Everything You Need to Know About Perimenopause

Perimenopause is the time before menopause, and it marks the transition to the end of your reproductive years. Learn more about perimenopause symptoms, when it typically begins, and what it means for your reproductive health.

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Before they experience menopause, women must go through a transitional period called perimenopause. "Just like the word perimeter means the area around an object, perimenopause is the time around menopause. It's a transitional window from reproduction into post-reproduction," explains Mache Seibel, M.D., faculty member for menopause treatment at Harvard Medical School Beth Israel Deaconess Medical Center, and author of The Estrogen Fix: The Breakthrough Guide to Being Healthy, Energized, and Hormonally Balanced.

During perimenopause, the reproductive hormones (mainly estrogen) become unbalanced in the body. As a result, women might have irregular menstrual cycles, hot flashes, weight gain, and other symptoms. Keep reading to learn more about the signs of perimenopause, when it starts and ends, and how it affects your chances of getting pregnant.

When Does Perimenopause Start?

Perimenopause happens at a different time for everyone, but it typically starts during your 30s or 40s. Perimenopause typically lasts between 1 year and 3 years, but it sometimes sticks around up to 10 years, says Dr. Seibel. It ends when the ovaries stop releasing eggs and you haven't had a period for 12 months, which signals that menopause has officially started.

According to Dr. Seibel, "Menopause begins, on average, at age 51 in the United States. But up to 5-10 percent of women will already be in menopause at age 45, and one in 100 will be in menopause at age 40." By the time they begin menopause, then, most women have experienced perimenopause symptoms for several years.

What are the Signs of Perimenopause?

"There are many signs of perimenopause," says Dr. Seibel. Some women have extremely noticeable symptoms that affect their everyday life, while others barely detect any changes. Here are some of the telltale signs to watch for.

  • Changes in the menstrual cycle. Your periods may be "lighter, further apart, closer together, or variable," says Dr. Seibel. To signal early perimenopause, these menstrual changes must persist for at least seven days.
  • Hot flashes. These typically occur randomly, and they last for several minutes. Hot flashes might also cause chills, sweating, and flushing.
  • Night sweats
  • Difficulty sleeping
  • Mood swings
  • Forgetfulness
  • Irritability
  • Changed sex drive
  • Slight changes in skin (acne, hair growth, dryness, etc..)
  • Weak bladder (urinary incontinence)
  • Weight gain
  • Decreased fertility (it becomes harder to get pregnant)

Even though these perimenopause symptoms are normal, Dr. Seibel recommends visiting your OB-GYN if you notice them. "You have to exclude other conditions that could be common with these symptoms too," he says. "It's a good time to start getting a general bill of health."

Women should also call their doctor for heavy vaginal bleeding, prolonged bleeding (longer than seven days), spotting, blood or clots. Your healthcare provider might want to rule out fibroids, hormonal imbalances, and certain types of cancer.

Can You Get Pregnant During Perimenopause?

"It's harder to get pregnant during perimenopause, but it can categorically happen," says Dr. Seibel. Women who are trying to conceive during perimenopause might rely on fertility treatments like in vitro fertilization (IVF). If you don't want to conceive, use a form of birth control until you've officially reached menopause (12 months without a period).

One option is hormonal birth control pills, which can also relieve some of the symptoms associated with perimenopause. If you do take the pill, though, Dr. Seibel points out that you won't get your monthly menstrual cycle. (Women get a "withdrawal bleed" during the placebo pills due to a decrease in hormone levels, which isn't the same thing). Therefore women on the pill wouldn't necessarily realize they're going through perimenopause or menopause. Talk to your doctor for more information about taking hormonal pills during this time.

How Can You Treat Perimenopause Symptoms?

Many women don't need assistance dealing with perimenopause symptoms, but others feel more comfortable with slight intervention. The most common treatment options are hormonal therapy, medication, and lifestyle changes.

Hormonal Treatment

Because many perimenopause symptoms result from decreasing estrogen levels, hormone therapy may help relieve them. Your doctor may recommend taking estrogen in the form of a pill, gel, vaginal ring, cream, or skin patch. This treatment option is especially helpful for hot flashes and night sweats.


A form of antidepressants called selective serotonin reuptake inhibitors (SSRIs) has also been shown to relieve hot flashes. They may also control mood swings and irritability.

Lifestyle Changes

The following lifestyle changes can also help with perimenopause symptoms.

  • Use water-based vaginal lubricants (preferably those without glycerin) to relieve vaginal irritation.
  • Get sufficient exercise to prevent weight gain, promote better sleep, and decrease the irrationality and mood swings associated with perimenopause.
  • Maintain a regular sleep schedule.
  • Stop smoking.
  • Eat a healthy diet with enough calcium, fiber, fruits, vegetables, and whole grains.

No matter which treatment method you choose, it's important to realize that your perimenopause symptoms might change over time. "People can find something that works, but they have to remember they are in transition. Just like puberty doesn't end in a minute, neither will this," says Dr. Seibel.

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