Perimenopause is the period of time when a person’s body transitions into menopause. It usually starts in the mid to late 40s and lasts about 4 years.

During perimenopause, menstrual periods may be longer or shorter as well as heavier or lighter than usual. Aside from irregular periods, nearly 90% of people undergoing perimenopause experience symptoms of menopause, such as hot flashes, poor sleep, mood issues, and vaginal dryness.

Management of these symptoms may include hormone therapy unless an individual has a condition that increases the risks associated with the medications. Strategies for coping with physical and emotional changes include lifestyle factors such as staying active and engaging in stress reduction techniques.

Read more to learn about the symptoms and management of perimenopause.

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Perimenopause refers to the years leading up to menopause, which is when menstrual periods permanently stop. In most people, it lasts about 4 years.

During this time, the ovaries make varying quantities of estrogen and progesterone. These hormone fluctuations cause perimenopausal symptoms.

The primary sign of perimenopause is irregular menstrual periods. This may involve one or more of the following symptoms:

  • longer or shorter than usual periods
  • heavier or lighter periods
  • skipped periods

Additionally, many people experience menopause symptoms. These may include hot flashes, which affect 80% of individuals, along with:

Learn more about the differences between menopause and perimenopause.

Management includes hormonal medications, nonhormonal medications, and lifestyle changes.

Management with hormones

A 2016 study reports that females with hot flashes, poor sleep, adverse mood, or vaginal dryness have a strong likelihood that their symptoms are related to perimenopause. For most people, hormones are the most effective treatment.

However, some people have contraindications, which are conditions that would make the side effects and risks of hormones more problematic. These individuals should not take hormonal medications.

Menopausal hormone therapy addresses all the symptoms and comes in various forms, including:

  • pills, such as ethinyl estradiol (Estinyl)
  • patches, such as a combination of estradiol and norethindrone (CombiPatch)
  • vaginal creams, such as 17 β-estradiol vaginal cream (Estrace)

Management with nonhormonal medications

For those who cannot or prefer not to take hormonal medications, other options are available that address individual symptoms. These include:

  • Paroxetine (Paxil): This is an antidepressant that increases the amount of serotonin in the brain. Doctors prescribe it for hot flashes, and a study found it reduces their frequency by 33–67%.
  • Gabapentin (Horizant): This is an anti-seizure medication for hot flashes that occur at night. Older research from 2013 concluded that it can reduce hot flashes in people who cannot take hormones.
  • Ospemifene (Osphena): This is in the class of drugs called selective estrogen receptor modulators. It changes the structure and pH of the vagina, which helps relieve vaginal dryness and painful intercourse.
  • Selective serotonin reuptake inhibitors (SSRIs): This is a class of antidepressants that can relieve the mood conditions associated with menopause. One example is citalopram (Celexa).
  • Melatonin: This is a hormone that the brain produces. It may improve sleep, but experts are uncertain whether the benefits outweigh the potential side effects.

Research indicates that non-medication remedies for menopausal symptoms are largely ineffective. Additionally, some herbal products are not safe and can cause serious side effects. For example, black cohosh, a herbal remedy for menopause, may cause liver damage.

Management with lifestyle changes

The National Institute on Aging advises the following lifestyle changes for hot flashes:

  • carrying a portable fan
  • dressing in layers
  • quitting smoking (if applicable)
  • avoiding caffeine, alcohol (if applicable), and spicy food
  • maintaining a moderate weight

The chart below shows the differences between perimenopause and menopause.

Characteristic Perimenopause Menopause
Definitionthe several-year transition into menopausethe phase that starts after 12 months of not having a monthly period
Average agemid to late 40saround 52 years of age
Ovariesmake fluctuating levels of estrogenmake small amounts of estrogen

The North American Menopause Society (NAMS) recommends the following strategies for coping with perimenopausal changes:

  • Create balance: People should make time to take care of themselves. It is important to remember that self-care is as necessary as caring for family and friends.
  • Stress reduction: Relaxation techniques, psychotherapy, and counseling can help reduce feelings of anxiety.
  • Stay active: Exercising and staying active mentally and socially may help prevent memory problems.

Additionally, NAMS suggests paying attention to attitude, which includes:

  • Monitoring thoughts: Growing evidence indicates that the absence of positive thoughts affects health more than the presence of negative thoughts.
  • Laughing: Laughter has multiple benefits, such as stimulating immunity, boosting a positive mindset, improving memory, and coping with stress.
  • Connecting with others: Having a social support system fosters longevity.
  • Being mindful: Being aware of the present moment helps prevent a person from worrying about the future and dwelling on past regrets.

Below are answers to some frequently asked questions:

How long does perimenopause last?

On average, it lasts 4 years before a person’s periods stop, but it may last 2–8 years.

Do your periods stop during perimenopause?

In the first years of perimenopause, a person may experience skipped or irregular periods. However, because the definition of menopause involves having no periods for 12 consecutive months, an individual’s periods will stop at the beginning of the last year of perimenopause.

At what age does perimenopause happen?

It typically starts in the mid to late 40s.

Perimenopause is the time when menstrual cycles become irregular due to fluctuating hormones. It is the period of time before menopause.

Management of symptoms may involve medications containing the hormone estrogen, such as ethinyl estradiol (Estinyl). For people who are unable to take hormones, alternative treatments that address specific symptoms are available.

Strategies to help someone cope with the changes of perimenopause may include mindfulness techniques and connecting with others.