What to know about perimenopause

Contrary to popular belief, menopause isn’t the time in your life when your menstrual cycle slows down and periods begin to dwindle. Instead, menopause occurs when you’ve gone 12 consecutive months without a period.

The time leading up to this transition is called perimenopause. For some people, it can last a few months. For others, it can continue for as many as 13 years.

Hormonal changes during perimenopause can affect the way you feel and the way your body behaves. It's common to experience mood swings, weight fluctuations, and other perimenopausal symptoms. Here’s what to know about this natural phase of life.

Perimenopause age of onset

Since it’s a life stage that occurs over a long period of time, there is no single diagnostic test for perimenopause. No blood draw or exam will tell you if you’ve started or how long it’s been occurring. Instead, a healthcare provider (HCP) can consider your symptoms, age, overall health, and menstrual history to get an idea.

While the normal range of menopause tends to be roughly 45 to 55 years old, perimenopause can begin in your 30s. “A lot of women are caught off-guard by that," says Margery Gass, MD, executive director emeritus of the North American Menopause Society.

One significant factor that can help predict when you may experience perimenopause is your mother’s age when they went through the transition. Other factors include your body mass index and level of physical activity, as well as use of oral contraceptives and number of pregnancies.

Also, some research suggests people who smoke are more likely to hit menopause sooner than those who don’t smoke. The chances of early menopause increase with the amount smoked and the duration of smoking.

Signs of perimenopause

A common sign of perimenopause is menstrual cycle irregularity, marked by periods that can show up an entire week early or late, explains Dr. Gass. As you progress into late perimenopause, menstrual cycles become longer and you may go up to 60 days without a period. You may also have periods that are heavier or lighter than usual.

"It's during this time that women will start to have some symptoms, such as hot flashes, but only during that time of the month," says Judith Volkar, MD, an OBGYN in Columbia, South Carolina.

Hot flashes and night sweats—also called vasomotor symptoms (VMS)—are characterized by a sudden and spreading feeling of warmth throughout the body. In addition to VMS, you may experience perimenopausal symptoms like:

• Fatigue
• Irritability
• Vaginal dryness
• Weight gain
• Sleep problems, such as problems falling and staying asleep, or sleep disruptions
• Needing to urinate more frequently than usual

The perimenopause symptom Dr. Volkar hears about most from her patients is emotional changes, or ebbs and flows in mood.

“When you have a sullen teenager, you say, ‘Oh, it’s their hormones.’ Well, you have a lot of that same feeling when you’re perimenopausal, because you can have such wild hormonal fluctuations from day to day,” Volkar says. The result can be that you feel sad or angry over things that ordinarily wouldn’t bother you.

According to some estimates, around 40 percent of women experiencing perimenopause will have mood symptoms that are comparable to those seen with premenstrual syndrome.

Treatments for perimenopause

Symptoms of perimenopause can affect your health, relationships, and quality of life. Often, making healthy changes to your lifestyle can help to relieve them. These include:

• Eating a healthy diet rich in fruits, vegetables, whole grains, lean proteins, and heart-healthy fats
• Making physical activity a priority—especially strength training exercises that help to build or maintain muscle
• Maintaining a healthy weight
• Prioritizing good sleep and practicing sleep hygiene, such as waking up and going to bed at the same time each day and avoiding screens 30 minutes before bedtime
• Finding relaxation techniques and stress-reduction practices that work for you
• Avoiding tobacco
• Avoiding alcohol or drinking only in moderation (a limit of one drink each day for women)
• Limiting caffeine, especially after lunchtime

Many people visit an HCP about symptoms, especially when they disrupt day-to-day life. An HCP may prescribe medication, such as vaginal estrogen to help with dryness and pain or hormone therapy for dryness, VMS, mood swings, and other symptoms. An HCP can tailor recommendations and treatments to fit your lifestyle and needs.

Pregnancy during perimenopause

Since menstrual cycles often become erratic, many people wonder if they can get pregnant once signs of perimenopause begin. The answer is yes. It's possible to get pregnant as long as you're still menstruating. "It's not that common," Volkar says, "but it can happen."

If you are sexually active and want to avoid getting pregnant, use birth control until your periods have stopped for 12 consecutive months. Many experts recommend using birth control until age 55, a point at which more than 90 percent of women have hit menopause.

If you wish to become pregnant, speak with an HCP about possible fertility treatments that may increase your chances. And be sure to speak with a provider right away if you’re experiencing changes to your menstrual cycle or having any new symptoms.

Bottom line, perimenopause is a common, natural experience that can be made smoother by adopting healthy habits and visiting an HCP for guidance. When you’re proactive, it may feel much more manageable.