause ends when you hit menopause. Menopause is less of a phase and more of a doorway you step through. It happens when your menstrual cycle comes to a stop–officially marked when you go a full year without having a period.

• Perimenopause: The transitional phase leading up to menopause that can last a few months or several years, when you might start having symptoms similar to menopause
• Menopause: When your menstrual cycle officially stops, marked as the point when you’ve gone 12 months without a period

What are the symptoms of perimenopause?

During perimenopause, your estrogen levels are on the decline overall–but they can still spike now and again (just to keep things interesting 🙃). Everyone’s body reacts differently to these hormonal changes and symptoms vary from person to person.

That said, the first signs of perimenopause are often irregular, skipped, or unusually heavy or light periods. But! That doesn’t mean you can’t get pregnant during perimenopause. Even if your periods have been irregular, you should still stick to your birth control if you don’t want to get pregnant.

Some common symptoms of perimenopause include (2, 3, 4):

• Irregular periods: Early in perimenopause your cycle might only change by a few days, while in late perimenopause you might go two months without a period.
• Hot flashes: Over 60 percent of women in late perimenopause experience hot flashes, but they vary in intensity and frequency.
• Sleep changes: Both hot flashes and general hormonal changes can make it harder to fall asleep and stay asleep during perimenopause.
• Mood changes: Perimenopause can cause irritability, increased anxiety, and higher rates of depression.
• Bladder problems: You might need to pee more often during perimenopause and lower estrogen increases your risk of developing UTIs.
• Fatigue: Perimenopause fatigue is very real, as one study showed that 46 percent of perimenopausal women experienced physical and mental exhaustion.
• Hair changes: Hormonal fluctuations can make your hair lose volume, feel thinner, or change texture.
• Concentration difficulties: Perimenopause can cause brain fog and make it hard to concentrate, not helped by overall fatigue and increased anxiety.
• Changes in libido: Hormone changes can make your sex drive increase or decrease during this time.
• Vaginal dryness: Decreases in estrogen can lead to vaginal dryness, which can improve when treated properly. Common options include Estradiol Vaginal Cream, non-hormonal moisturizer, and external vulvar moisturizer.

Like we mentioned, the symptoms and signs of perimenopause are different for everyone. The transition to menopause can last several years and symptoms often become more noticeable as time goes on. So, if you’re wondering if your symptoms are related to perimenopause, consider reaching out to a healthcare provider and know that treatment options exist!

What age does perimenopause start?

Unfortunately, it can be hard to pinpoint exactly when perimenopause starts. Perimenopause typically starts in your 40s, but it can begin as early as your mid-30s or as late as your early 50s. So, if you’re concerned you’re experiencing signs of menopause at 35, you might be starting perimenopause. But! This transition can last for years and having some early symptoms definitely doesn’t mean you’re menopausal.

During the early stage of perimenopause, your estrogen levels start to fluctuate and your periods can start coming a little later–usually around seven days later. The later stage of perimenopause is marked by lower estrogen production, going 60 days or more without a period, and experiencing more early signs of menopause. Perimenopause ends when your periods stop for good and you officially transition into menopause.

What age does menopause begin?

Funnily enough, you can’t really figure out when you’ll enter menopause until it’s already happened. If you have ovaries, they’ll eventually stop producing estrogen and releasing eggs–meaning your period stops. You step through the menopause threshold when you haven’t had a period for 12 consecutive months.

Women typically go through menopause when they’re between 45 and 56 years old. The average age for menopause in the U.S. is 51 years old (1). This means that women spend about 40 percent of their lives in the postmenopausal years! That’s more than 30 years of postmenopausal living for most women! There are plenty of treatment options available for bothersome menopause symptoms, which means we can all look forward to absolutely thriving during these years of our lives. 😎

Even though the average age of menopause is 51, it’s important to note that about five percent of women naturally go through early menopause between 40 and 45 years old. One percent of women experience premature menopause, also called primary ovarian insufficiency, and stop having periods before age 40 (1).

How do I know I’m menopausal?

If you’ve been dealing with some early signs of menopause like hot flashes, mood swings, brain fog, or fatigue, it’s totally normal to wonder if you’re menopausal! But, until you go a full year without a period, you might still be ovulating and you’ll still be considered perimenopausal.

Key indicators of menopause include:

• Going 12 months without a period
• High and variable follicle-stimulating hormone (FSH) levels
• Consistent menopausal symptoms

Starting perimenopause and heading towards menopause can be a long and gradual transition. But, just because it’s a natural process doesn’t mean you have to endure or suffer through the symptoms! Healthy diet, regular exercise, and avoiding alcohol and cigarettes can help you manage mild symptoms–but plenty of stronger treatment options also exist. As always, you know your body best! Reach out to a healthcare provider to discuss what signs of menopause your experiencing and what treatments will work best for you. With the right knowledge, support, and care you can navigate this transition with confidence.