When Does Perimenopause Start?

Know the symptoms of perimenopause and when to talk to your doctor

The signs of perimenopause may be subtle at first. Your period may not be as regular as it once was. Maybe you can’t get a good night’s sleep. Or you can’t find words or remember dates like you used to. If you’re a woman in your 30s or 40s, various changes can be signs you’ve entered a new phase of life: perimenopause.

“You didn’t go through puberty in 1 day or 1 year. In a similar way, your body needs time to shift out of the reproductive stage of your life,” says Samantha Bennett Backer, CRNP, a specialist in women’s health at Geisinger.

While perimenopause is natural, your healthcare provider can help you manage the symptoms if they disrupt your life or become too severe.

What is perimenopause?

Perimenopause is a phase of life before menopause. You enter menopause when you haven’t had a menstrual period for 12 consecutive months. Before you stop having a period, your body gradually slows the production of hormones including estrogen, progesterone and even testosterone. This can change how you feel.

It’s still possible to get pregnant in perimenopause. Until you’ve gone without a period for a full year, continue birth control if you are sexually active and want to prevent pregnancy.

At what age does perimenopause start and how long does it last?

Everyone’s body is different. Most women enter perimenopause in their 40s, although some start earlier, in their 30s.

“If you had your period earlier than many of your peers, you’ll likely start perimenopause earlier too,” says Ms. Backer.

This phase of life typically lasts about 4 years, although for some it can last for 8 to 10 years and for others it’s only months. Timing tends to run in families.

However, having your ovaries removed surgically puts you immediately into menopause.

How do I know I’m in perimenopause?

No single physical test can tell doctors where you are on your menopause journey. Blood tests only capture a moment in time and hormone levels change constantly throughout the day. Your best clue is noticing symptoms that may indicate hormone levels are falling. If you’re noticing changes — especially changes that are bothering you — tell your concerns to your healthcare provider.

They can examine you and run tests to check whether the symptoms are caused by other conditions.

Perimenopause symptoms

Some perimenopause symptoms are well known, but you may not be aware of other signs you’re approaching menopause.

Irregular periods

When perimenopause begins, your cycles may vary in length. One cycle may last 4 days and another 10 days. As you transition closer to full menopause, the time between cycles starts to shift. It’s not unusual to have 60 days in between. Remember, even though your periods are irregular, it’s still possible to become pregnant.

“The amount of bleeding can vary or increase, especially if the time between cycles is longer,” says Ms. Backer. “If you’re bleeding excessively, it could cause anemia or harm your health, so contact your provider.”

Menstrual bleeding is considered heavy if you’re:

Needing to change your pad or tampon every hour for several hours
Needing to double up pads or wear both a pad and a tampon to prevent leaks
Needing to get up in the night to change pads or tampons
Having bleeding for more than a week
Passing blood clots that are larger than a quarter
Feeling extremely tired or having trouble breathing

Hot flashes and night sweats

Hot flashes and night sweats are the most recognized symptom of perimenopause. And they’re common: 80% of women report hot flashes, sometimes called vasomotor symptoms or VMS. Your face can turn red. It might feel like your body suddenly has a furnace inside it. You may sweat suddenly when no one else in the room is uncomfortable. Hot flashes at night — night sweats — can wake you drenched in sweat, making it hard to get back to sleep. Drinking alcohol can make hot flashes worse, night or day.

Women report having hot flashes and night sweats for 3 to 4 years on average. They’re the most common reason women seek medical support during menopause.

“If hot flashes or night sweats are disrupting your life, speak to a healthcare provider,” says Ms. Backer.

Sleep changes

Between 40% and 60% of women report trouble sleeping between ages 40 and 60. Women in perimenopause are more likely to have trouble falling asleep or staying asleep.

“If you often have hot flashes, you’re more likely to have insomnia or disrupted sleep,” says Ms. Backer. “You may also develop sleep apnea, especially if you’ve gained weight during your transition to menopause.”

Lack of sleep drastically affects your physical and mental health. Tell your healthcare provider.

Mood changes and brain fog

In perimenopause, you may feel more confident, care less about the opinions of others and lean into lifelong wisdom. You may also find the hormone shifts affect your mental health. Once, mood swings might have been a predictable part of the days before your period, but now they’re happening at unexpected times. Many women in this phase of life report not feeling like themselves due to things like anxiety, brain fog and fatigue. You may:

Become tearful or cry more often
Feel angry or anxious more often
Feel “flat” or depressed
Forget things
Lose your train of thought or find it hard to focus
Feel tired

“Women in perimenopause are more likely to have depression or report anxiety,” says Ms. Backer. “This is especially true if you’ve had bouts of depression or anxiety before perimenopause, or if you often have hot flashes or night sweats.”

Seek support if you’re depressed, anxious or have mental health concerns. There are many options from lifestyle changes to counseling to medication that can help.

Painful joints

You might be achy and stiff in your hands, hips and knees, one of the most reported symptoms of perimenopause. This pain sometimes stumps healthcare providers because there’s no signs of arthritis in medical scans. You might even have frozen shoulder, where the capsule around the joint becomes inflamed and prevents movement.

“Regular movement, especially gentle movement like stretching, yoga and walking, can be helpful, as well as weight-bearing exercise,” says Backer. “In some cases, you may need physical therapy or medications to maintain mobility and manage pain.”

Vaginal dryness and sexual problems

As estrogen retreats, the tissues around your vagina and vulva can thin and become less stretchy. Sex might be painful, or you may find your response dwindling. Also, the muscles of your pelvic floor can weaken. You might need to urinate often or get urinary tract infections. You might pee when you laugh, cough or exercise.

“It may be embarrassing to tell your healthcare provider if you have vaginal pain or bladder problems,” says Ms. Backer. “Fortunately, there is specialized pelvic floor care and options including topical and oral medications that can greatly improve your life and even help your relationships. Don’t be afraid to talk about it.”