How Well Do You Understand Perimenopause?

Why does menopause get all the attention when it's actually perimenopause that brings those infamous symptoms? Because, most people don't know there's a difference.  Understanding perimenopause however, might help women enter a new time of life healthier, happier and more in control. 

What is perimenopause?  According to the Women's Health Initiative, "Perimenopause is the time leading up to menopause when you start to notice menopause-related changes—plus the year after menopause." It's what some people call going through menopause.  During perimenopause, your ovaries make less estrogen and progesterone. This change is a natural part of aging that signals the ending of your reproductive years. Menopause itself is only one day—the day you haven't had a period for 12 months in a row.

When does it start?  On average, women's reproductive hormone production starts declining in her late 30s, though not usually enough to interrupt her menstrual cycle.  During her mid 40s however, she might notice her body changing.  Her periods might be different - shorter, longer, lighter, heavier.  She might experience mood swings, premenstrual symptoms and cramping, even if she's never had them before.  She might notice weight gain, vaginal dryness, thinning hair and other signs of aging.

Hot flashes are real attention grabbers that often start in a woman's late 40s.  They feel like sudden heat that rises from your chest to your face and lasting from a few seconds to several minutes.  ACOG says 75-85% of perimenopausal women experience them, some just few a month and others  several times per day.  They can be especially problematic night (called night sweats) because they tend to wake women up and leave them feeling groggy the next day.

Some women experience other uncomfortable symptoms associated with decreased hormone levels like headaches, difficulty concentrating and decreased sex drive.  But many women don't experience any of these symptoms at all.

When does it end?  The average age for menopause is 51.  That means you might experience perimenopausal symptoms for 10 years.  The American College of Obstetricians and Gynecolotists say, "Some women compare perimenopause to puberty-another time when you have to adjust to big changes. These changes may make you feel unlike your usual self."

What can you do if perimenopausal symptoms bother you? Use this time to focus on your total health.  Women who exercise, eat properly, don't smoke or abuse alcohol usually have an easier time dealing with perimenopause.  If that's not enough, gynecologists and alternative therapists have many treatments to help women through the transition. 

  • Herbal remedies like black cohosh and natural, plant-based sources of estrogen and progesterone help relieve many symptoms, including hot flashes.  Acupuncture, massage and meditation are also effective as supportive therapies for many women.
  • Hormone Replacement Therapy and oral contraception are very effective treatments for perimenopausal symptoms.  While some studies link HRT with increased risks for cancer and heart disease, other studies show they may prevent age-related problems like osteoporosis.  This is something each woman should discuss with her doctor.

Perimenopause is a normal, natural change, and doesn't require any medical treatment at all but it's good to know support is available if needed to make a smooth transition. 


American College of Obstetricians and Gynecologists
Midlife Transitions - A guide to approaching menopause - US Department of Health and Human Services