Perimenopause: signs, timing and what helps

Perimenopause is the transition before menopause, when the ovaries' hormone production fluctuates and periods become irregular. It often begins in the 40s and can last several years. It ends at menopause — 12 months after the final period.

Common signs

• Changes in periods — shorter or longer cycles, lighter or heavier bleeding, skipped periods.
• Hot flashes and night sweats.
• Trouble sleeping.
• Mood changes, irritability or low mood.
• Vaginal dryness or discomfort with sex.

How perimenopause is recognized

For most people in their 40s, perimenopause is recognized from age, symptoms and changes in the menstrual cycle. Because hormone levels swing from day to day during the transition, a single blood test is often not needed and may not be conclusive. A clinician may order tests to rule out other causes, such as thyroid problems.

You can still get pregnant

Ovulation can still happen during perimenopause, so pregnancy is possible until menopause is confirmed. Talk with a clinician about contraception if pregnancy is not wanted.

What helps

Options range from lifestyle changes to hormonal and nonhormonal medicines. Low-dose hormonal contraception or hormone therapy may be options for some people; the right choice depends on symptoms, age and personal health history.

When to talk with a healthcare professional

• Periods are much heavier, last longer than usual, or come closer than three weeks apart.
• You bleed between periods or after sex.
• Symptoms are affecting sleep, work, relationships or daily life.
• You want to understand whether treatment — hormonal or nonhormonal — fits your health history.
• You have questions about your personal risk of heart disease, stroke, blood clots, breast cancer or osteoporosis.

When to get prompt care

• Very heavy bleeding (soaking a pad or tampon every hour), or bleeding with dizziness or faintness, needs prompt care.

How Dot can help

Dot's cycle and symptom tracking helps you see how your periods and symptoms are changing over months — useful context to bring to an appointment. Dot does not diagnose perimenopause.

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Related topics

• Menopause
• Hot flashes & night sweats
• Sleep
• Mood & anxiety
• Irregular periods
• FSH
• TSH (thyroid) test
• Menopausal hormone therapy (MHT / HRT)
• Nonhormonal menopause treatment
• Perimenopause vs menopause

Sources

1. National Institute on Aging (NIH). What Is Menopause?.
2. Office on Women's Health, U.S. HHS. Menopause.
3. American College of Obstetricians and Gynecologists. The Menopause Years (patient FAQ).
4. American College of Obstetricians and Gynecologists. Perimenopausal Bleeding and Bleeding After Menopause (patient FAQ).

This page is educational and not medical advice. Dot does not diagnose or prescribe. See our editorial policy.