Perimenopause: Causes, Symptoms, Treatment & More

Last updated 11.27.2023 | by Sabrina Johnson | 14 Minutes Read

This article has been reviewed and fact checked by Dr. Karen Pike, a senior physician administrator and board-certified emergency room doctor actively working in northern California. Read more at our medical disclaimer page.


Before getting to the topic, let’s look at some facts. The ACOG (American College of Obstetricians and Gynecologists) estimates that around 6000 women in the United States experience menopause daily. That’s quite a number – about 2 million a year. The average menopausal age in America is 51. Most women enter menopause at 45-55. There are exceptions, though. 

Menopause isn’t a day’s affair. It’s a prolonged process. Your hormones go haywire. Like, every action is met with an opposite reaction. Your body gets affected due to the fluctuating hormone levels, and several symptoms appear. The changes mostly begin at 40. That is when you are transitioning into menopause. This period is referred to as perimenopause. I started experiencing the initial symptoms, that is, irregular periods, in my early 40s. 

For my sister, it was pretty late, at 50. Her perimenopause phase lasted for just two years, after which she had her menopause. I cite this example to help you understand that not all women will go through the transition phase at the same time. It will vary from one woman to another. 

What is perimenopause? How long does it last? What are the symptoms of perimenopause? All these questions must be running through your mind, right? Here I am with all the answers. I will elaborate on perimenopause. I will also discuss the age at which it begins, the causes, and the symptoms. I hope this clears most of your doubts.

What is Perimenopause?

The prefix peri stands for near, about, and all-around. That’s what perimenopause stands for, around or near menopause. It is synonymously called the menopausal transition. This is because the end of perimenopause marks the beginning of menopause.

Perimenopause is often considered similar to puberty. In both cases, hormonal fluctuations are responsible for the body’s symptoms. Both these phases occur for a long time. That’s why it is alternately called reverse puberty. Puberty was a little overwhelming for me. I could handle perimenopause in a better way. 

Are Premenopause and Perimenopause the Same?

The terms premenopause and perimenopause are not interchangeable and have separate meanings.

There is a long gap in between the time when a woman has her first period and when she enters into perimenopause. This duration is referred to as premenopause. In premenopause, you’ll have your periods, which could be regular or even irregular.

However, perimenopause is marked by hormonal imbalance and other symptoms. Once it ends, you’ll be in the menopause phase.

At What Age Does Perimenopause Begin?

The average age for perimenopause in most women is between 40 and 44  years. There are exceptions, though. In some women, perimenopause may begin when they are in their 30s. While some women may experience it quite late, in their 50s. It’s never the same for each woman.

How Long Does Perimenopause Last?

Perimenopause lasts for 4-5 years on average. But the time frame varies from one woman to the other. This phase may not last for more than a couple of months in some women. In some, the perimenopause stage may continue for a long time, around 8-10 years. This is likely seen in those who undergo perimenopause quite early, in their 30s.

When women do not continuously have their menstrual cycle for 12 months, this means that perimenopause has ended. It marks the beginning of menopause.

What Are the Causes of Perimenopause?

Nothing, in particular, causes perimenopause. It happens when the ovaries do not function as effectively as in your menstrual years. When the transition begins, the ovaries release fewer eggs than before. The nearer you are to your menopause, the lesser eggs will be produced by the ovaries.

The ovaries are also primarily responsible for producing estrogen, which significantly controls the reproductive system.

When the menopause transition phase begins, the ovaries stop producing sufficient estrogen. There is a dip in its level. A reduction in estrogen also disrupts the levels of progesterone. In fact, in perimenopause, there is a massive fluctuation in estrogen and progesterone levels. This causes the hormones to go through a rise-and-fall cycle.

As I began researching these facts, the unique findings about hormonal functions fascinated me immensely.

10 Symptoms of Perimenopause

10 Symptoms of Perimenopause

Perimenopause comes with a whole lot of symptoms, which vary from one woman to the other. While some might have too many hot flashes and night sweats, a few may be troubled with vaginal dryness and bone problems. Here are some of the symptoms that often make perimenopause a bothersome phase.

1. Changes in the Menstrual Cycle

If you’ve had a regular cycle till your 40s, which suddenly becomes irregular. It means perimenopause has set in. Also, your periods could last for longer or shorter than usual. There will be no consistency in the flow as well. It could be very heavy or too light. You could even skip one or two cycles of your periods. Irregular periods were my perimenopause story. In one month the flow would be heavy with increased cramping. The following month, the flow would be scanty, to my surprise.

2. Hot Flashes

As the ovaries are not as effective as before, there is a decline in hormone production. Hot flashes are an outcome of reduced hormone levels. It isn’t a good feeling at all. Most women would feel warm on their neck, chest, and face. There’ll also be associated symptoms, like a rapid heartbeat and increased sweating.

3. Night Sweats

Episodes of hot flashes mainly occur between 6 am-8 am and 6 pm-10 pm. If you have hot flashes at night, they are known as night sweats. This is also annoying, and you will find yourself and the bedsheets drenched in sweat.

