Perimenopause is the process of change leading up to menopause, which is the point in your life when you stop having periods. It can start as early as your late 30s or as late as your early 50s.
How long perimenopause lasts varies by the person, but it typically ranges from two to eight years.
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Perimenopause is the hormonal transition leading up to menopause, which is the point in your life when you stop having periods for 12 months (or immediately following the surgical removal of both ovaries). Perimenopause may begin as early as in your late 30s or as late as in your early 50s.
As you approach menopause, your body begins to produce less estrogen and progesterone. These hormonal changes can affect your mood and cause irregular periods and physical symptoms.
Perimenopause is a natural part of aging. It occurs due to the declining number of eggs available in the ovaries, which produce hormones needed for menstrual periods and pregnancies.
When people talk about menopause, they're often really referring to perimenopause.
Menopause is the cessation (stopping) of your period. When a person hasn't had a period for 12 months, they're considered menopausal. They are also considered menopausal immediately after both ovaries are surgically removed, regardless of how young they are.
Perimenopausal women may have irregular periods but are still able to get pregnant. During perimenopause, you should continue to use protection during sexual intercourse to prevent unwanted pregnancies.
About 1% of U.S. women are considered to have premature menopause, meaning they experience menopause before age 40. Premature menopause can be the result of genetic, metabolic, or autoimmune conditions. It also occurs with the surgical removal of both ovaries.
The symptoms of premature menopause are similar to those of perimenopause. Because people with premature menopause spend less time without the benefits of estrogen production, they're at greater risk for health problems like osteoporosis, heart disease, and dementia.
Perimenopause typically lasts two to eight years, and ends when a person hasn't had a period for 12 months. At that point, they have reached menopause.
For some women, the onset of perimenopause can occur in their 30s, but for most people, it happens in their 40s or 50s.
There are many symptoms of perimenopause. How severe these symptoms are and how long they last will vary by person.
Menopausal symptoms are thought to be a result of changing hormone levels, which is why they may be unpredictable and vary in severity.
Many people undergoing the menopausal transition will experience genitourinary syndrome of menopause, or GMS. This condition involves changes to the vulva, vagina, urethra, and bladder. People with GMS may experience vaginal dryness, pain during sex, urinary urgency, or bladder infections.
If you're approaching your 40s or 50s and notice irregularities in your period, you may be experiencing perimenopause.
Irregularities may include periods that:
Other common perimenopause experiences include:
The menopausal transition also may result in a range of mental health problems. Women with a history of clinical depression, premenstrual syndrome (PMS), or postpartum depression are at a higher risk of experiencing depressive symptoms during perimenopause.
If you're between the ages of 30 and 50 and having symptoms of perimenopause, consider discussing them with your health care provider, especially if your symptoms are bothersome or your periods stopped before age 45.
Call your doctor right away if you're experiencing any of these symptoms consistently:
To determine if you're in perimenopause, your doctor will assess factors such as your age, menstrual pattern, symptoms, and family history.
Menopause is diagnosed after you have had no periods for 12 months or if you have had both ovaries surgically removed at any age.
If your health care provider suspects you are experiencing perimenopause and is unable to monitor your periods (due to prior hysterectomy, endometrial ablation, or use of hormonal IUD), they may order a blood test to check your follicle-stimulating hormone (FSH). FSH levels are high during menopause but fluctuate up and down during perimenopause.
While this test does not ensure a diagnosis, it may raise suspicion that you actually are in menopause if the FSH level is high.
You don't need treatment for perimenopause unless your symptoms bother you. Symptoms that are severe and affect your quality of life should improve with treatment.
Making changes to your lifestyle may help you alleviate the symptoms of perimenopause without the need for medical intervention.
You can often ease mild symptoms of perimenopause with lifestyle changes and adaptations, such as wearing light layers and carrying a portable fan.
Other things you can do to take care of yourself during perimenopause include:
Perimenopausal symptoms can be alleviated and treated through the use of hormone therapy.
Some people prefer not to use hormone therapy. In this case, non-hormonal medicines can be prescribed. If you're interested in pursuing non-hormonal treatments, you should speak with your provider about your options.
Lower levels of hormones may lead to intense symptoms of perimenopause. Many people find relief in menopausal hormone therapy (MHT). Often, they're prescribed estrogen with or without a progesterone/progestin.
MHT should be used at the lowest effective dose and for the shortest duration needed.
Hormone therapy can help relieve:
MHT also may reduce your chances of developing osteoporosis — a condition in which bones become thin and weak and may break more easily.
Hormone therapy may not be appropriate for perimenopausal women who might be pregnant or have problems with vaginal bleeding, certain cancers, or liver disease, or have a history of heart attack, stroke, or blood clots.
As with all medical interventions, there are some risks associated with MHT. These include stroke, blood clots, heart attacks, breast cancer, gallbladder disease, and endometrial cancer. Smoking while using MHT can further increase your risk.
Anyone experiencing perimenopause can develop related emotional, behavioral, and cognitive issues. However, if you have a personal or family history of mental health conditions, you may be at a higher risk of developing a mental health problem related to perimenopause.
You may also be at a higher risk for mental health issues during perimenopause if you have:
The best way to prevent mental health issues is to be proactive about your mental and emotional condition and get help at the first sign of problems.
Treatment for anxiety, depression, perceived cognitive decline, stress, and other perimenopause-related mental health concerns depends on their specific cause, your symptoms, and the severity of your condition.
Your doctor may recommend one or more treatments to improve your mental health during perimenopause.
Lifestyle changes you can make to improve your mental health during perimenopause include:
Antidepressant and anti-anxiety medications may be prescribed to treat moderate to severe psychiatric symptoms.
Before prescribing medication, your doctor will consider how the medication may interact with other medicines you're taking. UPMC psychiatrists will work closely with you and your ob-gyn to determine the safest and most effective mental health treatment.
UPMC offers one-on-one counseling and group therapy to help women discuss and manage stress, depression, anxiety, and mood disorders. Our specialists may also recommend exercise therapy, light therapy, or other alternative options to help you manage your mental health condition during perimenopause.
By UPMC Editorial Staff. Last reviewed on 2024-09-05.
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