Am I in Perimenopause? Key Signs, Symptoms, and What to Expect

If you’re in your 30s, 40s, or 50s and have begun experiencing mood swings, hot flashes, or unusual changes in your menstrual periods, these may be early signs of perimenopause. 

Perimenopause refers to the years in a woman’s life when the body is naturally transitioning towards menopause. New symptoms that develop during this phase of life can be confusing or unsettling, and some women may no longer feel entirely in control of their minds and bodies as they once did. 

Understanding the signs of perimenopause is the first step toward feeling empowered in your menopause journey. This article will help you gain a thorough understanding of perimenopause, explore effective ways to manage symptoms, and recognize when it’s time to seek support from your healthcare provider.

What is perimenopause, really?

Menopause doesn’t happen overnight. It’s a transition that occurs in stages, starting with perimenopause. If you’ve never heard the term “perimenopause,” here’s what you need to know about this natural phase of life.

Defining Perimenopause: The Transition to Menopause

Perimenopause, also known as the menopause transition, refers to the years leading up to a woman’s final menstrual period (FMP). During this time, the body undergoes numerous physiological changes as it approaches menopause.⁽¹⁾⁽²⁾ 

What hormonal changes drive perimenopause?

Levels of estrogen, progesterone, and testosterone begin to shift during perimenopause as the ovaries start to produce less of these sex steroid hormones. These hormones play an important role in reproductive life events like puberty, pregnancy, and menopause.⁽³⁾ Levels of a fertility-related hormone called follicle-stimulating hormone (FSH) also change during the menopause transition.⁽⁴⁾ These hormonal fluctuations can affect everything from digestion to sleep to bone and muscle health, leading to new and often uncomfortable symptoms.

When does perimenopause typically start, and how long does it last?

Most women enter perimenopause between the ages of 45 and 55, with the average age being around 47.⁽²⁾⁽⁵⁾ However, symptoms can set in as early as a woman’s 30s or early 40s.⁽¹⁾ Perimenopause lasts an average of four years, although some women may spend anywhere from five to ten years in this transitional stage.⁽¹⁾⁽²⁾ The severity of symptoms, the age at which a woman reaches perimenopause, and each woman’s personal experience of the menopause transition can vary significantly.

Perimenopause vs. Menopause: Clearing Up the Confusion

Perimenopause and menopause share many similarities, but there are key differences between the two stages.

The Defining Difference: When does perimenopause end and menopause begin?

Perimenopause ends when a woman has gone 12 consecutive months without a menstrual period, indicating that they have reached the threshold of menopause. Postmenopause encompasses the years after a woman’s final menstrual period, which means that the late perimenopause stage and early postmenopause stage may share some overlap.⁽¹⁾⁽²⁾ 

Once perimenopause comes to an end, hormone levels continue to fall, and symptoms may continue throughout menopause and the early postmenopause stage. However, symptoms often improve as women progress through postmenopause and hormone levels eventually stabilize.⁽⁶⁾ 

Important Note: Pregnancy is still possible during perimenopause.

It’s still possible to become pregnant during perimenopause. This is because women are still menstruating during this phase of life, even if periods may be irregular. Once periods stop completely during menopause, a woman is no longer in her reproductive years.⁽⁵⁾ 

Recognizing Common Changes: Are these perimenopause symptoms? 

If you suspect your symptoms may be related to perimenopause, you’re not alone. Over 80% of women experience perimenopausal symptoms.⁽⁴⁾ However, if you’re still unsure whether you may be in the menopause transition, the following are common changes to look out for that may give you some clues. Want help keeping track of your symptoms? Download Winona’s Ultimate Menopause Tracking Guide.

Irregular Menstrual Periods

Changes in menstrual periods are a signature symptom of perimenopause. Periods may last longer or shorter than usual, and the flow may become lighter or heavier. You may also begin to miss periods, which is common during the early stages of perimenopause. As women move into the late perimenopause stage, periods typically become even more irregular.⁽²⁾⁽⁵⁾

Hot Flashes

Hot flashes are particularly common during the late perimenopause stage. A hot flash is a rush of heat in the upper body that may last for several minutes. They are thought to be caused by hormonal changes that affect the central nervous system and impact the body’s ability to regulate temperature.⁽⁴⁾ 

Night Sweats

Night sweats are also a key symptom of perimenopause. Excessive sweating during sleep can cause frequent awakenings, disrupting rest and making it harder for women to function during the day.⁽⁴⁾ 