4. Mood Changes

Since your hormones are all over the place, and you don’t feel good, mood changes are expected in perimenopause. It often continues to menopause. Moreover, you’ll be tormented even further by hot flashes and night sweats. All these could make you irritable and jittery, accounting for your mood swings.

Sometimes, staying focused and meeting deadlines would be troublesome for me. This often led to my mood going for a toss. I had read somewhere that about 4 of 10 women went through perimenopausal mood swings, just like it would be in PMS. 

5. Vaginal Dryness

The estrogen maintains the thickness, lubrication, and elasticity of the vagina. When the estrogen levels reduce, the walls of the vagina are thin, dry, and inflamed. This happens all the more in the perimenopause phase.

6. Troubled Sleeping

The main reason for disturbed sleep during perimenopause is night sweats and hot flashes. Teamed with this are mood swings and bouts of depression. All these disrupt your sleep to a great extent. I had major sleep issues, and sometimes I would get scanty sleep of just three hours each night. Resorting to meditation and relaxation techniques helped me immensely. That’s why finding ways to manage your sleep during this time is important. 

7. Frequent Urination

As there is a decline in estrogen levels, the area surrounding the pelvic organs gets weaker. This results in an overactive bladder. That is why the need to urinate frequently becomes higher during this time.

8. Weight Gain

In the perimenopausal stage, women are estimated to gain 2-5 pounds as per studies. The reason behind the extra kilos may be blamed on the reduced levels of progesterone and estrogen. This leads to a slow metabolism and results in increased fat accumulation in the body. I, too, was gaining weight quite fast in my mid-40s, faster than I could imagine. It was exercise and a proper diet regime that came as my savior.

9. Concentration Problems and Forgetfulness

Due to low estrogen levels, women become forgetful during the transition phase.Due to low estrogen levels, women become forgetful during the perimenopause and menopause phases.

The hippocampus is one of the complex structures of the brain that helps in memory and learning.

The PFC (Prefrontal Cortex) is part of the brain that controls high-order cognitive functioning. It regulates how we emote, act, and think. Estrogen has a positive impact on these two structures of the brain. So a low estrogen level means a decline in cognitive function.

Besides the reduced estrogen levels, other factors responsible for low cognitive function include the associated symptoms of perimenopause, like hot flashes, night sweats, vaginal dryness, and mood swings.

A study was conducted in 2013 on 16065 women aged 40-55 years. The aim was to find out how cognitive development was affected during menopause and the transition phase. According to the results, around 44% of the females who reported forgetfulness were in the early perimenopausal stage. Meanwhile, 41% of them were in their late perimenopausal stage, while another 41% had entered the postmenopause phase.

The study further mentioned that the cognitive development of women, particularly their learning skills, was compromised in the perimenopause stage. However, with postmenopause, the cognitive skills started to become better. In fact, the cognitive issues women faced in the later years of life were related to aging, not menopause.

10. Sore Breasts

The constant rise and fall in estrogen and progesterone levels affects the tissues of your breasts. This results in sore and painful breasts during the transition phase. However, once you are through the perimenopause stage and enter menopause, the breast pain and soreness get better since your body doesn’t produce estrogen anymore.

The symptoms mentioned here are not the only ones women would go through in perimenopause. There are many more, like bone loss, disinterest in sex, lessened fertility, change in cholesterol levels, and so on.

How to Treat Perimenopause?

Perimenopause is a natural phenomenon, and there is no way you can treat it. But, yes, you may for sure treat the symptoms associated with perimenopause, especially if they are in the way of your daily living. The symptoms will eventually ease with time after menopause has set in. Let’s look at some of the treatment procedures that will help you with perimenopause.

  • If your mood swings are getting high, then the doctor might advise antidepressants. I finally managed to control my mood fluctuations with relaxation techniques. Also, I started doing things that gave me pleasure. I decided to be easy on myself and give ‘me’ more time.
  • For vaginal dryness, vaginal creams will come to aid. They’ll help to lubricate the area and also relieve you from pain after sex.
  • Gabapentin, a seizure medication, is prescribed to lessen severe bouts of hot flashes.
  • Estrogen therapy is available in gel, sprays, creams, skin patches, and swallowable pills. It helps to keep the estrogen level in control. However, there have been controversies regarding hormone therapy. It could put you at risk of certain conditions. These include stroke, blood clots, gallbladder problems, and uterine cancer.

How Can You Manage Your Perimenopause Symptoms at Home? 6 Beneficial Tips

Maintaining a healthy lifestyle, and a proper diet, are the prerequisites to managing your perimenopause symptoms at home. Let’s check out some of the things that you can do to ease out the hot flashes, night sweats, and other associated symptoms that often make things troublesome for you.

