Perimenopause is the five to seven year period before a woman has her final menstrual period. During this time, she still has periods but also experiences symptoms of menopause, such as hot flashes, night sweats, mood changes, and weight changes, according to board-certified OB-GYN Brandye Wilson-Manigat, M.D.
The term premenopause is sometimes used interchangeably with perimenopause, but they are not the same. Premenopause refers to any stage before menopause, while perimenopause is the hormonal transition that comes right before menopause. Menopause itself is defined as the permanent end of menstruation, confirmed after 12 consecutive months without any bleeding. A woman officially becomes menopausal on the day that marks 12 months after her last period, but this stage continues for the rest of her life. The terms menopausal and postmenopausal are often used to describe this period.
Perimenopause is triggered by changes in estrogen production from the ovaries. Genetics is the main factor that influences when a woman enters perimenopause and menopause, said Lauren Streicher, M.D., medical director of community education and outreach at Midi, a virtual care clinic. If a woman’s mother and older sister were still having periods in their mid-50s, she likely will too. Ethnicity may also play a role. Some research suggests that Hispanic American and Black American women tend to enter menopause earlier than Caucasian American and Japanese American women. Lifestyle and personal health history can also affect timing. Menopause tends to occur earlier in smokers and women with autoimmune diseases such as hypothyroidism, rheumatoid arthritis, and Type 1 diabetes. Women who work the night shift also tend to experience menopause earlier.
Contrary to popular belief, the age at which a woman started menstruating does not determine when she will stop. A 2018 study found that women who had their first period at younger ages actually had longer menopausal transitions.
Research shows that perimenopause lasts four years on average, but in some cases it can last as long as a decade. Symptoms typically appear in a woman’s mid-40s, but can start anywhere from her late 30s to mid-50s. There are over 30 physical signs of perimenopause. Common symptoms include fatigue, hot flashes and night sweats, mood changes, changes in menstrual cycle length, skipped or missed periods, heavier periods, brain fog, sleep disturbances, dry skin, brittle hair, hair loss, body and muscle aches, vaginal dryness, increased urinary urgency and frequency, and weight gain.
Fatigue, mood changes, and hot flashes or night sweats are often the first symptoms a woman notices. To cope with symptoms, doctors suggest layering clothing that is easy to remove and carrying a handheld fan. Staying hydrated with electrolyte-based drinks can help replace fluids lost during hot flashes or night sweats and keep body temperature steady. Regular exercise helps with weight management, mood changes, and stress levels.
Women should see a doctor any time symptoms become bothersome. Irregular, heavy menstrual bleeding can lead to anemia, which worsens fatigue and may require a blood transfusion. Poor sleep can worsen depression and lead to weight gain, increasing the risk of high blood pressure and diabetes. Speaking with a doctor can also help reduce embarrassment or anxiety about symptoms. The more conversations women have about perimenopause, the less mysterious it becomes.
