Navigating perimenopause can feel like uncharted territory. Questions like how long does perimenopause last, when does perimenopause start, and what are the symptoms of perimenopause often arise as women seek clarity about this stage of life. This guide will help you understand the phases of perimenopause, the hormonal changes behind them, and when to seek care.

‍

Understanding the menopause journey

Perimenopause, also known as the menopause transition, is a natural stage of life, not an illness or disease. It doesn’t need to be "fixed," but the impacts of shifting hormone levels can be managed to support long-term health and well-being.

Every woman’s experience with perimenopause is unique, making it difficult to pinpoint an exact timeline. Symptoms vary widely in type and severity, and there is no definitive test to diagnose perimenopause. However, understanding the phases of this transition can provide valuable insights into what’s happening in your body.

‍

Phases of the menopause transition

1. Late reproductive phase

• This phase marks the beginning of declining fertility. While menstrual cycles remain regular, slight variations in cycle length and flow may occur. Hormone levels are still relatively stable.

2. Perimenopause: the transition to menopause
   

• Perimenopause means "around menopause" and refers to the years leading up to menopause. It typically begins in the 40s but can start as early as the mid-30s. The duration of perimenopause varies widely, averaging four years, though it can last anywhere from two to ten years.

3. Early perimenopause
   

• Menstrual cycles become increasingly irregular, varying by more than a week in length.
• Hormone fluctuations begin, particularly a decline in estrogen.
• Symptoms may include sleep disturbances, mood changes, vaginal dryness, changes in libido, and brain fog.
• Diagnosis is often one of exclusion, ruling out other potential causes of symptoms.

4. Late perimenopause
   

• Menstrual cycles become more irregular, with periods occurring more than two months apart.
• This phase usually occurs in the late 40s or early 50s and lasts one to three years.
• Symptoms may intensify, including more frequent and severe hot flashes, night sweats, and vaginal dryness.

5. Menopause and postmenopause
   

• Menopause is officially reached when 12 consecutive months have passed without a period. The average age of menopause in the U.S. is 51-52, with most women transitioning between ages 45 and 55.
• Postmenopause refers to the years after menopause. While symptoms such as hot flashes and genitourinary syndrome of menopause (GSM) are common, many women experience relief from the more unpredictable fluctuations of perimenopause. However, symptoms can persist for years after the final menstrual period.

‍

Hormonal changes during perimenopause

Perimenopause is characterized by hormonal fluctuations as the ovaries gradually stop producing estrogen and progesterone.

1. Early cycle (Follicular Phase): Estrogen levels rise in preparation for ovulation, with follicle-stimulating hormone (FSH) and luteinizing hormone (LH) peaking at ovulation.

2. Late cycle (Luteal Phase): Estrogen and progesterone rise and then drop if pregnancy does not occur, triggering menstruation.

3. During perimenopause: Ovarian function declines, leading to irregular cycles, skipped ovulations, and unpredictable hormonal surges and drops. This instability contributes to common perimenopausal symptoms.

Because hormone levels fluctuate so unpredictably, testing hormone levels at a single point in time is not a reliable method for diagnosing perimenopause.

‍

Common symptoms of perimenopause

While every woman’s experience is different, here are the most commonly reported symptoms:

• Fatigue/low energy
• Brain fog
• Sleep disturbances
• Weight changes
• Mood swings
• Anxiety/depression
• Skin/hair changes
• Joint/muscle pain
• Hot flashes
• Irregular periods
• Vaginal dryness

Other less common but notable symptoms include migraines, tingling sensations, changes in body odor, heart palpitations, dry eyes, and bloating.

‍

How long will perimenopause last?

The median duration of perimenopause is approximately four years, with a range of two to eight years.

Symptoms start off mild and increase in prevalence as estrogen levels decline.

Symptoms tend to be most intense in the first 1-2 years after the final period.

Women who experience symptoms earlier in the transition may have a longer duration of symptoms.

While perimenopause is a natural process, if symptoms significantly impact your daily life, discussing them with a healthcare provider is recommended.

‍

When to seek care

Certain symptoms warrant a conversation with your healthcare provider, including:

• Heavy or prolonged bleeding
• Symptoms of depression or severe mood swings
• Sleep disturbances affecting daily life
• Persistent or severe hot flashes and night sweats

Your doctor or Evernow provider can guide you through treatment options, including hormone therapy, lifestyle changes, and alternative treatments.

‍

Thriving through perimenopause

Understanding the phases of perimenopause, its symptoms, and the hormonal changes behind them can make this transition more manageable. Knowledge is power—by staying informed and seeking support, you can navigate perimenopause with confidence and set yourself up for long-term health.

‍