  • Diet plays a significant role in perimenopause. It will not just help to manage hot flashes and night sweats but will even be beneficial for your bone health. Make sure you have a balanced diet. It should contain fruits, lean protein, whole grains, healthy fats, vegetables, and dairy products. That was my motto as well.
  • It would be best if you exercised regularly. Make sure you go for daily walks and engage yourself in weight-bearing workouts. It will help you remain healthy and keep your weight under control.
  • Yoga is another good way to keep yourself in good shape during perimenopause. Studies have suggested that women who practice yoga in their premenopause stage live a better life than those who don’t.
  • Avoid any heavy workout before bedtime, and try relaxation techniques for a better night’s sleep.
  • If you smoke, it is time that you give up smoking. It could worsen your perimenopausal symptoms, mainly hot flashes and night sweats. Moreover, smoking also puts you at the risk of early menopause.
  • Cut down on caffeine intake and alcohol consumption. A coffee lover like me deliberately sacrificed the several cups of coffee I would have each day, bringing it down to just a single cup.

FAQs

The transition phase isn’t just about the symptoms and treatment. It involves a sea change that you would go through physically, psychologically, and emotionally. But that doesn’t mean it’s something scary. It all depends on the way you live, and your diet as well. Let’s discuss some of the many questions that may bother you regarding the transition phase.

How Do You Know You Have Entered into Perimenopause?

The main indication is your menstrual cycle. It could be preponed or postponed by seven days from the regular cycle. If this happens in every cycle, the transition phase has started. That was the first signal for me as well. When my menses started getting irregular, I was sure  that I was transitioning into menopause.

Can You Postpone or Delay Perimenopause?

It is a natural phenomenon and will happen when it has to happen. There is no way you can delay, prevent or postpone it. But, leading a healthy lifestyle may save you from entering into the transition phase way too early than the estimated time.

How Can Acupuncture Help in Perimenopause?

Acupuncture would help in dealing with specific symptoms of menopause. These include night sweats, hot flashes, insomnia, dry skin, acne, and so on. It is a kind of holistic treatment that may help you manage your symptoms well.

Does Perimenopause Mean Increased Hair Growth?

Because of the decreased estrogen levels, women may experience increased hair growth around their face, back, abdomen, and chest.

Does Everyone Go Through Perimenopause?

Yes, except for women who have had induced menopause because of any medical interventions like cancer treatment or gynecological problems.

Will You Ovulate in Perimenopause?

Yes, you will ovulate. In fact, till the time your periods are on, it signals that your ovaries are producing eggs. If you haven’t had your menses for twelve months in a row, that means you aren’t ovulating anymore.

Can You Get Pregnant in Perimenopause?

Yes, you can get pregnant in since eggs are still being released by the ovary. However, the chances aren’t always that high. If you wish for family expansion during this time, have a word with your medical consultant about the various fertility options.

Will Birth Control Pills Help in Perimenopause?

In case you don’t wish to get pregnant during the transition phase, using birth control pills would be a safe option. You should do the same even if your periods aren’t regular. This is because your ovaries are still releasing eggs, even if that isn’t regular. So, you won’t know the months you’re ovulating. That’s why birth control pills would prevent you from any unwanted pregnancy.

Can A Blood Test Help to Diagnose Perimenopause?

You can talk to the doctor When you have irregular periods for several months in a row. They might recommend an FSH (Follicle-stimulating Hormone) level test. If you are in the late premenopause stage and are nearing menopause, the FSH level will be on the higher side. Another test would be the  LH (Luteinizing Hormone) levels test. Their levels would also be high in menopause.

How Will You Identify That The Changes in the Menstrual Cycle Are Due to Perimenopause or Other Underlying Conditions?

You may have irregular periods or an inconsistent flow during the menopause transition phase. Yet, there are certain red flags that you must watch out for. Like, you are bleeding heavily and having blood clots as well. Your periods might last for a very long time. You are bleeding or spotting even after your cycle ends or after sex. Your cycles keep coming too close to each other. I have always mentioned that you know your body the best. So, any symptom that seems alarming should not be left unaddressed. A doctor’s consultation must be sought at once.
It could indicate other medical conditions like fibroids, hormonal imbalances, endometrial polyps, etc. So it’s better to get checked.

Conclusion

No periods for 12 months mean the end of perimenopause and the onset of menopause. It might seem taxing to you. When you follow a proper diet and maintain a healthy lifestyle, you’ll find things a lot easier.

References:

  1. ncbi.nlm.nih.gov
  2. Why am I gaining weight so fast during menopause? And will hormone therapy help?
  3. First Signs Of Perimenopause
  4. medlineplus.gov
  5. The Change Before the Change: 9 Questions About Perimenopause
  6. medlineplus.gov
  7. ncbi.nlm.nih.gov

Author

  • Sabrina Johnson

    Meet Sabrina Johnson, a compassionate author and a seasoned expert in Obstetrics and Gynecology. She is a driving force behind Simply Menopause, where her extensive medical knowledge and empathetic nature come together to empower women in their menopausal journey. Sabrina offers culturally sensitive guidance and support through her approachable writing, making her a trusted friend on the path to menopause wellness.