Medically Reviewed by Zilpah Sheikh, MD on October 02, 2023
6 min read

Perimenopause, or menopause transition, is when your ovaries gradually begin to make less estrogen. It lasts until menopause, the point when your ovaries stop releasing eggs. In the last 1-2 years of perimenopause, this drop in estrogen speeds up. At this stage, you may have menopause symptoms.

It usually starts 8-10 years before menopause. It usually happens when you're in your mid-40s, but it can start in your 30s or earlier.

If you go through menopause before age 40, that's called premature menopause. It can be caused by some medical conditions or procedures. If there is no medical or surgical cause for premature menopause, it's called primary ovarian insufficiency.

Early menopause can be caused by:

  • Smoking or using other tobacco products
  • A family history of early menopause
  • A history of cancer treatment
  • Having your uterus or ovaries removed

You might hear the terms perimenopause and premenopause used interchangeably, but they mean different things:

  • Premenopause is the time between your first period and the onset of perimenopause.
  • Perimenopause is when you transition into menopause.

The average length of perimenopause is 4 years, but this stage may last only a few months or continue for 10 years. Perimenopause ends when you've gone 12 months without having a period.

Perimenopause symptoms may include:

  • Hot flashes and night sweats, or vasomotor symptoms (VMS)
  • Breast tenderness
  • Worse premenstrual symptoms 
  • Lower sex drive 
  • Fatigue 
  • Irregular periods (also called perimenopause periods) 
  • Vaginal dryness or discomfort during sex
  • Leaking pee when you cough or sneeze
  • Having an urgent need to pee more frequently
  • Mood swings
  • Trouble sleeping 
  • Short-term memory problems
  • Trouble concentrating 

Irregular periods are common and normal during perimenopause. But other conditions can cause changes in menstrual bleeding. If any of the following situations apply to you, see a doctor to rule out other causes:

  • Your periods are very heavy, or they have blood clots.
  • Your periods last several days longer than usual.
  • You spot between periods.
  • You have spotting after sex.
  • Your periods happen closer together.

Causes of abnormal bleeding include hormone problems, birth control pills, pregnancy, blood clotting problems, or rarely, cancer. It can also be a sign of fibroids. Symptoms of fibroids, which can worsen during perimenopause, include heavy cycles, backaches, pelvic pain and pressure, frequent urination, and anemia. See your doctor if you have these symptoms.

Your doctor can often make the diagnosis of perimenopause based on your symptoms. A blood test to check hormone levels may also help, but your hormone levels keep changing during perimenopause. It may be more helpful to have several blood tests done at different times for comparison.

At-home perimenopause tests are available over-the-counter to measure follicle-stimulating hormone (FSH) in your pee. But health experts aren't sure taking these tests is a good idea. That's because your FHS levels fluctuate, and your doctor considers other things such as your health history and overall condition when diagnosing perimenopause.

Yes. Despite a decline in fertility during the perimenopause stage, you can still become pregnant. If you do not want to become pregnant, you should use some form of birth control until you reach menopause (you have gone 12 months without having your period).

For some women, getting pregnant can be difficult once they are in their late 30s to early 40s due to a drop in fertility. If becoming pregnant is the goal, there are treatments that can help you get pregnant.


You may get relief from hot flashes and night sweats, or VMS, after taking low-dose birth control pills for a short time. Other options that may control hot flashes include the birth control skin patch, vaginal ring, and progesterone injections. Certain women should not use birth control hormones, so talk to your doctor to see if they are right for you.

Medical treatment for perimenopause

There isn’t any treatment to stop perimenopause. Perimenopause is a natural part of life. The “cure” for perimenopause happens when your periods stop and you enter menopause.

However, to help ease symptoms, your doctor may recommend over-the-counter or prescription perimenopause treatment, such as:

Antidepressants: These medications help with mood swings or depression. Low doses of antidepressants can help with hot flashes, too.

Birth control pills. These medications stabilize your hormone levels and typically ease symptoms.

Estrogen therapy: This treatment stabilizes estrogen levels. You may take estrogen therapy as a cream, gel, patch, or pill.

Gabapentin (Neurontin®): This medicine is a seizure medication, which also relieves hot flashes for some women.

Vaginal creams: Your doctor can tell you about prescription and over-the-counter options. Treatment can decrease pain related to sex and relieve vaginal dryness.

Hormone therapy. If you choose this treatment to ease your perimenopause symptoms, your doctor may want you to start it within 10 years of beginning menopause symptoms, and use it for less than 5 years. That's because estrogen and hormones are linked to an increased risk of heart problems and some types of breast cancer.

But treating perimenopause with hormone therapy can increase your risk for:

  • Stroke
  • Uterus cancer 
  • Heart attack
  • Blood clots
  • Gallbladder disease

Home remedies for perimenopause

Certain lifestyle changes such as eating a healthy diet, light exercise, and avoiding foods or activities that trigger hot flashes can also help. You may also feel better if you do things that enhance your general well-being, such as:

  • Exercise
  • Stop smoking
  • Get more sleep, and try sleeping and waking up at the same time each day
  • Drink less alcohol
  • Avoid caffeine
  • Maintain a healthy weight 
  • Get enough calcium in your diet
  • Ask your doctor if you should take a multivitamin
  • Reduce your stress and build stress-coping skills

Talk to your doctor if you are having problems with your sex drive. They may be able to recommend a counselor or therapist to help you and your partner work through this problem. Vaginal lubricants may also be recommended if vaginal dryness is a problem.

Talk to your doctor about your specific symptoms and goals of treatment. This will help them make a plan that is right for you.

Signs that your perimenopause stage may be ending include increased symptoms but no period for several months. You're in menopause after 12 months without a menstrual period.

  • Perimenopause, or menopause transition, is when your ovaries gradually begin to make less estrogen.
  • Perimenopause usually starts in your 40s but can start in your 30s, or even earlier.
  • Perimenopause usually lasts 4 years, but it can last longer.

What are the first signs of perimenopause?

The most common first sign of perimenopause is a change in the flow and length of your menstrual cycle, or going 60 days or more between periods.

What is the perimenopause age?

Perimenopause can begin in your 30s, but it mostly happens when you're 40 to 44.

What are the three symptoms of perimenopause?

Three of the most common symptoms of perimenopause are:

  • Mood changes
  • Changes in sexual desire
  • Trouble concentrating

What are the two stages of perimenopause?

  • Early Stage. Perimenopause can begin in your 30s, but most often it starts when you're 40 to 44.
  • Late Stage. The late stages of perimenopause happen when you're in your late 40s or early 50s.