Perimenopause - Symptoms and causes (2023)


Perimenopause means "around menopause" and refers to the time during which your body makes the natural transition to menopause, marking the end of the reproductive years. Perimenopause is also called the menopausal transition.

Women start perimenopause at different ages. You may notice signs of progression toward menopause, such as menstrual irregularity, sometime in your 40s. But some women notice changes as early as their mid-30s.

The level of estrogen — the main female hormone — in your body rises and falls unevenly during perimenopause. Your menstrual cycles may lengthen or shorten, and you may begin having menstrual cycles in which your ovaries don't release an egg (ovulate). You may also experience menopause-like symptoms, such as hot flashes, sleep problems and vaginal dryness. Treatments are available to help ease these symptoms.

Once you've gone through 12 consecutive months without a menstrual period, you've officially reached menopause, and the perimenopause period is over.

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Throughout the menopausal transition, some subtle — and some not-so-subtle — changes in your body may take place. You might experience:

  • Irregular periods. As ovulation becomes more unpredictable, the length of time between periods may be longer or shorter, your flow may be light to heavy, and you may skip some periods. If you have a persistent change of seven days or more in the length of your menstrual cycle, you may be in early perimenopause. If you have a space of 60 days or more between periods, you're likely in late perimenopause.
  • Hot flashes and sleep problems. Hot flashes are common during perimenopause. The intensity, length and frequency vary. Sleep problems are often due to hot flashes or night sweats, but sometimes sleep becomes unpredictable even without them.
  • Mood changes. Mood swings, irritability or increased risk of depression may happen during perimenopause. The cause of these symptoms may be sleep disruption associated with hot flashes. Mood changes may also be caused by factors not related to the hormonal changes of perimenopause.
  • Vaginal and bladder problems. When estrogen levels diminish, your vaginal tissues may lose lubrication and elasticity, making intercourse painful. Low estrogen may also leave you more vulnerable to urinary or vaginal infections. Loss of tissue tone may contribute to urinary incontinence.
  • Decreasing fertility. As ovulation becomes irregular, your ability to conceive decreases. However, as long as you're having periods, pregnancy is still possible. If you wish to avoid pregnancy, use birth control until you've had no periods for 12 months.
  • Changes in sexual function. During perimenopause, sexual arousal and desire may change. But if you had satisfactory sexual intimacy before menopause, this will likely continue through perimenopause and beyond.
  • Loss of bone. With declining estrogen levels, you start to lose bone more quickly than you replace it, increasing your risk of osteoporosis — a disease that causes fragile bones.
  • Changing cholesterol levels. Declining estrogen levels may lead to unfavorable changes in your blood cholesterol levels, including an increase in low-density lipoprotein (LDL) cholesterol — the "bad" cholesterol — which contributes to an increased risk of heart disease. At the same time, high-density lipoprotein (HDL) cholesterol — the "good" cholesterol — decreases in many women as they age, which also increases the risk of heart disease.

When to see a doctor

Some women seek medical attention for their perimenopausal symptoms. But others either tolerate the changes or simply don't experience symptoms severe enough to need attention. Because symptoms may be subtle and come on gradually, you may not realize at first that they're all connected to the same thing — hormone fluctuations of the menopausal transition.

If you have symptoms that interfere with your life or well-being, such as hot flashes, mood swings or changes in sexual function that concern you, see your doctor.

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(Video) Treating Perimenopause Symptoms


As you go through perimenopause, your body's production of estrogen and progesterone, key female hormones, rises and falls. Many of the changes you experience during perimenopause are a result of decreasing estrogen.

