You can’t quite put your finger on it, but lately you’ve just been feeling less-than-amazing, health-wise. Maybe you’re having trouble sleeping, or you’re struggling to stay focused, or your period isn’t quite as predictable as it used to be. If you’re in or around your 40s, these symptoms could be a sign that you’re in perimenopause.
What Is Perimenopause?
Perimenopause, meaning “around menopause,” is the time leading up to your final period. It can last from two to ten years—or even longer.
Perimenopause ends a year after your last period, which is when menopause officially starts. But recognizing the start of perimenopause isn’t always quite so clear-cut. Perimenopause symptoms can be subtle, gradual, and different for everyone.
“Perimenopause is as unique as each woman,” says Dr. Banafsheh Bayati, MD, Perelel's Medical Co-Founder and a board-certified OB/GYN in Los Angeles, California. “The key is to be informed and prepared and ready for this transition.”
The hormonal shifts that come with this ovarian “retirement” can lead to sleep troubles, mood issues, and vaginal dryness. Hot flashes are caused by changes to the brain's thermoregulatory system, which is the part of the brain that balances heat gain and loss.
This transition can be very up and down. You might have some typical menstrual cycles mixed with unpredictable menopausal symptoms.
Here’s what you can expect during perimenopause—along with helpful tips for navigating the transition.
How Your Hormones Change During Perimenopause
“Perimenopause is defined by changing hormone levels as your body transitions to menopause,” Dr. Bayati says.
During your reproductive years, hormone levels fluctuate in a fairly predictable rhythm throughout your menstrual cycle. But in perimenopause, ovarian function starts to decline, which can throw your hormones out of whack.
“As we enter perimenopause, the rise and fall of our hormones—including but not limited to both estrogen and progesterone—changes,” Dr. Bayati says. Estrogen levels fluctuate more erratically, and progesterone production starts to dip. “Ultimately, estrogen and progesterone levels remain low, with lack of follicular development and ovulation,” Dr. Bayati adds.
Perimenopause Symptoms
Up to 75 percent of women will experience symptoms of perimenopause.1 Not all women will experience the same symptoms, or symptoms to the same degree—but there are a few common symptoms to be on the lookout for.
- Irregular periods. Hormonal changes during perimenopause can affect your menstrual cycle. Your cycle may become shorter or longer, and your flow may get heavier or lighter. PMS symptoms may feel worse, or you may skip a cycle altogether.
- Hot flashes. This is the hallmark symptom of menopause, but many women actually first experience hot flashes during perimenopause. A hot flash is typically described as a rush of heat that radiates through the upper body and lasts for a few minutes. Some women may experience sweating or chills during a hot flash.
- Sleep issues. Fluctuating estrogen and progesterone levels can also disrupt your sleep cycle. “One of the greatest changes that can occur in perimenopause involves sleep quality,” Dr. Bayati says. “As you can imagine, poor sleep will lead to daytime fatigue.”
- Mood changes. Hormonal changes may also leave you feeling moody and irritable, or struggling with anxiety, brain fog, decreased libido, or depression, Dr. Bayati says.
Perimenopause may also cause more subtle symptoms for some women, which can easily get chalked up to age or stress. These might include increased belly fat, digestive changes, hair loss, skin changes, headaches, and changes in gum health. “There are so many other symptoms that are both common and overlooked,” Dr. Bayati says. “As a result, many women may seek help for years from several physicians before recognizing the underlying cause as perimenopause.”
When Does Perimenopause Start?
Short answer: It depends.
The average age for menopause is 51 years old, and perimenopause can start anywhere from a few months to a full decade before that.2 “It may start for some women in their mid-30s, but more commonly is noticed by age 40 to 45,” Dr. Bayati says.
Menopause that happens between 40 and 45 is called “early menopause.” When your ovaries stop ovulating before age 40, it’s called “primary ovarian insufficiency” (or POI).
A few factors can affect how early you start menopause—which, in turn, can impact how early you might start experiencing symptoms of perimenopause. “Our genetics play a role in determining our age at menopause, but our environment is just as important,” Dr. Bayati says. If you’re wondering whether perimenopause should be on your radar right now, here are three key things to consider.
Family history
Genetics can play a role in the timing and intensity of perimenopause and menopause symptoms, so start a conversation with the women in your family to get a sense of what you can expect. “Find out when your mother and female members of both sides of your family entered menopause,” Dr. Bayati suggests. “Find out how they experienced perimenopause. Ask what helped them during this transition.”
Medical conditions
Certain autoimmune conditions, low body mass index (BMI), and chemotherapy or radiation treatments can all potentially contribute to an earlier onset of menopause—which means perimenopause symptoms could pop up sooner than expected. Reproductive surgeries can also impact the age of onset. “Surgeries, including removal of tubes and/or uterus, may affect blood flow to the ovaries and thus hasten menopause,” Dr. Bayati says. Removal of both ovaries, she notes, is considered surgical menopause.
