Perimenopause: What It Is and How to Treat It

What is perimenopause?

Perimenopause is so deeply misunderstood—by women, society, everyone—that many of us have no idea we’re even in it when it begins. Let’s start with the basic definition: Perimenopause refers to the natural and normal period when your body adjusts to the end of your reproductive years. The name comes from “peri,” a Greek word meaning “around,” which makes sense since it happens in the years before your period stops. It’s marked by fluctuating hormones, particularly estrogen, which gradually declines—but not in a totally straight line.

Like puberty, perimenopause is a natural hormonal shift, but it can still bring about uncomfortable symptoms, like hot flashes, sleep disturbances and changes in brain and sexual function. Understanding these symptoms and how to manage them through treatment, like hormone replacement therapy (HRT) and lifestyle adjustments, can be a game-changer for your physical and emotional wellbeing.

Menopause, on the other hand, isn’t a stage, but rather a moment: You reach it when you’ve gone exactly 12 consecutive months since your last menstrual period. That point in time marks the definite end of your fertility. The average age of menopause is 51, but it may come years later, or earlier.

While menopause is the same for all women in at least a few respects (no more birth control needed and no more periods, tampons, cramps or wrecked underwear), perimenopause is as unique as your individual body. How it feels, when it starts and how long it lasts varies enormously from one woman to the next.

5 common symptoms of perimenopause

You can think of perimenopause as your body going through estrogen withdrawal. For some, the experience may feel like a walk in the park, but for others, it’s intense, both physically and emotionally.‍ While there are more than 100 (yes, 100!) symptoms of perimenopause and menopause, below are some of the more telltale signs that many women experience.

1. Erratic menstrual cycles

This is usually the first and most obvious sign of perimenopause. As your body begins its march towards menopause, your periods will become more irregular until they eventually stop. But this doesn’t necessarily mean that your periods will become shorter, lighter and further apart—in fact, 78% of women experience longer and heavier periods during perimenopause. The stretch between periods can be longer one month, shorter the next, and flow can be heavier this time around, then suddenly lighter. Your period may go missing entirely for months on end, then come roaring back. If estrogen spikes between cycles, the uterine lining will be thicker and your period, in turn, will tend to be heavier. When estrogen drops low, there’s less buildup of the uterine lining, so periods will tend to be lighter (more like spotting).

2. Hot flashes and night sweats

About 75% of women experience vasomotor symptoms—hot flashes, night sweats and palpitations—during the menopausal transition. The frequency and severity of hot flashes varies widely among women, depending on factors like race, weight and whether you smoke (which makes them worse). Estrogen influences the hypothalamus, the brain’s temperature-regulating headquarters. As estrogen levels fluctuate in perimenopause, the hypothalamus becomes more sensitive to even minor changes in body temperature and gets easily fooled into believing the body is overheated when it’s not.

3. Brain fog

Losing your keys or phone happens to all of us (pretty much daily), but memory glitches can become even more frequent during perimenopause, thanks in large part to estrogen’s role in promoting activity in the hippocampus, the memory and learning capital of the brain. About 60% of menopausal women report brain fog, described as difficulty remembering details—from names to appointments to common words.

4. Sleep disturbances

Difficulty sleeping affects 61% of menopausal women, and for those who experience hot flashes, nearly 44% suffer from chronic insomnia (anxiety and night sweats are top culprits). Missing out on the rest your body needs isn’t just a matter of dragging a little the next day. Ongoing sleep problems contribute to a wide range of health problems, including cardiovascular diseases, obesity and mental health disorders.

5. Mood swings

Life throws a lot at us, so there’s often good reason to feel testy during this stage of life. As many as 70% of women deal with emotional fluctuations through the menopausal transition. That can include overwhelming reactions to everyday events, ranging from tiredness to tears to full-blown rage. Another 25% of women notice increased mood swings that can range from mild to severe. Estrogen affects the production of serotonin, the hormone responsible for mood stabilization (it’s known as the “happy hormone” for good reason). When estrogen fluctuates and declines, serotonin follows a similar path, and your emotions rollercoaster with it.

FAQs about perimenopause

How is perimenopause diagnosed?

Unfortunately, there is no test that can predict in advance when you will start the transition or even fully confirm that you’re in the midst of it. What your physician can do is consider your age, the age at which your mother or sister entered menopause, your health history and all the symptoms you might be experiencing. Testing hormone levels isn’t routinely recommended because hormones are going up and down a lot during this stage, so a single blood test can be misleading.

What are my treatment options for perimenopause?

Perimenopause may be unpredictable, painful and mysterious, but the most important thing to know is that it’s treatable. Hormone replacement therapy, sometimes referred to as menopausal hormone therapy or MHT, is a treatment used during perimenopause and menopause to supplement hormones, namely estrogen and progesterone, that naturally decline as your reproductive years wind down. HRT has been shown to be the most effective treatment for things like hot flashes and vaginal dryness. While not every woman is a candidate for HRT, most can safely take it.

Beyond HRT, there are a host of other hormonal, non-hormonal and lifestyle solutions you can try to mitigate your symptoms, including:

• Hormonal birth control, which can relieve perimenopause symptoms including menstrual irregularity, heavy menstrual bleeding, menstrual pain and vasomotor symptoms. And let’s not forget they prevent pregnancy, which is a real possibility when you’re still having periods.
• Certain non-hormonal prescription medications, like antidepressants, have been shown to greatly improve hot flashes.
• Wellness therapies, like cognitive behavioral therapy, have also been shown to make a significant difference in perimenopausal symptoms, improving hot flashes, depression and other menopausal symptoms.
• Botanicals and dietary supplements such as black cohosh, soy, calcium and vitamin E may bring relief for specific symptoms.

When to seek help for perimenopause symptoms

If your symptoms are disrupting your life in any way—causing you to call out of work, preventing regular exercise, or otherwise forcing you to change your routine to accommodate bothersome changes— then it’s time to seek out support from a healthcare professional, especially a menopause specialist. If the root cause of your symptoms is menopausal hormonal fluctuations, you can find relief. ‍

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