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What is perimenopause and when does it typically begin?

Get a clear understanding of perimenopause. Learn about its onset, symptoms and coping strategies.

Published: June 6, 2024 |5 minutes to read

Written by: Tim Gower

A person lies in bed, squeezing the bridge of their nose.

During the transition into menopause, people experience a natural shift in hormone levels that can bring about significant changes in their physical and emotional health.

But perimenopause — the phase that precedes menopause when these changes begin to occur — remains somewhat of a mystery to many, explains Lisa Larkin, MD, president of The Menopause Society.1

“So many women in their forties come to my office with new symptoms such as weight gain, fatigue, sleep disturbances or worsening migraines, and they don't correlate that with hormonal changes,” says Dr. Larkin. Unfortunately, many of these same people have had their complaints dismissed or downplayed, she adds, making them hesitant to speak up.

A health care provider is a great first stop when these symptoms begin. Read on to learn more about the basics, including when perimenopause occurs and managing what comes next.

In this article:

The basics of perimenopause

Think of perimenopause as a transitional time between two major phases of a person’s life: (1) their reproductive years, when they can become pregnant, and (2) menopause, when their menstrual cycle ends and pregnancy is no longer possible. (Learn more about menopause.)

Key hallmarks of perimenopause are reduced fertility and fluctuations in hormone levels, which occur as the body changes with time.

“I tell women, ‘Your ovaries are aging, just like everything else is starting to age, and that has physiological consequences,’” says Dr. Larkin, who is also chief executive officer of Ms. Medicine, a nationwide network of clinics focused on women’s health.

The ovaries produce eggs, as well as estrogen and other hormones that regulate menstrual cycles and pregnancy.2 During perimenopause, the number and quality of eggs the ovaries produce is reduced, making it harder (though not impossible) to become pregnant.3 Moreover, the ovaries’ production of estrogen becomes inconsistent — it may be high one day, but plummet the next.4 As a result, the cycle between menstrual periods may become shorter or longer.

When does perimenopause start?

Perimenopause can begin in some people in their thirties, but most often it starts in people ages 40 to 44.5,6

How long does perimenopause last?

Typically, people spend four to eight years in perimenopause, with those entering this phase at an earlier age having a longer average duration. (Learn more about the stages of menopause.)

Signs and symptoms of perimenopause

Everyone experiences perimenopause in their own unique way. Some of the major signs and symptoms of perimenopause include the following:7

  • Hot flashes and night sweats
  • Irregular periods, caused by fluctuating hormone levels
  • Mood problems
  • Sleep disturbances, which are often caused by night sweats
  • Urinary incontinence
  • Vaginal dryness, which can contribute to pain during sexual intercourse

Many of these symptoms continue once menopause is reached. (Learn more about symptoms of menopause and supporting relief.)

Signs perimenopause is ending

The signs that perimenopause is coming to an end tend to vary depending on the individual. “Every woman’s journey is different,” says Dr. Larkin.

As perimenopause approaches its end, some people will notice that the time between menstrual periods becomes longer. (Indeed, menopause is reached when a person hasn’t had their period for 12 consecutive months). Some may also notice that symptoms they developed during perimenopause, such as hot flashes, become more persistent, explains Dr. Larkin — while others, such as mood fluctuations and headaches, may become more stable or milder.

While there is no perimenopause test, people can consult their health care provider, who may order tests to check hormone levels and will consider age, menstrual history and body changes to help diagnose when a person enters or exits this phase of their life.

Factors that influence perimenopause

Many aspects of a person’s life will influence how they experience perimenopause.

For example, factors such as smoking and obesity seem to affect when and how long perimenopause lasts. Meanwhile, certain gene variants (or mutations) have been identified that seem to increase the likelihood of experiencing hot flashes.8

Furthermore, depression and anxiety that a person may experience during perimenopause can be worsened by other events in their life, such as struggling with finances or dealing with the loss of a parent.9

Coping strategies and management for perimenopause

The good news is: “You don’t have to suffer in silence,” says Bruce Dorr, MD, an obstetrician/gynecologist at Littleton Gynecology & Wellness Providers in Littleton, Colorado.10 He notes that simply following standard health advice — such as eating a balanced diet, avoiding junk food and getting plenty of exercise — can go a long way toward improving some symptoms of perimenopause like mood swings and poor sleep.

People can also adopt a variety of home remedies for managing certain symptoms. You can combat hot flashes, for instance, by dressing in layers that can be removed to cool off or set up a fan in the bedroom to ease night sweats.

Some going through perimenopause will benefit from a prescription pill. The most effective option may be systemic estrogen therapy. It can relieve hot flashes and night sweats and is available as a cream, gel, patch, pill or spray.11

Hormone replacement therapy levels out estrogen and progesterone, which prevents steep fluctuations in hormones that cause perimenopause symptoms. Demonstrated benefits for people in perimenopause include fewer hot flashes, stronger bones, a reduced risk of uterine cancer and a lower risk for some of heart disease.12,13

Talk to your health care provider to discuss options, including whether supplements may be appropriate. Other supplements that may help include calcium supplements, collagen supplements and glucosamine for joint pain. (Learn more about supplements for menopause.)

People can also try a few over-the-counter (OTC) aids to help with vaginal dryness and incontinence.

Support and resources for menopause

If you think you are experiencing symptoms of perimenopause, it’s important to talk your health care provider.

This content is for informational purposes only and is not medical advice. Consult your health care provider before taking any vitamins or supplements and prior to beginning or changing any health care practices.