Your medical history can also help predict if perimenopause may get pushed back. “Women with PCOS tend to reach menopause a bit later than average,” Dr. Bayati says. And researchers are studying whether pausing ovulation via birth control pills or pregnancy may also lessen the risk of early menopause.3,4
Lifestyle
Smoking and alcohol can have a negative impact on reproductive health, which is why experts suggest taking steps to curb both habits while trying to conceive. So it makes sense that they can also affect the timing of perimenopause and menopause. “Smoking contributes to earlier menopause,” Dr. Bayati says. “Alcohol intake contributes to how we experience perimenopause, as well as increasing many health risks.”
Early vs. Late Menopause
Early perimenopause begins when your periods become irregular, usually in your late 40s. It happens because of fluctuations in hormones like estrogen and progesterone.
Some symptoms of early menopause include:
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Irregular periods that may be longer or shorter.
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Hot flashes or sudden feelings of heat that come on for no reason, last for a few seconds or a few minutes and are accompanied by sweating, a racing heart, and feeling lightheaded.
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Night sweats that may cause you to wake up feeling hot, sweaty, and uncomfortable.
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Sleep changes and challenges.
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Vaginal dryness, which can make sexual intercourse uncomfortable and painful and increase the risk of urinary tract infections.
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Mood changes, such as irritability, anxiety, and depression.
Symptoms of perimenopause and menopause can vary from person to person. Some may experience all of the symptoms, while others may only experience a few.
During late perimenopause, which usually begins around an average age of 49 and ends around 51, your periods become even more irregular, sometimes even skipping periods, and stop completely by the end.
Symptoms experienced in early menopause often become more intense and occur more frequently during late perimenopause, which is why this stage is known as the “speed bump” of the menopausal transition.
Symptoms vary from person to person and might happen or intensify at different ages than the average.
5 Strategies to Ease Your Perimenopause Symptoms
Hot flashes, fatigue, and mood swings can be pretty disruptive. But there are a few simple steps you can take to help minimize perimenopause symptoms and support your wellbeing during this transition.
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1. Clean up your diet.
What you eat can make a big difference in how manageable your perimenopause symptoms are. “A diverse diet rich in fiber, lean protein, fruits and vegetables, whole grains, and healthy fats plays an important role in how we experience perimenopause,” Dr. Bayati says. “Removing excess caffeine, sugar, and alcohol may be difficult, but will quickly reduce many symptoms.”
And don't forget to optimize your vitamin routine, too. Our Peri Support Pack is a complete supplement routine formulated by doctors to support the hormonal shifts and symptoms of perimenopause.
2. Carve out time for exercise.
“Movement is key,” Dr. Bayati says. “It is wise to incorporate both cardio and strength training as regularly as possible and maintain steps daily.”
3. Make sleep a priority.
“Sleep is a complex and highly important area of study for our overall wellbeing,” Dr. Bayati says. “Its value should not be taken for granted or underestimated.” To help minimize the impact of perimenopause on your sleep quality, she suggests the following:
- Maintain a consistent sleep schedule. Aim to go to bed and wake up around the same time every day.
- Avoid heavy meals too close to bedtime. Digestion can disrupt sleep, especially after a heavy or high-fat meal. Ideally, experts say it’s best to stop eating around three hours before bedtime.5
- Keep your bedroom cool and dark. The ideal temperature for restful sleep is around 65 degrees.6
- Consider adding a sleep support supplement to your wellness routine to help your mind and body unwind.
4. Find stress relief strategies that work for you.
“Stress management needs to be prioritized as well,” Dr. Bayati says. “Quality time—both alone and with loved ones, as well as in nature—can not be overstated. Taking up a new hobby or skill such as meditation, journaling, or tai chi is a privilege and may help symptoms experienced during this transition in life. Finally, I highly recommend incorporating activities that are grounding and meditative which may include alternative or complementary health care such as massage, acupuncture, or meditation.”
5. Talk to your doctor.
If perimenopause is affecting your sense of wellbeing, talk to your healthcare provider. In addition to supplements, “there are many treatments, including non-hormonal options, to target individual symptoms,” Dr. Bayati says. If perimenopause is wreaking havoc on your mood, therapy may also be a valuable part of your perimenopause self-care plan. Your doctor can help you find the right course of action to manage your specific symptoms.
“This life stage can last a decade or longer,” Dr. Bayati says. “It is important to face this time with patience, support, and an open mind and heart. Despite the difficulties, there is much freedom and empowerment that comes as we transition through this complex and important life stage.”
Next up: Understanding if your hormones are out of whack or if it's perimenopause. Plus, make sense of your hot flashes.
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References
- University of Utah Health: Perimenopause
- The North American Menopause Society; Menopause 101: A primer for the perimenopausal
- C R Langdon et al; Association of oral contraceptives and tubal ligation with risk of early natural menopause; Jul 2021
- National Institutes of Health; Pregnancy, breastfeeding may lower risk of early menopause, NIH-funded study suggests; Jan 2020
- Cleveland Clinic: Is Eating Before Bed Bad for You?
- Sleep Foundation: Best Temperature for Sleep
This article is for informational purposes only. It is not, nor is it intended to be, a substitute for professional medical advice, diagnosis, or treatment and we recommend that you always consult with your healthcare provider. To the extent that this article features the advice of physicians or medical practitioners, the views expressed are the views of the cited expert and do not necessarily represent the views of Perelel.
