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Article by Rachel Cady, MD, Welia Health Women’s Health and OB/GYN provider

While everyone talks about menopause symptoms, it is perimenopause, or the menopause transition (MT) that is usually the most symptomatic for women. Perimenopause begins with menstrual cycle irregularities and ends following one year of absent menses. The average age of perimenopause is 47, and the average age of menopause is 51-52 year old. MT lasts about 4-8 years, but tends to be longer in smokers and in those with earlier symptom onset.

Common perimenopause symptoms

Below are the most common symptoms you’ll experience during perimenopause:

  • Menstrual cycle changes
  • Hot flashes
  • Vaginal/vulvar dryness with painful sex
  • Poor sleep
  • Weight gain
  • Difficulty concentrating and concerns about one’s memory
  • Mood changes, depression and anxiety

Menstrual cycles vary depending on if ovulation (release of egg) occurred. About 25% of menstrual cycles in the perimenopause are ovulatory. Ovarian follicle aging progresses in the perimenopause. Progesterone and estrogen levels are extremely variable, which changes bleeding patterns.

Very heavy bleeding or bleeding in between periods are abnormal, and you should schedule a visit with your clinician. Cycles in early perimenopause are 7 or more days shorter, while cycles in the late perimenopause are at least 60 days apart.

Hot flashes that occur during the perimenopause are the result of a narrowing in the brain’s thermoregulatory center. This area of the brain is estrogen sensitive. When estrogen levels decline, the body is not able to accommodate as quickly. Therefore, skin redness, sweating, sometimes anxiety, and waking up at night result. About 75% of women report hot flashes with the average duration of about 5-7 years.

Metabolism goes down about 25% for perimenopausal women, which commonly results in weight gain. Most women have no idea this is going to happen, and are therefore not prepared.

So, what other things do you have to look forward to during MT?

  1. Bone loss starts in perimenopause.
  2. Risk factors for heart disease increases in the MT, including high blood pressure and high cholesterol.

Okay, so those weren’t really “things to look forward to.” But I can tell you something good!

Being prepared helps lessen symptoms

The latest-and-greatest data clearly shows that by being proactive, planning ahead, being open to treatment options, and being prepared, you can help yourself be healthier in the postmenopause.

Women on average are living one third of their lives postmenopause. The New York Times recently referred to perimenopause as “The Puberty of Midlife,” and most importantly, the conversation is not being heard enough.

Women are hungry for accurate information pertaining to health. Perimenopause is not “doomsday.” By recognizing what is normal, understanding common symptoms and their causes/treatments, and having a preventive/proactive mindset, you can largely lessen these symptoms. Perimenopause remains a wonderful time to check in with your clinician to help in this process.

Welia Health’s Women’s Health providers can help you navigate your transition through perimenopause to menopause. Meet our Women’s Health providers. Sign onto MyChart to schedule an appointment.


Our ovaries start to sunset in our 40s, with the onset of perimenopause. Throughout the decade, the ovaries gradually begin to make less estrogen. Perimenopause can start earlier, but it often marks the march toward 50.

Signs of perimenopause

You might notice the occasional hot flash, where heat radiates from your inner core, regardless of the temperature. You might sweat at night. A cough or a sneeze might result in a little urine leakage—or you might feel a sudden need to go. (“Urinary urgency” is the medical term for the latter.)

Or you might feel a sudden rage that just feels different than a typical reaction. For 70 percent of women, irritability is the most common perimenopause symptom (see the 2008 study abstract, A new female-specific irritability rating scale).

Other perimenopause symptoms can include breast tenderness, worse premenstrual syndrome, lower sex drive, fatigue, irregular periods, vaginal dryness or discomfort during sex, and trouble sleeping. If this sounds like the end of a prescription-drug warning, it might be that perimenopause is the warning of what’s to come during menopause itself!

Physiological symptoms
  • Anger
  • Anxiety
  • Depression
  • Irritability
  • Dizziness
  • Difficulty concentrating
  • Fatigue
  • Mood swings
Physical symptoms
  • Hot flashes
  • Night sweats
  • Reduced libido
  • Weight gain
  • Urinary incontinence
  • Vaginal dryness
  • Bloating

How long does perimenopause last?

Perimenopause lasts until menopause, which occurs when the ovaries stop releasing eggs, marked by when a woman has not had a period for a year. In the last year or two of perimenopause, the drop in estrogen speeds up, and many women have menopause symptoms (see above).

The average length of perimenopause is four years. However, for some women perimenopause may last only a few months (lucky) or continue for 10 years (not as lucky).

Yes, you can get pregnant during perimenopause.

Fertility plummets during perimenopause. But you can still become pregnant. If that’s not the desired outcome, you’ll definitely need to use some form of birth control until you’ve reached menopause (again, a year of not having your period). If becoming pregnant is the goal, there are treatments to help you get pregnant. Just talk to your Welia Health provider.

Ways to ease perimenopause symptoms

Low-dose birth control pills can help you find relief from hot flashes. Similarly, birth control skin patches, a vaginal ring, or progesterone injections (other hormone-based birth controls) may control hot flashes as well. Talk to your Welia Health provider to see if these solutions might be an option for you.

The following lifestyle approaches may also help relieve perimenopause symptoms and just enhance your general well-being:

  • Exercise
  • More sleep (try going to sleep and waking up at the same time each day)
  • Less alcohol consumption
  • Smoking cessation
  • Getting to a healthy weight and maintaining it
  • Taking a multivitamin (though it’s best to check with your doctor first)
  • Getting enough calcium in your diet

If you’re having problems with your sex drive, talk to your doctor. If vaginal dryness is an issue, vaginal lubricants might help. Mental health counseling can be beneficial during perimenopause as well.

We encourage you to speak with your doctor about your specific perimenopause symptoms and treatment goals. Together we can make a plan that’s right for you. Perimenopause doesn’t have to be as miserable as it sounds! Let us help you make this the best stage of life yet.

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