What are the signs of perimenopause?

Question 1

Accepted Answer

A change in your periods can be the first sign you notice, and hot flashes often come with it. Perimenopause is the stretch of years leading up to your last period. Trouble sleeping, mood swings, vaginal dryness and less interest in sex are also on the usual list.

Not everyone gets all of these, or any of them. Some women have no symptoms or only mild ones, and The Menopause Society notes that many women report no physical change besides irregular periods.

Question 2

What changes in your cycle can come with perimenopause?

Accepted Answer

Periods can get shorter or longer, heavier or lighter, and less regular, and you might skip some months. That happens because ovulation becomes hit or miss. Early on the changes are often subtle: The Menopause Society describes cycles that run a little shorter than usual at first, then vary by 7 days or more, with skipped stretches of 60 days or more late in the transition.

A missed period alone doesn't settle much, since OWH says missing a few periods does not always mean perimenopause. NIA lists very close-together periods, heavy bleeding, bleeding after sex or between periods, periods lasting more than a week, and bleeding that returns after a year without one as changes to raise with a doctor. A fair question for your clinician is whether anything else could explain a change in your periods.

Question 3

What are hot flashes and night sweats like, and do they affect sleep?

Accepted Answer

Most hot flashes last between 30 seconds and 10 minutes, NIA says, and they can come several times an hour or only once or twice a week. Each one is a sudden feeling of heat, mostly in the upper body and face, and night sweats are the ones that happen at night.

As many as three out of four women have hot flashes, OWH says, and some start having them while they still get a period.

Sleep trouble can mean not falling asleep easily or waking too early, and night sweats or a need to urinate may wake you up.

Question 4

What other changes are linked to perimenopause?

Accepted Answer

Beyond periods, heat and sleep, the other changes involve mood, memory, the vagina and bladder, and the body itself. Mood changes can mean feeling moody or more irritable. Scientists don't know why, NIA says, and stress, family responsibilities or feeling extra tired could also play a part. Loss of bladder control is on the list too.

Forgetfulness is common: 40 to 60 percent of midlife women report it or similar cognitive symptoms during the transition, according to The Menopause Society, which calls it brain fog. As estrogen falls, the lining of the vagina may become thinner, dryer and less elastic, and ACOG says the dryness may cause pain during sex.

Joint and muscle discomfort and a larger waist are on NIA's list as well, though some of these midlife changes may be part of aging rather than directly related to menopause.

Question 5

When does perimenopause start, and how long does it last?

Accepted Answer

It usually starts in the mid- to late 40s, and it sometimes starts earlier. On average it lasts about four years, with a range of two to eight, according to OWH.

Menopause is where the transition ends, and it is only known in hindsight: you have reached it after 12 months in a row with no period or spotting. The average age in the United States is 52, NIA says.

Sources place the end of perimenopause in two spots. OWH describes it as the time leading up to the last period. The Menopause Society's glossary has it running through menopause to 1 year after the last period.

Question 6

Can you still get pregnant during perimenopause?

Accepted Answer

Yes, you can still get pregnant during perimenopause. You may still ovulate in some months, even after skipping a period for a month or a few, and OWH says it is impossible to know for sure when ovulation will happen. The Menopause Society's patient page makes the same point about irregular cycles.

A fair question for your clinician is how any of this applies to you.

Question 7

How does a clinician tell whether it is perimenopause?

Accepted Answer

Often by talking it through, and sometimes it is hard to tell. A doctor may ask about your age, symptoms and family history to judge whether the transition is a likely cause, NIA says.

A hormone blood test isn't the usual route. Providers don't usually recommend one without a medical reason, OWH says, because hormone levels go up and down unpredictably for most women during the transition. A test may be considered if periods stop before age 40.

Question 8

What is worth writing down and bringing to an appointment?

Accepted Answer

Your period dates are the detail the sources point to most clearly. A calendar or phone app can work, and The Menopause Society says tracking bleeding that way can be useful because it is easy to review and assess. OWH says to tell your provider about any symptoms, such as hot flashes or trouble sleeping.

Family history is one thing a doctor may ask about, and OWH notes that the age your mother went through menopause is one way to tell when you might.

A fair question for your clinician is whether past results from your gynecologist or primary care doctor would be useful to bring. You could also ask whether what you are noticing fits perimenopause or whether something else could explain it.