Perimenopause is the transitional period of five to seven years before a woman’s final menstrual period, according to board-certified OB-GYN Brandye Wilson-Manigat, M.D. During this time, a woman still has periods but also experiences symptoms of menopause, such as hot flashes, night sweats, mood changes, and weight changes. The term “premenopause” is sometimes used interchangeably, but it technically refers to any stage before menopause, while perimenopause specifically describes the hormonal transition immediately before menopause. Menopause itself is defined as the permanent end of menstruation, confirmed after 12 consecutive months without any bleeding. This designation is given on a single day, exactly one year after the last period, but the postmenopausal stage continues for the rest of a woman’s life.
What triggers perimenopause
The timing of perimenopause is largely influenced by two factors: estrogen production and genetics, explains Lauren Streicher, M.D., medical director of community education and outreach at Midi, a virtual care clinic. Fluctuations in ovarian estrogen production trigger the transition, and genetics play a major role in when it begins. If a woman’s mother and older sister were still menstruating in their mid-50s, she likely will too. Ethnicity may also be a factor, with some studies suggesting 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 night shifts also tend to experience earlier onset. Contrary to common belief, the age at which a woman started menstruating does not determine when she will stop. A 2018 study even found that women who had their first period at younger ages had longer menopausal transitions.
How long perimenopause lasts
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 they can start anywhere from the late 30s to mid-50s. There are over 30 physical indicators of this stage, according to Streicher. 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, says Manigat. If a woman is unsure whether a symptom is due to perimenopause or something else, the only way to find out is to visit a doctor. An experienced menopause expert can evaluate symptoms in the context of personal medical history, family history, and sometimes blood work.
How to cope with symptoms
To manage hot flashes, Manigat suggests wearing layers of easy-to-remove clothing and carrying a handheld fan. Staying hydrated with electrolyte-based fluids rather than plain water can help replenish fluids lost during hot flashes or night sweats and keep the body’s internal temperature steady. Electrolyte-based hydration may also reduce trips to the bathroom compared to plain water. Regular exercise can help with weight management and mood changes by releasing feel-good hormones and decreasing stress levels.
When to see a doctor
Streicher advises seeing a clinician any time symptoms become bothersome. If a general practitioner is not helpful, she recommends switching to a more experienced expert. While a recent editorial in the medical journal the Lancet claimed that menopause has been over-medicalized, Streicher disagrees, stating that under 10% of women get appropriate treatment. Untreated women may face symptoms that impact daily life and increase the risk of cardiovascular disease, osteoporosis, cognitive issues, and sexual problems. Manigat adds that even seemingly minor symptoms may require medical attention. Irregular, heavy menstrual bleeding, if untreated, can lead to anemia, which worsens fatigue and sometimes requires a blood transfusion. Poor sleep can worsen feelings of depression and fuel weight gain, increasing the risk of high blood pressure and diabetes. Speaking with a doctor can also help alleviate embarrassment or anxiety about symptoms. The more conversations women have about perimenopause, the less mysterious it becomes.