Sleep Disturbances

Sleep can suffer during perimenopause. While vasomotor symptoms may be a contributing factor, approximately 40% of women are affected by sleep disorders during the menopause transition, such as insomnia and sleep apnea.⁽⁴⁾

Mood Swings and Irritability

Changes in mental health can be a particularly isolating symptom for women in this phase of life. If you’ve been feeling more irritable lately, sometimes called menopause rage, it may be a sign of perimenopause. Low mood is also a common psychological symptom of the menopause transition. Research shows that the risk of a major depressive episode is two to four times higher in perimenopausal women.⁽¹⁾ 

Increased Anxiety

Some women experience heightened anxiety during the menopause transition. A study found that premenopausal women with previously low anxiety levels were more likely to experience high anxiety during the early or late perimenopause stage.⁽⁷⁾

Changes in Emotional Well-Being

Perimenopausal symptoms can negatively impact women’s quality of life. One study showed that quality of life decreased among perimenopausal and menopausal women but increased during the postmenopause stage.⁽⁸⁾

Vaginal Dryness and Discomfort

Fluctuating estrogen levels can cause the vaginal lining to become thin and dry. This may make sex painful, making it harder for women to experience orgasms.⁽⁴⁾

Changes in Libido (Sexual Desire)

If your interest in sexual activity has dipped, it may be a sign of perimenopause. Mood changes and vaginal dryness can contribute to a loss of sexual desire.⁽⁴⁾

"Brain Fog" or Cognitive Changes

Brain fog, difficulty concentrating, and forgetfulness are common complaints during the menopause transition. In most cases, cognitive function returns to normal during the late perimenopause stage.⁽⁴⁾

Fatigue

Along with irregular periods and vasomotor symptoms, fatigue is one of the main symptoms of perimenopause. If you’re feeling excessively tired or sapped of energy on a daily basis, you may be entering the menopause transition.⁽⁴⁾

Weight Gain and Metabolic Changes

As the ovaries produce less estrogen, changes in metabolism and weight distribution can occur. Estrogen also helps regulate hunger, so as hormone levels decline, some women may feel hungrier and find themselves eating more. Abdominal weight gain is particularly common during this phase of life.⁽⁹⁾

Skin and Hair Changes

Lesser-known signs of perimenopause include changes to the skin and hair. The skin may sag and become dry or itchy. Wrinkles may also develop as collagen production decreases. Some women may also notice changes in hair growth, with less growth occurring on the scalp and mild hair growth developing on the face.⁽¹⁰⁾

Bladder Issues

Hormonal changes can lead to bladder problems. If you find yourself going to the bathroom more often than usual or experiencing increased urinary urgency or bladder leakage, these symptoms may be related to perimenopause.⁽⁴⁾ 

Breast Tenderness

Breast tenderness can occur during early perimenopause, although it tends to go away as women enter the late perimenopause stage.⁽¹¹⁾ 

How do I know if it's perimenopause?

Many perimenopausal symptoms can also be signs of other health conditions. This can make it hard to know for sure whether you’ve entered the menopause transition. That’s where a healthcare provider can help.

Why Consulting a Healthcare Provider Is Important

It’s important for women to consult with their doctor to determine the underlying cause of their symptoms. Doing so also ensures that perimenopausal women receive the support and care they need. Research shows that up to 90% of women may visit a doctor for menopausal symptoms. Without knowing the signs of perimenopause, women may delay seeking medical treatment.⁽¹⁾⁽²⁾

How Doctors Typically Diagnose Perimenopause

The menopause transition is a natural life event, not a health condition. There’s no specific test that can diagnose perimenopause. Instead, a doctor will consider a patient’s age, symptoms, medical history, and medication use to determine whether they’re in perimenopause and if they may benefit from hormone replacement therapy (HRT). Want to know if HRT is right for you? Take Winona’s brief quiz to see if you’re eligible for treatment. 

Understanding Hormone Tests

Hormone tests are used to detect hormonal imbalances in the body. While they can be helpful in diagnosing certain health conditions, such as thyroid disorders, hormone levels change on a daily basis. Therefore, hormone testing is not considered a reliable means of determining a woman’s menopause status. 

