Last Updated June 2022 | This article was created by editorial staff and reviewed by Robert "Chuck" Rich, Jr., MD, FAAFP

What is perimenopause?

Perimenopause is a stage in a woman’s reproductive years. It’s a sign that a woman is getting closer to menopause. Menopause is the time in a woman’s life when she stops having periods and can no longer become pregnant. Perimenopause generally starts in a woman’s 40s and commonly lasts several years. However, it can vary for every woman. It’s important to remember that a woman can still become pregnant during perimenopause. Birth control would still be important to use during this phase of your life if you want to prevent a pregnancy.

Symptoms of perimenopause

There are many symptoms a woman will not see during perimenopause. For example, estrogen (the female hormone) will fluctuate. And a woman’s ovaries will slowly stop releasing eggs (meaning you are not ovulating). Other symptoms that you will notice include some that are similar to menopause, including:

  • Hot flashes (feeling intensely warm or hot from the inside out)
  • Sleep disturbances
  • Mood changes
  • Vaginal dryness (This may cause pain during sexual intercourse.)
  • Longer, shorter, or skipped periods (During the early phase of perimenopause, you may see changes of 7 days or more between periods. Once you reach menopause, the difference is 60 days or more.)
  • Heavy or light flow menstrual flow
  • Bladder problems (urinary infections or leakage)
  • Decreased fertility
  • Changes in sexual desire or arousal
  • Bone loss
  • Higher cholesterol levels

While irregular periods are normal during perimenopause, talk to your doctor if your period is extremely heavy (you are changing pads or tampons every couple of hours). Also, talk to your doctor if your bleeding lasts longer than seven days, if you bleed between periods, or if you are getting your periods less than 21 days apart.

What causes perimenopause?

Perimenopause is a natural part of aging for women. However, other factors can cause it to start earlier than normal. Those factors include:

  • Family history
  • Hysterectomy (surgical removal of all your female reproductive organs)
  • Cancer treatment (chemotherapy and radiation)
  • Some synthetic hormones used to treat certain medical conditions

How is perimenopause diagnosed?

Your doctor will talk to you about your symptoms. They will consider your age, your family history, and your menstrual history to determine if you are experiencing perimenopause. A blood test can check your hormone levels. However, your doctor may not order this unless your symptoms are occurring at an unusually young age.

Can perimenopause be prevented or avoided?

It cannot be prevented or avoided. However, not smoking can delay an early onset.

Perimenopause treatment

Perimenopause is often treated with prescription hormone medicine or nothing at all. Hormones treat the symptoms of perimenopause. They are offered in pill form, as a cream, or a skin patch. Your doctor will typically start you on the lowest possible dosage. This approach is called hormone replacement therapy (HRT). It is a risk factor for certain types of female cancers. Certain over-the-counter vaginal products can relieve dryness. Water-based vaginal dryness products are best. Certain prescription medicines can treat urinary incontinence (leaking). Talk to your doctor if you are having significant mood changes. They may treat it with prescription antidepressant medicine.

Some common healthy practices can help with symptoms. This includes eating healthy foods, exercising, getting enough sleep, reducing your alcohol consumption, and practicing relaxation exercises.

Living with perimenopause

Living with perimenopause can be frustrating at times. Many of the symptoms appear without warning, including hot flashes, mood changes, and sleep disturbances. Irregular periods or periods with a heavier flow can be a difficult adjustment. And if you are trying to prevent a pregnancy, you have to be absolutely certain you have reached menopause before giving up birth control. Menopause occurs when you have gone through 12 consecutive months without a menstrual period.

Questions to ask your doctor

  • Is increased pain with my period normal during perimenopause?
  • Will hot flashes eventually go away after menopause?
  • Does perimenopause start earlier if you started your period at a young age?
  • If I had breast cancer, should I avoid hormone therapy?


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