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Perimenopause: Signs and When to See a Doctor
The signs of perimenopause, from irregular periods and hot flashes to sleep and mood changes, which bleeding needs a check, and the treatments that help.
Key takeaways
- Perimenopause often starts in your 40s and lasts several years; menopause is 12 months without a period.
- Irregular periods, hot flashes, sleep problems and mood changes are common, and effective treatments exist.
- Very heavy bleeding, bleeding between periods and any bleeding after menopause should be checked.
On this page
Perimenopause is the transition to menopause, when your ovaries gradually make less estrogen and your cycles start to change. It often begins in your 40s, sometimes earlier, and typically lasts several years. Menopause itself is confirmed once you’ve gone 12 months without a period; in the US, the average age is about 51.
Common signs of perimenopause
- Changing periods: shorter or longer cycles, heavier or lighter bleeding, or skipped periods
- Hot flashes and night sweats
- Sleep problems, often linked to night sweats
- Mood changes: irritability, anxiety or low mood
- Vaginal dryness and discomfort during sex
- Bladder changes, such as urgency or more infections
- Brain fog, joint aches and lower sex drive
Not everyone has all of these, and symptoms can come and go. Blood tests aren’t usually needed to diagnose perimenopause, because hormone levels swing from day to day. Your age, cycle history and symptoms usually tell the story.
Bleeding: what’s normal and what isn’t
Irregular periods are expected, but some bleeding patterns need a check to rule out other causes, such as polyps, fibroids or, less often, precancer or cancer of the uterine lining.
What helps
| Symptom | Options to discuss |
|---|---|
| Hot flashes and night sweats | Hormone therapy, non-hormonal medicines, CBT, a cool bedroom |
| Irregular or heavy periods | Hormonal birth control, a hormonal IUD, other treatments |
| Vaginal dryness | Lubricants, moisturizers, low-dose vaginal estrogen |
| Sleep problems | Treating night sweats, sleep habits, CBT for insomnia |
| Mood changes | Talking therapy, treatment for depression or anxiety, hormone therapy in some cases |
Menopausal hormone therapy is the most effective treatment for hot flashes. According to The Menopause Society, for most healthy people who start it before age 60 or within 10 years of menopause, the benefits usually outweigh the risks. It isn’t right for everyone, for example after certain cancers or blood clots, so it’s a personal decision to make with your clinician. Non-hormonal prescription options are also available.
Lifestyle changes help too: layered clothing, regular exercise, limiting alcohol and managing stress. Weight-bearing exercise, calcium and vitamin D support bone health as estrogen falls.
Don’t forget contraception
Pregnancy is still possible during perimenopause. Keep using contraception until your clinician confirms you’ve reached menopause; some methods, such as a hormonal IUD, can also ease heavy bleeding. Our birth control guide compares the options.
Mood and mental health
Perimenopause can trigger or worsen depression and anxiety, especially if you’ve had them before. Tell your clinician if low mood lasts more than two weeks or affects daily life. If you’re having thoughts of harming yourself, call or text 988 (the Suicide & Crisis Lifeline), or call 911 in an emergency.
Preparing for your appointment
Track your periods and symptoms for a few months before your visit, and note what bothers you most. Our lists of questions to ask your gynecologist and advice on how often to see a gynecologist can help you plan.
Frequently asked questions
How long does perimenopause last?
It varies widely. Many people have symptoms for around four years before their final period, but it can be shorter or much longer, and hot flashes can continue after menopause.
Can perimenopause start in your 30s?
It can, though it’s less common. Menopause before 40 is called premature ovarian insufficiency and should be evaluated by a clinician.
Is hormone therapy safe?
For many people it is a safe, effective option, but risks depend on your age, health history and the type of therapy. Discuss your personal risks with your clinician.
Sources
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