(Video) Perimenopause: Signs, Symptoms, and Solutions

Risk factors

Menopause is a normal phase in life. But it may occur earlier in some women than in others. Although not always conclusive, some evidence suggests that certain factors may make it more likely that you start perimenopause at an earlier age, including:

  • Smoking. The onset of menopause occurs 1 to 2 years earlier in women who smoke than in women who don't smoke.
  • Family history. Women with a family history of early menopause may experience early menopause themselves.
  • Cancer treatment. Treatment for cancer with chemotherapy or pelvic radiation therapy has been linked to early menopause.
  • Hysterectomy. A hysterectomy that removes your uterus, but not your ovaries, usually doesn't cause menopause. Although you no longer have periods, your ovaries still produce estrogen. But such surgery may cause menopause to occur earlier than average. Also, if you have one ovary removed, the remaining ovary might stop working sooner than expected.


Irregular periods are a hallmark of perimenopause. Most of the time this is normal and nothing to be concerned about. However, see your doctor if:

  • Bleeding is extremely heavy — you're changing tampons or pads every hour or two for two or more hours
  • Bleeding lasts longer than seven days
  • Bleeding occurs between periods
  • Periods regularly occur less than 21 days apart

Signs such as these may mean there's a problem with your reproductive system that requires diagnosis and treatment.

By Mayo Clinic Staff

(Video) Dr. Paru David - What are common symptoms of menopause?

Aug. 07, 2021


What is the most common early symptom of perimenopause? ›

Irregular periods are the most common symptom of perimenopause. But it's important to know when to talk to your healthcare provider about your periods. Sometimes, irregular bleeding can point to an underlying problem. You can lower your risk of complications by seeking treatment when necessary.

What are five of the most common symptoms of perimenopause? ›

These are the most common symptoms:
  • Night sweats.
  • Hot flashes.
  • Vaginal dryness.
  • Trouble with sleep.
  • Joint and muscle aches.
  • Heavy sweating.
  • Having to pee often.
  • PMS-like symptoms.

What are the unusual symptoms of perimenopause? ›

10 Weird Perimenopause Symptoms That Can Happen After 40
  • Bugs crawling on your skin. A feeling that insects are crawling on you is called formication. ...
  • Burning Tongue or Mouth. ...
  • Altered Depth Perception or Bumping into Things. ...
  • Body Odor. ...
  • Wild Hairs (Chin, Nipple and More) ...
  • Dizzy Spells. ...
  • Tinnitus or Ringing Ears. ...
  • Cold Flashes.

What does the start of perimenopause feel like? ›

Common physical symptoms of menopause and perimenopause include: hot flushes, when you have sudden feelings of hot or cold in your face, neck and chest which can make you dizzy. difficulty sleeping, which may be a result of night sweats and make you feel tired and irritable during the day.

How do you confirm perimenopause? ›

Perimenopause is a process — a gradual transition. No one test or sign is enough to determine if you've entered perimenopause. Your doctor takes many things into consideration, including your age, menstrual history, and what symptoms or body changes you're experiencing.

What can perimenopause be confused with? ›

Medical conditions including endometriosis or cancer are sometimes confused with perimenopause in midlife women because they can alter your menstrual cycle.

What is the average age of perimenopause? ›

Perimenopause can begin in some women in their 30s, but most often it starts in women ages 40 to 44. It is marked by changes in menstrual flow and in the length of the cycle.

What are the symptoms of low estrogen? ›

Signs of low estrogen include:
  • Dry skin.
  • Tender breasts.
  • Weak or brittle bones.
  • Trouble concentrating.
  • Moodiness and irritability.
  • Vaginal dryness or atrophy.
  • Hot flashes and night sweats.
  • Irregular periods or no periods (amenorrhea).
Feb 8, 2022

What vitamins are good for perimenopause? ›

By incorporating natural supplements for perimenopause into your daily regimen, you can relieve the associated symptoms while also safeguarding your long-term health.
  • Phytoestrogens. ...
  • Calcium. ...
  • Dehydroepiandrosterone (DHEA) ...
  • Vitamin D. ...
  • Bioidentical hormones. ...
  • Vitamin E. ...
  • B vitamins. ...
  • Omega-3s.

