10 Facts About Perimenopause

Perimenopause brings with it many questions. Here are ten facts about perimenopause that can help make your transition into menopause a little bit smoother. 

1. It’s all about the ovaries.

Researchers say that we have around 1,000,000 immature eggs (oocytes) in our ovaries at birth. By puberty, that number has dropped to 300,000; by the time we reach perimenopause, we have about 10,000.

During perimenopause, ovaries begin to reduce the amount of estrogen they produce. Fewer eggs can reach maturity, and ovulation becomes infrequent and erratic, eventually stopping altogether once you’ve reached menopause.

It’s important to note that not everyone experiences perimenopause and natural menopause. Surgical removal of the ovaries and some cancer treatments bypass perimenopause and move you directly into menopause, and this is known as surgical or medical menopause. 

2. Your first perimenopause symptom may not be an irregular menstrual period.

Perimenopause means “around menopause,” and it is the transitional time leading up to the end of fertility. It is also sometimes referred to as the menopause transition.

Until recently, irregular periods not due to another cause were the main criteria for determining when women started perimenopause. We now know that many women have other symptoms like sleep disturbance, mood swings, low libido, and more that signal the start of perimenopause. In early perimenopause, you can have irregular periods with a variation of up to 7 days per cycle. As you progress in your transition to menopause, you’ll enter late perimenopause. During this stage, your periods may vary by up to 60 days per cycle. You will also likely notice changes in menstrual flow and how long your periods last.

3. We don’t really know how long perimenopause will last.

Perimenopause begins when menstrual periods become irregular and ends when you haven’t had a period for 12 consecutive months. For most people, this will start in their early to mid-40s, although for about one percent of people, it will start before age 40 (premature menopause.)

Perimenopause can last for months or years; the average length is four years. When you enter perimenopause and how long it lasts are determined by many factors, including weight, smoking status, and genetics, to name but a few.

4. There are many physical symptoms associated with perimenopause.

  • Hot flashes
  • Irregular periods
  • Headaches
  • Depression and anxiety
  • Weight gain
  • Fatigue
  • Vaginal dryness
  • Decreased libido
  • Sleep problems
  • Skin and hair dryness

5. Hormone changes cause your perimenopause symptoms.

As your ovaries near the end of their fertility journey, your estrogen levels become irregular. During perimenopause, estrogen tends to rise and fall erratically and eventually drops permanently as you enter menopause.

Another sex hormone, progesterone, is affected by the vacillations in estrogen, and it, too, starts to decrease. Follicle Stimulating Hormone (FSH) increases during perimenopause as it attempts to do its job of maturing eggs in the ovaries, even though changing estrogen levels ultimately make that an impossible task.

These hormone shifts play a part in the symptoms you might experience during perimenopause, although low estrogen is the main culprit.

6. Perimenopause symptoms are not universal and may change over time.

Not everybody experiences significant symptoms of perimenopause, and others might experience every single one. People who begin perimenopause early tend to experience more severe symptoms.

Symptoms tend to start out mild in early perimenopause and increase in intensity and frequency as you get closer to menopause. This is because your estrogen levels decrease more and more over time.

7. You might still be able to get pregnant during perimenopause.

You may or may not be regularly ovulating during the perimenopause transition, and irregular periods make it difficult to track where you are in your cycle.

Because of this, you might want to take precautions if you are not trying to conceive. Until you have not had a period for 12 months in a row, assume you are still fertile.

8. You have some control over your perimenopause symptoms.

Researchers have noted that diet can play a significant role in the mitigation of certain perimenopausal symptoms. Low-fat, plant-dominant, nutrient-rich food can lessen the severity of hot flashes and help keep off excess weight.

Smoking has been shown to worsen hot flashes, and quitting can alleviate some vasomotor symptoms of perimenopause.

Hormone therapy (HT) can lessen or completely eradicate some symptoms of perimenopause, like hot flashes and vaginal dryness. Talk to your clinician about whether HT might be a good choice for you.

9. Caring for your mental health is essential during the menopause transition.

The hormonal changes experienced during perimenopause can make you feel like you’re always PMS-ing. If you’re experiencing insomnia or frequent uncomfortable physical symptoms, your natural mental resilience might be lessened. It’s not uncommon to become more irritable or emotional than normal, and anxiety and depression can develop or worsen.

It might also be challenging to adapt to this new phase of life, especially in a society that values youth over most other qualities. Perimenopause and menopause can trigger deep-seated emotions and challenge your conception of self.

It makes sense that the potential physical and emotional strains of perimenopause can lead to mental health struggles. Change is stressful. Listen to your body, be kind to yourself and your body, and ask for support if needed. 

10. Perimenopause is a normal, natural part of life.

Every woman will reach menopause, and most of us will go through perimenopause. It is inevitable and as nature intended.

Perimenopause marks the beginning of a new stage of life, free from the responsibilities and cycles of the fertile years. With adequate support and armed with knowledge, you can be healthy and happy during perimenopause and beyond.   

Looking for more expert support on perimenopause and what to expect next? Download Midday from the App Store – the only menopause app you’ll ever need!

Jennifer Turkyilmaz, RN, BSN, is a medical writer who worked for many years in women’s health as a high-risk pregnancy nurse. She is also a newly menopausal woman who wishes she had known more about what to expect before it happened to her.

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