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The buildup to menopause: Perimenopause

A lot of what you hear about menopause is really about perimenopause— the time before menopause when your hormone levels start to fluctuate, often causing symptoms such as hot flashes, irregular cycles, and, eventually, the end of your periods altogether. 

Perimenopause can start as early as your 30s or as late as your 50s, but for most people, the first signs appear in their mid-40s. On average, this transition phase lasts about four years, but there is a lot of variation between women. Once you’ve gone a full year without a period, you’ve reached menopause.

Preparing for menopause: The most common signs of perimenopause

While each person experiences perimenopause differently, here are some things you might notice: 

Changes in your menstrual cycle

For many people, the first sign of perimenopause is irregular periods. Your cycle might become longer or shorter, and your periods may be lighter or heavier. You may skip periods. Eventually, periods stop.

Hot flashes

About 75 percent of women experience hot flashes around the time of menopause. When a hot flash happens, your face and body suddenly feel hot and you may sweat or develop red blotches. Hot flashes vary in intensity and duration. They can last 30 seconds or up to 10 minutes, and they can happen any time. When hot flashes happen at night, they’re called night sweats. Hot flashes and night sweats are also called vasomotor symptoms.  

For most women (about 80 percent), the hot flash phase lasts two years or less. However, it’s not uncommon to have an occasional hot flash later, even after menopause. There are both lifestyle changes and medications that may help with hot flashes. 

Mood changes

Studies show that up to 23 percent of women have mood changes during and after perimenopause. Changing hormones and sleep disruptions can contribute to mood swings or a lower mood for some people. Menopause also happens at a time when life can be packed with stressors — from aging parents to children getting ready to leave home to careers in full swing. 

There’s no simple way to untangle exactly what causes any one person’s mood changes. If you’re concerned about your mood— especially if you have symptoms of depression— please talk to your healthcare provider for support and if medication is a good option for you.

Trouble sleeping

Nighttime hot flashes, mood changes, and major life events can all make it harder to sleep well. Managing the things that keep you from sleeping (like stress and hot flashes) and building healthy sleep habits can help. Menopause hormonal treatment may help with sleep.

Vaginal dryness

Estrogen helps keep the vagina elastic and moisturized. As estrogen levels fluctuate, some women notice vaginal dryness and discomfort during sex. Regular use of an over-the-counter moisturizer and lubricant during sex can make a huge difference. Hormonal therapy is also available.

Taking care of yourself during perimenopause and beyond

If you notice perimenopause symptoms that bother you, there are lots of approaches to help. Some lifestyle adjustments, like eating well, exercising regularly, or sleeping with a fan and dressing in layers can bring relief. There are also some proven natural remedies (keep in mind that some “natural” treatments make big promises and don’t deliver — so always check with your healthcare provider first). Many women also opt for hormone therapy to ease symptoms and reduce health risks. 

If the changes around menopause are frustrating or uncomfortable for you, talk to your healthcare provider. You can work together to find an approach that matches your symptoms, preferences, and lifestyle.

Reviewed by the Ovia Health Clinical Team

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