What You Need to Know About Perimenopause

Perimenopause is the transitional time before you reach menopause. Although the experience of perimenopause is unique to every woman, there are some things everyone should know about it.

What is Perimenopause?

Perimenopause is the time when your body transitions from a reproductive to a non-reproductive state. During this time, your sex hormones (estrogen and progesterone) decrease, and your ovaries start the process of shutting down their work of creating mature follicles. Perimenopause ends when you reach menopause and no longer ovulate (release eggs).

When Does Perimenopause Start?

When you begin perimenopause depends on a multitude of factors, and perimenopause onset varies from person to person. Some people start perimenopause in their 30s and others in their 50s.

On average, perimenopause begins in your 40s. A few factors that might affect how early or late perimenopause starts are genetics, weight, ethnicity, smoking, and certain medical conditions.

How Long Does Perimenopause Last?

Again, there is great variation from person to person in how long perimenopause lasts. It can last for months or up to a decade. The average length of perimenopause is four years. Perimenopause is officially over when you haven’t menstruated for 12 consecutive months that is not due to another reason. At that time, you will have entered menopause.

The Signs of Perimenopause

For many years, perimenopause was considered to have started when menstrual cycles became irregular. However, recent research has shown that other symptoms of perimenopause, such as sleep disturbance, low libido, mood changes, and hot flashes, can begin much earlier.

The length of your menstrual cycle may also change in early perimenopause. Researchers have determined that a defining characteristic of early perimenopause is a persistent, seven-day change. This can mean seven days shorter can mean that you have your periods closer together or farther apart. It is normal to experience both during this transition time.

If you’ve always had irregular periods, this may not be the clearest indicator for you. However, most women can expect to see changes in the characteristics and frequency of their periods. You may have a short and light period one month and the opposite the next.

As you reach late perimenopause, your menstrual cycles will become more irregular and infrequent. They can be 60 days apart or more, and this phase can last for several years before menopause is reached.

It is important to keep in mind that during perimenopause, you are still periodically ovulating. Be diligent with your birth control until you are sure you’re in menopause and can no longer get pregnant. About 4% of live births in the U.S. are to women over 40.

What Are Some Other Effects of Perimenopause?

During perimenopause, your estrogen and progesterone levels will become erratic and eventually permanently decrease as your body prepares to stop ovulating.

At the same time, your follicle-stimulating hormone (FSH) increases as it tries to do its job of getting the ovaries to produce mature eggs. It’s fighting a losing battle since there are no longer sufficient eggs to be matured, and FSH will remain high from now on.

All of these hormone changes cause a multitude of side effects and changes in your body. A few of the more common symptoms include:

• Hot flashes
• Sleep difficulties
• Fatigue
• Mood changes
• Vaginal dryness
• Low libido
• Dry skin and hair

Over the long term, the decrease in estrogen in your body contributes to loss of bone density and an increase in your risk of cardiovascular disease.

Final Thoughts

Although change can be uncomfortable and even a little scary, the more you learn about perimenopause, the more prepared you will be. Your perimenopause experience will be unique to you, but there are some constants that every woman will experience. Estrogen and progesterone will decrease, and FSH will increase. You will eventually stop ovulating and no longer be fertile.

When you reach menopause and no longer have menstrual periods, you should discuss any postmenopausal bleeding immediately with a healthcare provider. While postmenopausal bleeding is not usually serious, it is one of the signs of ovarian cancer.