What Is Perimenopause and How Long Does It Last?

As you approach your 40s, your body begins preparing for one of life's significant transitions —- menopause. However, before you reach that milestone, you may start to experience symptoms. This is perimenopause — the transitional phase leading up to the big M. Learn more about it and how long you can expect it to last.

What Is Perimenopause?

Perimenopause means "around menopause." It's a transitional period that occurs when estrogen production in the ovaries gradually begins to decline, marking the natural progression toward menopause.

Perimenopause is characterized by fluctuating hormone levels and irregular cycles. During this time, your body undergoes various changes as it adapts to these changes.

When Does Perimenopause Typically Begin?

Most women notice perimenopausal symptoms as early as three to seven years before amenorrhea — the last menarche. The average age of a woman's last menstrual cycle is around age 51 in the U.S., meaning you might start experiencing perimenopause in your 40s, though some women notice changes as early as their mid-30s.

Every person’s journey is unique — influenced by genetic factors, lifestyle and overall health. However, when symptoms begin earlier than the typical range, a blood test is done to rule out conditions that sometimes present as perimenopause, such as thyroid abnormality.

Common Signs and Symptoms You Might Experience

Recognizing the first signs of perimenopause can help you prepare for the changes. Common symptoms include:

Irregular Menstrual Cycles

Your periods may become unpredictable — longer, shorter, heavier or lighter. This irregularity is often the first sign you’re in perimenopause, especially if you’ve had regular menses over the decades.

Hot Flashes and Night Sweats

You might suddenly feel intense warmth spreading through your upper body, accompanied by sweating and a flushed face. These episodes can last from a few seconds to several minutes and disrupt sleep when they occur at night. Up to 15% of perimenopausal women experience severe hot flashes that interfere with daily functions.

Sleep Disturbances

Changes in your sleep patterns are common during perimenopause. You might have trouble falling asleep, wake up frequently during the night or experience night sweats that interfere with restful slumber.

Mood Changes

Hormonal fluctuations significantly affect your emotions, causing mood imbalances. During perimenopause, you might experience high irritability, anxiety and mood swings. It feels just like premenstrual syndrome (PMS) and affects about four in 10 women, with some also reporting feelings of depression.

These emotional changes are natural responses to hormonal shifts and life transitions. However, discuss severe mood changes with your healthcare provider.

Physical Changes

Your body undergoes various physical changes during this time, too. Weight gain, particularly around your midsection, is typical. You might notice thinning hair, drier skin and breast tenderness. These symptoms are related to your body's shifting hormonal landscape.

Cognitive Changes

Many women report experiencing "brain fog" during perimenopause. You might notice slight changes in memory or concentration. These cognitive changes are typically temporary and related to hormonal fluctuations.

How to Manage Perimenopause Symptoms

While perimenopause is a natural process, its symptoms can impact the quality of life. The most commonly used strategies to help manage discomfort and maintain health as you go through this period include:

Hormonal and Nonhormonal Therapies

Hormone replacement therapy is an option. This can include low-dose birth control pills or vaginal estrogen. The choice of treatment depends on your specific symptoms and medical history.

Several non hormonal options also exist for managing perimenopause symptoms. These include prescription medications for specific symptoms, over-the-counter lubricants for vaginal dryness and natural supplements.

Balanced Diet

Your nutritional needs evolve during perimenopause, and certain dietary choices can significantly impact your symptoms. Spicy foods, alcohol and caffeine trigger or exacerbate perimenopausal symptoms like hot flashes.

Nutrient-dense foods rich in calcium, vitamin D and phytoestrogens support hormonal balance. Complex carbohydrates can help stabilize mood and energy levels, while foods rich in omega-3 fatty acids may help with cognitive function and mood regulation.

Hydration

Fluctuating hormones affect metabolic processes, diminishing your body’s ability to maintain adequate hydration levels. This increases the risk of dehydration. Dark yellow urine,  constipation, headaches, fatigue and confusion are common signs of dehydration.

Other than drinking enough water a day, many hydrating fruits and vegetables contain 80%-96% water, like cucumbers, lettuce and oranges. Interestingly, mushrooms contain as much water as watermelons, making them an excellent addition to meals for hydration support.

Regular Exercise

Strength training, yoga and cardio improve mood and bone health. While it’s recommended that you work out for at least 150 minutes each week, you may need to adjust your intensity or incorporate more rest days. Listen to your body and modify your activities accordingly.

Managed Stress

Meditation, deep breathing and self-care routines reduce anxiety. During this transition, engaging in mentally stimulating activities, maintaining social connections and practicing mindfulness can help support mental health, emotional well-being and cognitive function. Some women find that keeping a journal or using organizational tools helps them stay focused and track their symptoms, effectively lowering stress.

Better Sleep

Quality sleep becomes especially crucial during perimenopause, yet it's often one of the most challenging things to maintain. Sleep disturbances create a cascade effect, impacting physical health, mood, cognitive abilities and overall well-being. Creating a consistent sleep routine can help regulate your body's natural rhythms. Consider keeping your bedroom cool and dark, as this can help minimize night sweats and their impact on your sleep.

What About Alternative and Complementary Therapies?

Many women explore complementary therapies during perimenopause. Acupuncture might help with hot flashes and mood changes, while aromatherapy can support relaxation and sleep. Herbal remedies like black cohosh or evening primrose oil are popular choices, though scientific evidence for their effectiveness varies.

To be safe, always consult your health care provider before starting alternative treatments — herbal or otherwise. They’ll run a quick test to ensure the regimen won’t interact with any medications or treatments you’re on.

How Long Does Perimenopause Last?

The duration of perimenopause varies significantly among women. On average, this transition lasts about four years but can be as short as a few months or as long as 10 years. You've officially reached menopause when you've gone a whole year without a menstrual period.

Embrace the Transition

Perimenopause is a significant part of a woman’s life, but it doesn't have to be a negative experience. By staying informed and maintaining open communication with health care providers, you can confidently transition through perimenopause with grace.

Remember, your experience is valid, and there are readily available resources and professionals to help you through this natural life transition.

About the author: Beth Rush

Beth is the fitness editor at Body+Mind. She writes about how women with PCOS can hack their exercise routines to balance hormones naturally. Shecovers topics like plant-based recipes for athletes and preaching the benefits of green exercise. You can find Beth on Twitter @bodymindmag.