What is not normal during perimenopause? ›

Your estrogen levels drop and you may have markedly irregular menstrual cycles. On top of irregular periods, hormonal changes can lead to weight gain, hot flashes, trouble sleeping, vaginal dryness, mood changes, and depression. Perimenopause ends with menopause, at which point you have not had a period for 12 months.

What happens right before perimenopause? ›

Your menstrual cycles may lengthen or shorten, and you may begin having menstrual cycles in which your ovaries don't release an egg (ovulate). You may also experience menopause-like symptoms, such as hot flashes, sleep problems and vaginal dryness.

Can you feel sick with perimenopause? ›

During perimenopause (the years leading up to menopause), changing levels of hormones can result in a variety of symptoms like hot flashes, night sweats, mood swings, and trouble sleeping. On days when declining levels of estrogen spike temporarily, women can experience bouts of nausea.

What is the best treatment for perimenopause? ›

Treatments may include:
  • Hormone therapy. Estrogen therapy is the most effective treatment option for relieving menopausal hot flashes. ...
  • Vaginal estrogen. ...
  • Low-dose antidepressants. ...
  • Gabapentin (Gralise, Horizant, Neurontin). ...
  • Clonidine (Catapres, Kapvay). ...
  • Medications to prevent or treat osteoporosis.
Dec 17, 2022

Can you self test for perimenopause? ›

No, you cannot conclusively self-diagnose perimenopause. At-home test kits measure certain hormones, and these levels may suggest you are in menopause or perimenopause. However, the results are qualitative, meaning they cannot definitively diagnose perimenopause.

Does blood work show perimenopause? ›

When testing for menopause is warranted, doctors may order an FSH test to detect elevated levels of FSH in the blood. Measuring FSH can help determine if a woman is perimenopausal or has already gone through menopause.

Can a blood test show if you are perimenopausal? ›

Rationale. In otherwise healthy women over 45, perimenopause and menopause can be diagnosed based on clinical history alone. In this age group, laboratory tests, particularly follicle-stimulating hormone (FSH), do not help with the diagnosis because hormone levels fluctuate during the perimenopause.

What is the end of perimenopause? ›

The drop in estrogen levels accelerates during the last couple of years of your perimenopausal cycle. Eventually, after 12 months with no period, perimenopause ends, and menopause officially begins.

Can a woman have an Orgasim after menopause? ›

That said, if you've heard or read that you won't be able to orgasm after menopause, you should know that's completely false. Orgasms — and great sex — are still absolutely possible, through menopause and beyond.

Do perimenopause symptoms come and go? ›

Perimenopause symptoms may come and go for years before your period stops altogether. You officially reach menopause 12 months after your last menstrual period.

Does vitamin D increase estrogen? ›

High blood levels of vitamin D linked to reduced estrogen – and potentially lower breast cancer risk.

What vitamins can increase estrogen? ›

B vitamins

B vitamins play an important role in the creation and activation of estrogen in the body. Low levels of these vitamins can lead to reduced levels of estrogen.

How do I know if I need estrogen? ›

Hot flashes and Night Sweats

Estrogen affects the hypothalamus, which regulates body temperature. Low estrogen causes hot flashes and night sweats, two annoying symptoms of menopause and perimenopause.

What can I take naturally for perimenopause? ›

Natural Remedies for Perimenopause
  • Ginseng.
  • Black cohosh.
  • Soy.
  • Vitamin D.
  • Wild yam.
  • Yoga.
  • Pine bark extract.
  • Dong quai.
Dec 5, 2017

How can I balance my hormones during perimenopause? ›

During perimenopause, a woman's estrogen and progesterone start to fluctuate.
What you can do now
  1. Quit smoking if you smoke cigarettes.
  2. Exercise regularly.
  3. Eat more protein, omega-3 fatty acids, fiber, and calcium.
  4. Limit saturated fats, highly refined carbs, and sugar.
  5. Limit caffeine and alcohol.

Is vitamin B12 good for perimenopause? ›

B12 deficiency is very common in women who are menopausal and perimenopausal, which can exacerbate symptoms. B12 injections can help ease symptoms of the menopause and perimenopause, improving cognitive function and vitality.

