Your Guide To Perimenopause: What To Expect & How To Feel Your Best During It

If you're a woman of a certain age, you know it's coming eventually—you just might not know when. It could begin next month, next year, or not for another decade. We're talking about perimenopause. 

Though we all know the window of menstruation doesn't last forever, there's still plenty of confusion around the time leading up to your last period.

First things first: What is perimenopause? "Perimenopause is the five to seven years before a woman reaches her final menstrual period. She is still having periods, but she is also experiencing the symptoms of menopause, such as hot flashes/night sweats, mood changes, and weight change," explains board-certified OB-GYN Brandye Wilson-Manigat, M.D.

Got it. So what about premenopause? You may sometimes hear this term used interchangeably with perimenopause, but technically, they're not the same. "Premenopause" simply means you are in any stage before menopause, whereas "perimenopause" refers to the hormonal transition that immediately precedes menopause. 

Menopause itself, on the other hand, is quite simple to pinpoint. "Menopause is the permanent cessation of menstruation, defined by when you've had your final menstrual period," Manigat says. This designation is given, she says, when you've had 12 consecutive months without any bleeding. 

In this sense, you officially become menopausal on a single day (exactly 12 months after your last period). But, according to Manigat, this stage goes on for the rest of your life. "The terms menopausal and postmenopausal are frequently interchanged to describe this period of a woman's life." 

In chatting with friends or family members, you've probably noticed that some women hit the hormonal transition of perimenopause before others. Lauren Streicher, M.D., health medical director of community education and outreach at Midi, a virtual care clinic for perimenopause and menopause, says this mostly comes down to two factors: estrogen production and genetics.

"Perimenopause is triggered by fluctuations in ovarian estrogen production, [and] the main thing that influences when someone enters perimenopause and menopause is genetics," she says. "If your mom and older sister were still using tampons in their mid-50s, there is a good chance you will be too." 

Still, she notes that ethnicity may also be a factor. At least one study1 has suggested that, compared to Caucasian-American and Japanese American women, Hispanic American and Black-American women tend to enter menopause earlier. Lifestyle and personal health history could also move the perimenopausal needle.

"Menopause tends to occur earlier in smokers and women with autoimmune diseases such as hypothyroidism, rheumatoid arthritis, and Type 1 diabetes," she says. "Women that work the night shift also tend to wind down early."

One rumor about onset that's not true: Getting your first period at a younger age means you'll hit perimenopause younger (and get over it sooner). "Contrary to popular belief, the age at which you started menstruating does not determine when you will stop—which seems kind of unfair," Streicher says.

There's good news and bad news about the potential duration of perimenopause. Research shows that perimenopause lasts four years3, on average. But in some cases, it can drag out for as long as a decade. 

Every woman will have a unique timeline of which of these she experiences and when. However, Manigat says some are more likely to show up first. "Fatigue, mood changes, and hot flashes [or] night sweats are likely to be the first symptoms a woman notices."

Hot flashes, poor sleep, brain fog, oh my! When perimenopause has you feeling off-kilter, Manigat encourages turning to a few DIY solutions. 

To head off hormonal heat, she suggests layering easy-to-remove clothing and carrying a handheld fan to cool yourself off in a, well, flash. Keeping up with your fluid intake may also help.

"Staying hydrated, not with just plain water but something electrolyte-based, replenishes the body's fluids lost during hot flashes or night sweats and keeps the body's internal temperature steady," she says.

That's not all electrolyte-based hydration might do. "The other benefit is fewer trips to the bathroom than with using plain water." 

Though certain unpleasant symptoms may be considered "normal" in perimenopause, that doesn't mean you have to suffer them in silence. Streicher advises seeing your clinician any time symptoms become bothersome. (And if your GP isn't helpful, don't be afraid to switch to a more experienced expert.) 

In fact, though a recent editorial5 in the medical journal the Lancet claimed that menopause has been over-medicalized, Streicher disagrees. "Under 10% of women get appropriate treatment," she says. "The other, untreated women are doomed to put up with symptoms that impact on their day-to-day lives, with a significant increased risk of developing life-threatening cardiovascular disease, osteoporosis, cognitive issues, and sexual problems."

Manigat agrees that even seemingly minor symptoms of perimenopause may be cause for medical attention. "For instance, irregular, heavy menstrual bleeding, if not treated, can lead to a low blood count (anemia), which worsens fatigue and sometimes requires a blood transfusion."

Poor sleep, meanwhile, could worsen feelings of depression and fuel weight gain, which increases the risk of high blood pressure and diabetes.

And besides helping you find the right treatments, speaking with your doctor can help alleviate any embarrassment or anxiety you may feel about your symptoms. The more conversations you have about perimenopause, the less mysterious it will feel.