Perimenopause

What is Perimenopause?

Perimenopause is the transition leading up to menopause — when your body begins winding down its reproductive years. 

When does perimenopause start? Usually in your 40s, but some women notice changes as early as their mid-30s. This phase can last anywhere from eight to 10 years and officially ends when you’ve gone a full year without a menstrual period. That’s when menopause begins.

During perimenopause, estrogen levels drop and you may notice more irregularity in your periods. That’s a sign you’re getting closer to menopause. 

Even though every woman goes through it, perimenopause hasn’t gotten the attention it deserves. Many women feel caught off guard by the symptoms and unheard by their healthcare providers. 

But perimenopause isn’t something you have to tough out. Understanding what’s happening with your body — and knowing your treatment options — can make it easier to navigate this transition with confidence. 

Symptoms of Perimenopause

Perimenopause is different for everyone. Some women barely notice the changes. For others, symptoms can make life difficult.

Here’s a look at some of the most common symptoms women report during perimenopause: 

• Irregular menstrual cycles (shorter, longer, heavier, or missed periods)

• Hot flashes

• Night sweats

• Sleep issues, like insomnia

• Mood swings or irritability

• Increased anxiety or depression

• Vaginal dryness

• Low libido (decreased sexual desire)

• Brain fog or difficulty concentrating

• Memory lapses

• Breast tenderness

• Weight gain, especially around the abdomen

• Fatigue or low energy

• Headaches or migraines

• Joint or muscle aches

• Thinning hair or hair loss

• Dry skin

• Changes in cholesterol levels or blood pressure

• Bladder changes or increased urinary urgency

• Reduced bone mass density

• Reduced lean muscle mass

You’re not imagining it — perimenopause is real. Many women going through this transition say they just don’t feel like themselves. That’s because shifting hormone levels can affect nearly everything, from your mood and sleep to your metabolism and memory.

Causes of Perimenopause

Perimenopause is a natural part of aging that starts when your ovaries start to slow down. It happens because of normal hormonal changes, though when it starts and how it feels can be different for everyone. 

Here’s what you should know about how perimenopause starts: 

• Ovarian function declines. As you age, your ovaries produce fewer eggs and less estrogen and progesterone — hormones that regulate your menstrual cycle. 

• Hormone levels get unpredictable. Instead of declining steadily, estrogen and progesterone levels spike and dip, causing irregular periods and other symptoms.

• Ovulation becomes spotty. You may not ovulate every month during perimenopause, leading to lower progesterone and more cycle changes. 

Most women start perimenopause in their 40s, but it can happen earlier depending on your genetics, lifestyle choices, or existing health conditions. (more on that below)

Ovary removal (AKA oophorectomy) and chemotherapy or radiation for cancer treatment can trigger early menopause.

Risk Factors for Perimenopause

Perimenopause happens to every woman — it’s a natural part of life. While you can’t avoid it, certain factors can influence when it starts and how intense the symptoms are, such as:

• Family history. If your mom or older sisters had early or intense perimenopausal symptoms, there’s a good chance you might too. 

• Smoking. Smoking can cause perimenopause to start one to two years earlier than typical. And it can make symptoms like hot flashes feel even worse.

• Chronic stress. Unmanaged stress can disrupt your hormone levels and cause inflammation, which can lead to more severe symptoms.

• Low body weight or a history of eating disorders. If you’ve had a history of restrictive eating or very low body fat, it can throw off your hormone balance. This may lead to earlier signs of perimenopause or even early menopause. 

• Chemotherapy or radiation. Cancer treatments that affect the ovaries may lead to earlier perimenopause or sudden menopause, often with more intense symptoms.

• Surgical removal of ovaries. Women who’ve had an oophorectomy skip the gradual transition of perimenopause and go straight into sudden, more intense hormone changes. 

Knowing your personal risk factors won’t stop perimenopause, but it can help you understand what’s happening in your body — and ask for what you need.

Diagnosing Perimenopause

There’s no single test for perimenopause. Your healthcare provider can measure your hormone levels, but they often fluctuate too much to give clear answers on their own. 

Instead, your healthcare provider will look at the full picture — your symptoms, medical history, and possibly some lab tests — to figure out if you’re in perimenopause. 

• Symptoms. Your doctor will ask you about symptoms like hot flashes, low libido, and sleep troubles. Tracking changes in your period, mood, and sleep can help identify patterns that might indicate perimenopausal hormonal shifts. 

• Medical history. Your medical and family history can give you and your provider insight into your potential perimenopause timeline. 

• Hormone testing. Healthcare professionals don’t usually diagnose perimenopause with a test, but your doctor may check your follicle-stimulating hormone (FSH), estradiol, or thyroid function. This can help rule out other potential reasons for your symptoms.

Perimenopause Treatment

There’s no one-size-fits-all treatment plan for perimenopause — every woman experiences it differently. The goal is to manage hormonal shifts that cause those frustrating physical and emotional symptoms.