What does perimenopause discharge look like? ›

During perimenopause, your discharge may take on a brownish tint. It may also be thin and watery or thick and clumpy. These changes usually aren't cause for concern.

Do I need to see a doctor for perimenopause? ›

Some women experience very few symptoms during perimenopause. While you should still see your doctor for regular physical checkups, it may not be necessary to seek specific care for perimenopause unless the symptoms cause significant discomfort.

What can I take over the counter for perimenopause? ›

Amberen and Estroven are two brands of over-the-counter supplement products. They are for people experiencing menopause or perimenopause. Both Amberen and Estroven claim that their products relieve various symptoms associated with menopause, such as hot flashes and mood changes.

What is the average age to start perimenopause? ›

Perimenopause can begin in some women in their 30s, but most often it starts in women ages 40 to 44. It is marked by changes in menstrual flow and in the length of the cycle. There may be sudden surges in estrogen.

What is the right age for perimenopause? ›

The years leading up to that point, when women may have changes in their monthly cycles, hot flashes, or other symptoms, are called the menopausal transition or perimenopause. The menopausal transition most often begins between ages 45 and 55. It usually lasts about seven years but can be as long as 14 years.

How many years before menopause does perimenopause start? ›

It usually starts in women's 40s, but can start in their 30s or even earlier. Perimenopause lasts up until menopause, the point when the ovaries stop releasing eggs. In the last 1 to 2 years of perimenopause, this drop in estrogen speeds up. At this stage, many women have menopause symptoms.

What is the difference between premenopause and perimenopause? ›

Premenopause is the time between a woman's first period and the onset of perimenopause. Perimenopause is the transition phase into menopause that typically lasts about six years. It typically occurs in women in their 40s to early 50s, according to the National Institute on Aging.

Does perimenopause make you tired? ›

During perimenopause your body's estrogen and progesterone levels begin to fluctuate. These fluctuations cause symptoms that can lead to perimenopause fatigue: Disordered sleep or insomnia frequently accompany perimenopause—the lack of sleep leads directly to fatigue.

Can you be 53 and still have periods? ›

Any woman still experiencing a menstrual cycle in her late 50s and 60s should see a doctor. However, it's important to note that each woman's reproductive system is different. Just as each young woman starts menstruating at a different age, menopause comes at a different age for each woman.

Does perimenopause cause weight gain? ›

The hormonal changes of menopause might make you more likely to gain weight around your abdomen than around your hips and thighs. But, hormonal changes alone don't necessarily cause menopause weight gain. Instead, the weight gain is usually related to aging, as well as lifestyle and genetic factors.

What is your last period like before menopause? ›

When your estrogen levels are low, your uterine lining is thinner. Bleeding, as a result, may be lighter and last fewer days. Short cycles are more common in the earlier stages of perimenopause. For example, you may have a period that's 2 or 3 days shorter than normal.

Do perimenopause symptoms get worse just before menopause? ›

Perimenopause can last 10 to 12 years, but the worst symptoms are usually in the five years leading up to menopause. Menopause happens when the ovaries no longer have eggs to expel and so ovulation stops. Because ovulation stops, the production of estrogen and progesterone is greatly decreased.


1. Perimenopause vs. Menopause: Signs, Symptoms & Treatments with Dr. Katrina Kelly | San Diego Health
(Scripps Health)
2. What to Expect During Perimenopause
(Penn Medicine Lancaster General Health)
3. Perimenopause & Perimenopausal Depression: Signs, Symptoms, and Treatment | Mass General Brigham
(Mass General Brigham)
4. Menopause Symptoms & Treatment
(Sutter Health)
5. Perimenopause: Symptoms and Signs - Dr. Meghan Lynch - Mercy
(Mercy Medical Center - Baltimore)
6. Menopause, Perimenopause, Symptoms and Management, Animation.
(Alila Medical Media)
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