What Is Perimenopause, Exactly? Ob-Gyns Weigh In

This informational guide, part of PS’s Condition Center, lays out the realities of this health concern: what it is, what it can look like, and strategies that medical experts say are proven to help. You should always consult your doctor regarding matters pertaining to your health and before starting any course of medical treatment.

Menopause begins one full year after your last period, according to the Mayo Clinic, but there’s also a name for the few years right before, when your periods start getting more unpredictable and your hormone levels begin to change. This time is called perimenopause, and while it’s not the same as menopause, it does come with similar symptoms that can feel just as tricky to address. You can think of perimenopause as a “transition phase,” says ob-gyn Mary Jacobson, MD, chief medical officer of Alpha Medical, when the experience of menopause is starting but you haven’t stopped getting your period altogether.

That said, perimenopause symptoms can be mistaken for other conditions, like thyroid problems, depression, and anxiety, per Sky Women’s Health — which only further highlights the misunderstandings around perimenopause and how to spot the signs. Ahead, three doctors weigh in on what can you expect from perimenopause, and how to address the symptoms as they come.

Mary Jacobson, MD, is an ob-gyn and the chief medical officer of Alpha Medical.

Jennifer Howell, MD, is an ob-gyn specializing in menopause at Duke Health.

Shieva Ghofrany, MD, is a board-certified ob-gyn and PS Condition Center advisory board member.

Emily Hu, MD, is a NAMS-certified menopause practitioner and medical director at menopause telehealth company, Evernow.

Perimenopause is “the timeframe surrounding the last menstrual period,” says Jennifer Howell, MD, an ob-gyn specializing in menopause at Duke Health. The average age of the final menstrual period is 51 in North America, according to Climateric Journal, and perimenopause can begin up to 10-plus years before that. “Usually mid 40s is when we can see [perimenopause] start to happen,” Dr. Howell says, “but sometimes we’ll see it early 40s or late 30s.”

Symptoms of perimenopause can vary, and some people may be asymptomatic, just experiencing “subtle changes in their periods,” Dr. Howell notes. When symptoms do occur, they can be similar to either PMS or menopause, a result of the fluctuating levels of hormones produced by the body during this time. According to our experts and the Mayo Clinic, symptoms of perimenopause may include any or all of these symptoms:

It’s also worth noting that “because cardiovascular disease (CVD) increases after menopause and is the leading cause of death as we age, it is very important to have a good relationship with your gynecologist and primary-care provider to help understand your individual risk and what strategies you can take to mitigate it,” says Shieva Ghofrany, MD, board-certified ob-gyn and PS Condition Center advisory board member.

Perimenopause is a phase of reproductive aging, caused by “the natural decline in function of the ovaries,” says Emily Hu, MD, ob-gyn, NAMS-certified menopause practitioner, and medical director at menopause telehealth company Evernow. The symptoms you experience stem from hormonal fluctuations, as the level of estrogen and progesterone in your body rises and falls.

This bears repeating: perimenopause is a normal function, Dr. Ghofrany says. If you find yourself experiencing any of the symptoms listed above and are in your late 30s to early 40s, “you do not need to worry that you are necessarily going through ‘early menopause,'” she explains. “Rather, you are entering the phase before menopause where your hormones fluctuate unpredictably that can last five to 10 years and, while uncomfortable, can be addressed and managed.”

“Your ovaries are essentially running out of eggs,” Dr. Howell explains. In the early phases of perimenopause, she says, your brain increases the hormonal signal to the ovaries to release more eggs, which is what causes the interval between your periods to decrease. This is also the time when people might see more PMS-type symptoms, like mood swings, breast tenderness, and migraines.

Later in perimenopause, you might start to skip periods as your ovaries are no longer able to respond to the hormone signals from your brain that tell you to ovulate. “Then they actually will have symptoms of estrogen deprivation,” Dr. Howell explains, “where they can get the more classic menopause symptoms like hot flashes and night sweats.”

There are also certain factors that can impact your menopausal journey. For example, family history can play a part in determining when you start menopause, Dr. Howell says. People who smoke may also experience an earlier onset of perimenopause, according to a 2018 review in the American Journal of Epidemiology.

You doctor will assess whether this “transition phase” has begun after evaluating your physical exam, symptoms, age, and medical history, per the Cleveland Clinic. Chances are, you may know that you’re entering perimenopause before your provider does as the changes in your body take place — and especially if symptoms become severe. Your provider may also do hormone testing to see whether your symptoms truly signal perimenopause.

Perimenopause is a natural part of reproductive aging, not a sign of anything bad or “wrong” happening in your body, but treatments are available if perimenopause symptoms are causing you discomfort. Hormonal birth control, such as the birth-control pill, hormonal IUD, patch, vaginal ring, or implant, is an option for settling down irregular periods and managing hormonal fluctuations. Even though your periods may be irregular and your hormones are changing, “many people actually can conceive in perimenopause,” Dr. Howell adds, so getting on hormonal birth control can also prevent pregnancy if that’s a concern.

If you’re dealing with worsening PMS symptoms, selective serotonin reuptake inhibitors (SSRIs), a common type of antidepressant, are an option as well. Hormone replacement therapy (HRT) may also be something to consider. It is often used to treat menopause symptoms but can also be used during later stages of perimenopause, even if you’re still getting your period intermittently. “You can use [HRT] to help with the hot flashes, night sweats, mood changes, and insomnia,” Dr. Howell explains. However, it does carry some potentially serious risks. “Several large studies have looked at possible links between systemic hormone therapy in menopausal women and different types of cancer,” according to the American Cancer Society. So be sure to talk to your doctor about your individual risk and concerns.

In general, perimenopause is a common and sometimes subtle experience. “It doesn’t mean something awful is about to happen to you . . . it’s just reproductive aging,” Dr. Howell says. If your symptoms are impacting your life, however, you don’t have to suffer in silence. Be sure to reach out to a doctor to explore treatment options that work best for you.