What Exactly is Perimenopause?

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Perimenopause literally means the time “around” menopause. The term is used by medical providers to describe the beginning of the estrogen decline leading to menopause, but it is used by many women to describe the time when they first begin to notice menopausal symptoms.

When Does Perimenopause Usually Start and End?

Perimenopause begins with the first signs or symptoms of menopause. For some women, this is as early as their thirties.

By their mid-forties, most women notice at least occasional signs that their estrogen is beginning to decline. Officially, perimenopause ends with the diagnosis of menopause, which is when you’ve had twelve consecutive months without a period.

What Causes Perimenopause?

As your ovaries change and are less able to produce estrogen and progesterone, your body responds. This may be subtle at first, and become more noticeable as you approach menopause. Your hormone levels can fluctuate wildly during the perimenopause, dipping and even rising to higher levels than before. You will have your own unique response to these changing levels, depending on how variable they are and how sensitive you are to changes. Some women notice symptoms at the first small variation, and some never have symptoms at all.

What Are the Usual Signs of Perimenopause?

There are several clues that women commonly notice when they are in perimenopause:

  • Changes in Menstrual Cycle
    Often, the first sign of your upcoming menopause is a change in your menstrual cycle. 410 It could be shorter cycles, longer cycles, heavier periods, lighter periods or irregular periods. The most common change is a shorter cycle.
  • Hot Flashes
    Now and then, you may notice a hot flash or night sweat that comes out of the blue. This may be your first sign of waning estrogen, or you may notice that these occur along with changes in your cycle.
  • Vaginal Symptoms
    If sex becomes more painful or you become more susceptible to urinary tract infections, you may be losing some of the natural lubrication that estrogen and progesterone provide. For some women, this is an early sign that menopause is on the way.
  • Trouble Sleeping
    Some women are unaware of any menopause symptoms until they start losing sleep. You may have trouble falling asleep, staying asleep, or you may wake with night sweats. Some women notice that they seem to wake at exactly the same time each night or early morning and can’t get back to sleep.
  • Mood Changes
    Your mood may be unpredictable as you move into perimenopause. Usually this is an unexplained sadness or irritability. You may find yourself feeling "PMS-y," but not at the usual time of month.

How Can I Tell If It’s Perimenopause or Something Else?

The short answer is: you can’t. If you are having symptoms that seem like those of menopause and you are over 35, it could very well be perimenopause. If those symptoms disrupt your life, make an appointment to discuss them with your healthcare provider.

If they are subtle or not too bothersome, talk to your provider at your next annual exam. Since many symptoms of menopause can also be signs of something more serious, discuss any symptom that worries you with your provider. Be sure to check with your doc if you:

  • Are bleeding heavily with periods, and this has not been evaluated before
  • Notice recurring heart palpitations
  • Have abdominal pain
  • Are short of breath, weak or have any numbness
  • Are feeling extraordinarily overwhelmed, anxious or extremely “down”
  • Are worried about any symptom you have because it is new for you

If I Think I’m In Perimenopause, What Should I Do?

If you suddenly realize that something you are experiencing is related to menopause, don’t panic. This is, after all, a natural event -- like puberty. True, it means that you are beginning a change. But it is also a perfect opportunity to take your health seriously. When you enter perimenopause you can:

  • Consider Your Health
    If you haven’t made your health a priority in your life up until now, this would be the time to start. Think about how you want to feel in 10 years. What activities will you want to take part in? What will your body need in order to do those things? Start a plan for your “healthy self” with the first sign of menopause. You know what changes you’ve wanted to make. Use this as your signal to start.
  • Consider Pregnancy
    If pregnancy is not how you want to spend your perimenopause, remember birth control. Just because your estrogen is beginning to slide does not mean you can’t get pregnant. Although you are probably less fertile than you were a decade ago, many women have “surprise” pregnancies in perimenopause. Sexually transmitted disease is also a risk if you are not in a steady, monogamous relationship. Protect yourself.
  • Keep a Calendar
    Whenever you are beginning a change in your body, it helps to keep track. Not only does it give you reliable information about what’s happening and how often, it serves as a reality check for you. If you see that you’ve been without a good night’s sleep for five nights running, you will understand why you are having trouble concentrating at work. A perimenopause calendar is a great tool for tracing your progress and symptoms. Keep track of you menstrual cycle, noticeable symptoms, life events and the remedies you try. Take it with you to your next doctor’s appointment.


National Women’s Health Information Center, www.4women.gov


North American Menopause Society, (NAMS), Menopause Guidebook: Helping Women Make Informed Healthcare Decisions Around Menopause and Beyond, 6th Edition, North American Menopause Society, 2006. 10 Oct. 2007.

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