All Your Perimenopause Questions, Answered

As women, we are wholly unique yet united by a few specific experiences: one of which is that we will all go through menopause. But while this transition is universal, it can affect each of us differently, and often leaves us with more questions than answers.

There are still considerable misunderstandings and confusion around the menopausal transition—particularly when it comes to perimenopause. What even is perimenopause? How is it different from menopause? When will it start and, more importantly, when will it end?

Understanding the basics of perimenopause may help you sail more smoothly through the tumultuous waters of this life phase. To get you started, here are some of the more common questions about perimenopause, answered.

How is Perimenopause Defined?

“Perimenopause, sometimes referred to as the menopause transition, is the time leading up to menopause,” explains Bonafide Chief Medical Officer, Dr. Alyssa Dweck. Menopause indicates the permanent cessation of menstruation, and perimenopause, which translates to “around menopause,” is the gradual transition between a woman’s reproductive years and this cessation.¹

Are Perimenopause and Menopause the Same Thing?

Although it’s often used to describe the entire menopause transition, menopause itself technically only occurs on a single day—one that marks 12 consecutive months without a menstrual period. The time leading up to this day is called perimenopause. After a woman has reached this moment in time, she is considered to be postmenopausal.²

What’s Happening with My Hormones During Perimenopause?

“During perimenopause, ovulation occurs less frequently and irregularly, leading to hormone changes,” says Dr. Dweck. She adds that estrogen and progesterone levels can fluctuate dramatically during this time, leading to symptoms such as irregular or skipped cycles, altered menstrual habits, hot flashes and night sweats, mood changes and irritability.³

It’s important to note that pregnancy is still possible amid the hormonal ups and downs of perimenopause, so women who are sexually active and use contraception should continue to do so until they reach postmenopause, if pregnancy is not desired.

What’s the Typical Timeframe for Perimenopause?

According to Dr. Dweck, perimenopause usually occurs when a woman is in her early 40s but can start as soon as the early-to-mid 30s and as late as the mid-50s. This transitional period lasts approximately four to eight years.⁴

What Perimenopause Symptoms Tend to Show Up First?

“Skipped menses and changes in menstrual habits are often a common first sign of perimenopause,” Dr. Dweck advises. “Cycle length, the duration of flow and the amount of flow may all change.” She adds that some women may also start to experience hot flashes during perimenopause, as well as changes in sleep patterns and sleep quality. As mentioned earlier, another common first symptom of perimenopause, according to Dr. Dweck, is a change in mood — more specifically, irritability.⁵ So, if you’re noticing more volatile mood fluctuations, you may want to check in with your healthcare provider.

Can a Test Tell Me if I’m in Perimenopause?

“Perimenopause—and menopause for that matter—are clinical diagnoses, meaning they are based on individual signs and symptoms, as well as medical acumen,” Dr. Dweck says. “Blood tests for FSH (follicle stimulating hormone) and estradiol can be used to support the diagnoses but are not standalone tests used for this purpose.”  In other words, there is no single perimenopause test to “diagnose” this transitional phase, but a healthcare provider can gather information through specific blood or hormone tests and potentially make a diagnosis based on that information.

Dr. Dweck adds that over-the-counter urine testing can also provide supportive information, “which is to be used in conjunction with one’s clinical signs and symptoms,” in order to deduce if you’re potentially in perimenopause.

When Should I See a Healthcare Provider About Perimenopause?

Every woman experiences perimenopause differently; some may have no symptoms at all, while others may find their symptoms are so severe they interfere with daily life. No matter how perimenopause impacts you, talking with a healthcare provider is always an option for those seeking information or support.

If you’d be interested in seeing a provider who specializes in menopause, consider using the “Find a Menopause Practitioner” directory provided by The Menopause Society. This directory consists of health professionals with a special interest in providing healthcare for women through perimenopause and beyond.⁶

Resources

1. https://www.menopause.org/for-women/expert-answers-to-frequently-asked-questions-about-menopause/perimenopause-premature-menopause-faqs#:~:text=What%20is%20perimenopause%3F,meaning%20%E2%80%9Caround%20menopause%E2%80%9D).
2. https://www.mayoclinic.org/diseases-conditions/menopause/symptoms-causes/syc-20353397
3. https://www.mayoclinic.org/diseases-conditions/perimenopause/symptoms-causes/syc-20354666#:~:text=As%20you%20go%20through%20perimenopause,a%20result%20of%20decreasing%20estrogen.
4. https://my.clevelandclinic.org/health/diseases/21608-perimenopause
5. https://www.acog.org/womens-health/experts-and-stories/the-latest/mood-changes-during-perimenopause-are-real-heres-what-to-know
6. https://portal.menopause.org/NAMS/NAMS/Directory/Menopause-Practitioner.aspx