FSH levels are known to increase during perimenopause, and FSH hormone testing has sometimes been used to assess ovarian aging. However, the hormone is not directly associated with decreased ovarian function, so the test cannot be solely used to diagnose menopause.⁽²⁾⁽⁴⁾ 

For these reasons, hormone testing for women is not recommended by the American College of Obstetricians and Gynecologists (ACOG), the Menopause Society, or Winona for dosing or monitoring HRT treatment in women.⁽¹²⁾ 

Managing Perimenopause: Options for Symptom Relief and Well-Being

Perimenopause is a natural process that every woman goes through. However, it doesn’t mean you have to endure the discomfort that can come with this transition.

Lifestyle Strategies: Diet, Exercise, Stress Reduction, and Trigger Avoidance

The following lifestyle changes can support women’s health and help manage perimenopausal symptoms:⁽¹³⁾

• Getting plenty of sleep

• Exercising regularly

• Eating a healthy diet

• Prioritizing foods rich in calcium, vitamin D, and B vitamins

• Avoiding hot flash triggers like caffeine, alcohol, and spicy foods

• Wearing light clothing to keep cool

• Drinking cold water

• Keeping the indoor temperature low 

• Managing stress levels

• Seeking emotional support from a mental health professional or a community support group

Medical Treatments: Understanding Hormone Replacement Therapy (HRT)

HRT is the most effective medical treatment for menopausal hot flashes, night sweats, and vaginal symptoms.⁽¹²⁾ It works by supplementing low levels of estrogen and progesterone in the body. Some women may experience symptom relief within a few weeks, although it can take a few months to reach full effectiveness.⁽¹⁴⁾

Winona uses bioidentical hormones, which are molecularly identical to the hormones made in the female body. Treatments are available in different forms, such as oral capsules, transdermal patches, and localized topical products, to best suit each patient’s needs. Take the first step towards feeling better by exploring Winona’s individualized HRT options tailored to you.

Other Medications and Therapies for Specific Symptoms

There may be instances in which other medications may be better suited to treat specific perimenopausal symptoms. For women experiencing low mood, a doctor may recommend antidepressants. Some antidepressants have also been shown to potentially reduce hot flashes.⁽¹⁵⁾

Certain herbal remedies may also help relieve perimenopausal symptoms, such as black cohosh, evening primrose oil, and ginseng, among others.⁽¹⁶⁾ However, these supplements are not approved by the U.S. Food and Drug Administration (FDA), and there’s limited scientific evidence regarding their dosing, safety, and effectiveness. Women should always consult with their healthcare provider about potential side effects and drug interactions before taking any supplements. 

Considering Bone and Heart Health During Perimenopause

Maintaining bone and heart health becomes increasingly important during perimenopause. Women experience bone loss as estrogen levels decrease, which increases their risk of osteoporosis.⁽⁴⁾ Menopause is also considered a risk factor for coronary heart disease (CHD). Hormonal changes during this phase may raise triglyceride levels and “bad” LDL cholesterol, while levels of “good” HDL cholesterol may also decline.⁽¹⁷⁾ 

Maintaining a healthy diet, getting regular exercise, and prioritizing calcium and vitamin D intake are important steps women can take to manage their bone and heart health as they age.⁽⁵⁾ HRT may also offer cardiovascular benefits and help reduce women’s risk of osteoporosis.⁽¹²⁾

When to Seek Further Medical Advice for Perimenopause Symptoms

Although lifestyle changes can help manage perimenopausal symptoms, there are cases in which women should consult with their doctor for medical advice.

Red Flag Bleeding Patterns That Need Attention

Menstrual cycle irregularities are common during perimenopause, but it’s important to check with your doctor if you experience any kind of abnormal uterine bleeding (AUB). This includes irregular periods with cycle length changes of seven to nine days, menstrual cycles lasting longer than 35 days or shorter than 21 days, the absence of a menstrual period for three to six months, or bleeding after menopause.⁽¹⁸⁾ 

If Symptoms Severely Impact Your Daily Life and Well-Being

Women should seek medical advice if the physical, cognitive, or emotional symptoms of perimenopause are making it difficult to function on a daily basis. A doctor can assess for any underlying health conditions and help develop a personalized treatment plan.

While the menopause transition can be a confusing and overwhelming time for many women, perimenopause is manageable. With comprehensive knowledge, proper medical care, and a strong support system, women can feel confident and prepared for the natural changes their bodies go through. Winona is here to be part of that support system. Get the resources and help you need with our live expert Q&A sessions and perimenopause resources to make the transition smoother.