What Is Perimenopause, and What Age Does It Start? MDs Share Everything You Need To Know

Tired? Can’t sleep? Gaining weight? All of these are symptoms of perimenopause, which is often misunderstood and under-discussed. During this time, women experience hormone fluctuations that can impact everything from our heart health to our bone health. But what is perimenopause, exactly? And how can you look and feel your absolute best during this key life stage? Here’s what experts want you to know.

Perimenopause vs. menopause: What’s the difference?

The two may sound similar, but they’re actually different stages of the menopausal transition.

Perimenopause

Perimenopause is the period leading to menopause. It’s a transitional process that takes months or years.

Bruce Dorr, MD, a board-certified ob-gyn and senior medical advisor at BioTE, says your menstrual cycle begins fluctuating during this time. What was once a relatively predictable, monthly occurrence can become sporadic, and bleeding can decrease or increase significantly.

“These changes occur because the ovaries stop producing as much estrogen and progesterone as they used to, causing a hormonal ‘feast and famine’ cycle,” Dr. Dorr explains.

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Menopause

You’ve officially entered menopause one year after your last menstrual period. At this stage, “your ovaries no longer produce eggs and you can’t get pregnant,” says Kenosha Gleaton, MD, a board-certified OB/GYN and Everlywell Medical Advisor.

“Since perimenopause causes fluctuating, unpredictable menstrual cycles, you can safely say you’ve reached menopause when you haven’t had your period for a full year,” she adds.

What age is perimenopause, and how long does it last?

Dr. Dorr says every woman’s experience is different. In most cases, perimenopause begins around age 45. However, it can start as early as the mid-30s or as late as the mid-50s. Regardless, the easiest way to tell you’ve entered menopause is irregular periods, or noticeable changes in your menstrual flow and cycle duration.

As for how long perimenopause lasts, it depends. Some women experience a relatively quick and symptom-free transition. But that’s often the exception, not the rule. Dr. Dorr says the process typically takes seven to 10 years, on average. Side effects vary, but for many women, “it’s a very frustrating time.”

Common symptoms of perimenopause

Much of this frustration is because perimenopause affects various bodily functions. Mary Jane Minkin, MD, ob-gyn, a clinical professor at Yale University School of Medicine, says the natural drop in estrogen levels that perimenopause causes can impact sleep patterns, energy levels, sexual health and weight.

This dip in hormone levels can also cause headaches, breast tenderness and irregular menstrual bleeding. These symptoms are typically mild, but for some women they’re severe. In fact, Dr. Dorr says a BioTE survey found that “17 percent of perimenopausal women felt like they had to leave their job or stop working because their symptoms were so bad.” (Learn how exercise can ease perimenopausal symptoms.)

How perimenopause is diagnosed

There’s no one specific test to formally diagnose perimenopause. Dr. Minkin says the diagnosis is often made retrospectively after a woman has gone a full 12 months without having a menstrual period. In that case, you’ve already entered menopause, so perimenopause is behind you.

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That said, there are over-the-counter tests like the Clearblue Menopause Stage Indicator. These assess your follicle-stimulating hormone (FSH) levels. Dr. Minkin says elevated FSH levels often indicate perimenopause, but not always. Therefore, it’s best to meet with your doctor, who can do a full work-up and discuss your symptoms.

Talking to your doctor about perimenopause

Considering perimenopause’s effect on women’s health, partnering with your doctor is crucial. But 73 percent of perimenopausal women don’t seek treatment for their symptoms.

“While there’s no ‘cure’ for perimenopause, there are ways to relieve symptoms to help you feel better,” Dr. Gleaton says. “It’s crucial you have a healthcare team that makes you feel supported. You should also feel empowered to get the important information you need about your hormone health.”

Here’s how to find a doctor (if you don’t already have one) and what to ask to make the most out of your visit.

1. Make an appointment with an ob-gyn who specializes in hormones

Perimenopausal hormone health “is almost a specialty in and of itself, because it’s very complicated and so many factors go into it,” Dr. Dorr says. What’s more, “only 10-20 percent of residencies offer any education on menopause. And those are through elective courses, not part of the standard curriculum.”

Dr. Dorr’s advice? Find a Menopause Society Certified Practitioner (MSCP) through The Menopause Society (TMS). “Provider members have completed a certification program and done advanced training in hormone health,” he explains. “It can still be difficult to find a provider who will meet your specific needs, but it’s a good place to start.”

Click here to search for an MSCP in your area.

2. Ask your doctor what to expect with perimenopause

Once you find a healthcare provider you trust and respect, have an open and honest conversation with them. Dr. Minkin recommends starting with a few basic questions. These include:

• What treatments or lifestyle changes can help alleviate my symptoms?
• Are hormone replacement therapies appropriate for me, and what are their risks and benefits?
• Do you recommend any over-the-counter products to help alleviate discomfort associated with perimenopause symptoms?
• How can I maintain my overall health and prevent issues related to menopause, such as osteoporosis or heart disease?

Dr. Gleaton says you should also address specific concerns, since everyone experiences perimenopause differently. “I recommend asking your healthcare provider about your unique experience such as: With my history of [insert condition], what should I expect during perimenopause?”

3. Don’t be afraid to discuss your sexual health

More than one-third of perimenopausal and menopausal women experience sexual health problems. Talking to your doctor about vaginal dryness or painful intercourse might feel awkward, but it’s nothing to stress over.

“Ask your healthcare provider about how to address your sexual wellness,” Dr. Gleaton says. For example, you might say “I’ve noticed that I’m less interested in sex than before, do you have any suggestions on how to improve my libido?”

Dr. Minkin echoes this advice, particularly when it comes to relieving vaginal dryness. “Reduced estrogen can cause thinning and weakening of the vaginal walls, which makes the vaginal tissues less flexible and more susceptible to dryness and irritation.”

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“With less estrogen, the vaginal glands produce less lubrication, leading to dryness,” she explains. “I always recommend Replens Long-Lasting Moisturizer to provide relief and help replenish vaginal moisture.”

​​This content is not a substitute for professional medical advice or diagnosis. Always consult your physician before pursuing any treatment plan.