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Perimenopause 101

Learn about perimenopause, the time leading up to menopause.

What is perimenopause?

Perimenopause means around menopause, more specifically the years (as many as 8+) prior to and the 12 months after the final menstrual period which signals menopause. Perimenopause is a time of ovarian aging and fluctuating hormones which is different for every woman.

Until recently, perimenopause was identified by very noticeable changes to menstrual cycles (i.e., irregular cycles or skipped periods). However, recent research — ours and others — has documented the experiences of women still having monthly periods who have many of the same symptoms as those who have already noticed significant changes to their menstrual cycles. This research suggests perimenopause begins earlier than previously thought, even before very noticeable changes to menstrual cycles happen — exactly what women have been reporting.

Note: We use “symptoms” but perimenopause is not a disease — it’s a normal life transition that everyone born with ovaries will make.

Learn about the four primary hormones that govern the menstrual cycle.

Wondering if what you are experiencing could be perimenopause?

Tracking your cycle can be empowering to understanding what’s going on in your body.

Common Symptoms During Perimenopause

Learn about perimenopause and the 12 most common symptoms reported by women ages 35-55 in longitudinal studies.

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Flow changes
Perimenopausal hormonal patterns can lead to changes in cycle length and flow — both the duration and the amount.
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Disrupted sleep
Disrupted sleep includes middle-of-the-night waking, trouble falling asleep, and early morning waking.
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Mood & anxiety
Many new mood changes such as anxiety, irritability, sudden anger or depressive feelings can arise in perimenopause.
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Night sweats & hot flashes
Changes in hormone levels can cause a narrowing of our internal thermostat. The body reacts by dissipating heat. Hot flashes are the daytime version.
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Sore breasts
Many women experience premenstrual breast tenderness in their twenties, which then resolves. The high and erratic estrogen of perimenopause brings it back for some.
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Headaches
Premenstrual headaches often begin or increase during perimenopause. For those that have had migraines, these often return or worsen.
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Body changes & weight gain
Body changes at midlife are a reality for most women but the reasons why things change are not fully understood.
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Cramps
For many women, premenstrual cramps occur in their teens and twenties and then go away, particularly for those who give birth. In early perimenopause, they often return.
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Shorter cycles
While not a symptom, slightly shorter cycles are one of the earliest signs of perimenopause. They can be hard to detect unless you are tracking.
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Sexual health changes
Lower libido around 40 is common and can be tied to hormonal changes, but many other factors are involved as well.
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Vaginal & urinary health
The decline of estrogen in later perimenopause (and menopause) causes changes in vulvar and vaginal tissue which can lead to a range of urinary and vaginal symptoms.
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Brain fog & cognitive changes
Changes to memory and attention are common during perimenopause.

Dive deeper

A New York Times opinion piece by Dr. Jen Gunter tells how women can have a better menopause

We were thrilled when this piece from NPR came out reporting that perimenopause can start younger than you think

A very thorough article about perimenopause by Robin Henig for Oprah Daily

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