For some, small changes in diet and lifestyle do the trick. Others may need hormone replacement therapy (HRT) or non-hormonal medications for relief.

Depending on what your body needs, your treatment plan might include:

Hormone Therapy

If your hormones are throwing things off and making life harder during perimenopause, the following hormone therapies may be an option:

• Low-dose birth control pills. Doctors sometimes prescribe combined estrogen and progestin in early perimenopause to regulate cycles and reduce hot flashes, mood swings, and heavy bleeding. And if you’re wondering, can you get pregnant during perimenopause, the answer is yes — while your fertility can be lower, pregnancy can definitely happen during perimenopause.

• Hormone replacement therapy. Doctors typically prescribe hormone therapy to menopausal women. But if you’re having chronic hot flashes, night sweats, or vaginal dryness your doctor might suggest low-dose HRT. 

• Vaginal estrogen. Estrogen creams, rings, or tablets can help with symptoms like dryness, discomfort during sex, and urinary issues.

Non-Hormonal Therapies

The following non-hormone treatments might also help with perimenopause symptoms:

• Fezolinetant. This medication works to treat hot flashes by blocking a pathway in the brain that helps regulate body temperature.

• Antidepressants. SSRIs or SNRIs can help reduce hot flashes and improve mood, even in women without clinical depression.

• Gabapentin. Gabapentin is an anticonvulsant medication that helps control seizures. Healthcare professionals sometimes prescribe it off-label to help with hot flashes.

• Clonidine. Clonidine is a sedative and blood pressure medication that doctors can prescribe off-label to help with sleep issues.

• Over-the-counter (OTC) vaginal moisturizers and lubricants. These products can ease vaginal dryness and discomfort during sex. Stick with mild, fragrance-free options to avoid irritation.

Lifestyle and Nutrition

Simple lifestyle changes can often ease perimenopausal symptoms and boost your overall well-being. For some, that’s all it takes. For others, lifestyle tweaks work best in combination with medical treatments.

• Regular exercise, stress reduction, and healthy sleep habits can lessen the impact of mood swings, fatigue, and weight gain.

• Optimizing your diet can support your overall health during perimenopause. Research shows that phytoestrogens, compounds that mimic estrogen in the body, help reduce hot flashes. You can get them from foods like tofu, tempeh, and edamame.

• Avoiding triggers like caffeine, alcohol, and spicy foods might help reduce hot flashes.

Supplements and Holistic Therapies

Some women find relief from hot flashes and night sweats with supplements like black cohosh, evening primrose oil, or red clover — but the research is mixed. And these supplements can come with side effects or even interact with medications.

You might have also heard about dehydroepiandrosterone (DHEA), a steroid made by your adrenal glands. Some people use it to ease vaginal dryness and pain during sex. But its long-term safety isn’t clear. And there’s not enough evidence to show it’s truly effective.

If you’re thinking about trying supplements for perimenopause, talk to your healthcare provider. And opt for products with third-party certification for safety, purity, and quality. 

Another natural option for tackling perimenopause symptoms? Cognitive behavioral therapy (CBT) and mindfulness techniques. These mental health approaches can help with sleep issues, anxiety, and emotional well-being. 

Take our free online quiz to connect with a licensed mental healthcare professional today.

Perimenopause Prevention Tips

While perimenopause isn’t something you can avoid, there are steps you can take to prepare yourself for this shift. 

Here are some tips to prep your body and mind:

• Eat to balance hormones and limit inflammation. Focus on a nutritious, mostly plant-based diet full of healthy fats and fiber. Add in phytoestrogen-rich foods like soy, and cut back on ultra-processed foods and alcohol. Why? Because inflammation can make perimenopausal symptoms worse and increase your risk for declining brain health later in life. 

• Stay physically active. Move your body most days of the week with a mix of cardio, strength training, and flexibility exercises. Movement helps support a healthy metabolism, strong bones, muscle strength, and mental health. It can also help you sleep better at night.

• Achieve and maintain a healthy weight. It’s common for women to start storing more body fat in their belly as their hormones start to fluctuate during perimenopause, which can increase certain symptoms. 

• Prioritize sleep and stress management. Chronic stress can mess with the delicate balance of estrogen, progesterone, and cortisol in your body. You can’t avoid every stressor, but practices like yoga, meditation, deep breathing, and journaling can help you manage how you respond to it. Also, a consistent sleep schedule, avoiding caffeine and alcohol, and limiting screen use before bed, can help improve the quality of your sleep. 

• Don’t smoke. Smoking can trigger early perimenopause and make symptoms worse. If you smoke, quitting is one of the best things you can do for your overall health.

• Talk to other women. Ask women who’ve been through it — moms, aunts, mentors — for their wisdom. Swap stories and questions with friends going through the same thing. Chances are, you’re not the only one wondering, “Is this normal?” 

Interested in learning more about perimenopause symptoms? Read our guide to perimenopause and hair loss.