All About Perimenopause

If you're noticing changes in your body—and your mood—it might be perimenopause. Here’s what to know and look for.

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Updated on June 23, 2023.

Hormonal changes on the road to menopause may cause changes in the way you feel and in the way your body behaves. And between mood swings and weight fluctuations, perimenopausal symptoms can make you feel out of sorts. Here’s what you need to know about this natural life stage.

Perimenopause and its relation to menopause

Contrary to popular belief, menopause is not the time in your life when your menstrual cycle slows down and your periods begin to dwindle. The true definition of menopause is the point when you've gone 12 consecutive months without your period.

The transition leading up to menopause is called perimenopause. For some people, it can last a few months, and for others, it can continue for as many as 13 years, explains Margery Gass, MD, executive director emeritus of the North American Menopause Society. 

Perimenopause can begin in your 30s 

For some people, perimenopause may start sooner than you may think. While the normal range of menopause tends to be roughly age 45 to 55, perimenopause can start in your 30s. “A lot of women are caught off-guard by that," Dr. Gass says. 

There's no test or crystal ball that can tell you when or if you're approaching perimenopause, says Judith Volkar, MD, an OBGYN in Columbia, South Carolina. One significant factor that can help predict when you may experience perimenopause is your mother’s age when they went through the change. Other factors include your body mass index and level of physical activity, as well as use of oral contraceptives and number of pregnancies.

Some research suggests people who smoke are likely to hit menopause sooner. One 2018 study published in the American Journal of Epidemiology found that women who smoked were nearly twice as likely to experience early menopause compared to non-smokers. The chances of early menopause increased with the amount smoked and the duration of smoking.

Even former smokers were observed to be more prone toward early menopause, depending on the volume and years smoked. Women who smoked but quit before the age of 25 tended to experience menopause at the same time as non-smokers. 

Signs of perimenopause 

According to Gass, the first sign of perimenopause is menstrual cycle irregularity, marked by periods that can show up an entire week early or late. As you progress into late perimenopause, menstrual cycles become longer and you may go as long as 60 days without a period. You may also have periods that are heavier or lighter than usual.

"It's during this time that women will start to have some symptoms, such as hot flashes, but only during that time of the month," Dr. Volkar says. 

In addition to hot flashes (which are characterized by a sudden and spreading feeling of warmth throughout the body), you may experience other perimenopausal symptoms like fatigue, irritability, vaginal dryness, weight gain, sleep problems, and the need to urinate more frequently than usual. The biggest perimenopause symptom Volkar hears about from her patients is emotional instability.

“When you have a sullen teenager, you say, ‘Oh, it’s their hormones.’ Well, you have a lot of that same feeling when you’re perimenopausal, because you can have such wild hormonal fluctuations from day to day,” Volkar says. The result can be that you feel sad or angry over things that ordinarily wouldn’t bother you. 

According to some estimates, around 40 percent of women experiencing perimenopause will have mood symptoms that are comparable to those seen with premenstrual syndrome.

Can I get pregnant during perimenopause? 

Many people wonder if they can get pregnant once signs of perimenopause begin. The answer is yes. It's possible to get pregnant as long as you're still menstruating. "It's not that common," Volkar says, "but it can happen."

If you are sexually active and want to avoid getting pregnant, use birth control until your periods have stopped for 12 consecutive months. If you wish to become pregnant, speak with a healthcare provider about possible fertility treatments that may increase your chances. And be sure to speak with a provider right away if you’re experiencing changes to your menstrual cycle or having any new symptoms.

Article sources open article sources

American College of Obstetricians and Gynecologists. The Menopause Years. Last reviewed: November 2021.
E K Bjelland and others, The relation of age at menarche with age at natural menopause: a population study of 336 788 women in Norway, Human Reproduction, Volume 33, Issue 6, June 2018, Pages 1149–1157.
Crandall CJ, Mehta JM, Manson JE. Management of Menopausal Symptoms: A Review. JAMA. 2023;329(5):405-420.
Ceylan B, Özerdoğan N. Factors affecting age of onset of menopause and determination of quality of life in menopause. Turk J Obstet Gynecol. 2015;12(1):43-49.
The North American Menopause Society. Menopause 101: A primer for the perimenopausal. Accessed June 23, 2023.
Whitcomb BW, Purdue-Smithe AC, Szegda KL, et al. Cigarette Smoking and Risk of Early Natural Menopause. Am J Epidemiol. 2018;187(4):696-704.
Silver, N. Mood Changes During Perimenopause Are Real. Here’s What to Know. American College of Obstetricians and Gynecologists. Last reviewed: April 2023.
Mayo Clinic. Perimenopause. May 25, 2023.
National Institute on Aging. What Is Menopause? Content reviewed: September 30, 2021.
Cleveland Clinic. Perimenopause. October 5, 2021.

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