What Is Perimenopause, and How Do I Know If I'm in It?

Your period came nine days early. Last month it was five days late. Tonight you’re awake at 3 a.m., and earlier today you walked into the kitchen for something and it was gone before you got there.

What perimenopause is

The NIA¹ defines menopause as the point when your periods end permanently and you can no longer get pregnant. The time leading up to it is the menopausal transition, or perimenopause. It isn’t a disease. The NIA calls it a normal part of aging for women.

The Menopause Society² describes what’s happening inside. The ovaries produce hormones erratically and release eggs less often, which is why your cycle changes. The NIA¹ says estrogen and progesterone decline greatly during the transition, and that the changes may explain the symptoms some women have.

The average age of menopause in the United States is 52. You only know you’ve reached it, the NIA¹ says, once you’ve gone a full year without a period or even spotting.

How long it lasts

The sources don’t agree, and that’s a fair picture of how variable this is. The NIA¹ says symptoms can last between two and eight years, and the NHS³ says they usually last 7 to 9 years, sometimes longer, and can change over that time.

The NIA¹ adds that timing and symptoms vary with genetics and with outside factors, including race and ethnicity, culture, lifestyle and environment. Smoking is associated with an earlier start and more severe symptoms.

Your periods go first

The NIA¹ says changes in your period may be what you notice first. They may no longer be regular. They may be shorter or last longer, and you may bleed more or less than usual.

The Menopause Society² fills in the picture. Cycles may start out a little shorter than usual. Bleeding may last fewer or more days, with a heavier or lighter flow. As perimenopause moves along, cycle length can vary by 7 days or more, and later in the transition you may skip 60 days or more.

A short cycle one month and a skipped one the next can belong to the same transition, so one odd month proves little.

Everything else that can change

The NIA’s¹ list of midlife changes is long, and it notes that some may come from aging rather than from menopause directly.

Hot flashes and night sweats are among the most common. The Menopause Society⁴ says up to 80% of women get hot flashes during menopause. Sleep trouble follows, from night sweats or from needing to pee at night.

Bladder changes show up too. The NIA¹ says many women develop bladder or urinary problems, including a sudden urge to go or leaks during exercise, sneezing or laughing, and that menopause raises the risk of urinary tract infections. The vagina can become drier, which can make sex uncomfortable.

Mood shifts are on the list. The NIA¹ says scientists don’t know why moodiness and irritability happen, and that stress, family responsibilities, depression or tiredness may be part of it. It says to talk with a primary care provider or mental health professional, because there are treatments.

And the body itself: a larger waist, muscle loss and fat gain, thinner and drier skin, stiff, achy joints, and memory or focus problems.

Several of these have their own articles on this site, and the sooner you can name them as part of the same transition, the less personal each one feels.

You can still get pregnant

Irregular doesn’t mean over. The Menopause Society² says that even when cycles are irregular, women in perimenopause can still get pregnant, and that contraception is advised until menopause is confirmed one year after the final period. The NIA¹ says the same: if you don’t want to get pregnant, keep using birth control for at least 12 months after your last period.

Sexually transmitted infections are still a risk after menopause, the NIA¹ adds.

How doctors tell

It isn’t always easy to tell. The NIA¹ says it may be difficult for you and your doctor to know if you’re in the transition. Doctors usually start with questions about your age, symptoms and family history. A blood test for hormone levels may be suggested in some cases, for example when periods stopped at an early age.

Surgery changes the timeline. The NIA¹ says if both ovaries are removed and you aren’t taking hormones, periods end and symptoms can start immediately.

The play

Try this: track your cycle

Mark the first day of every period on a calendar or in an app, and how long it lasts.

Note the flow: lighter, heavier, or skipped.

Add the other things: hot flashes, bad nights, mood swings. The Menopause Society² recommends tracking your pattern on a calendar or app, and it gives you something concrete to bring to an appointment.

When to get checked

The NIA¹ says that period changes can all be normal, but to make sure there isn’t a problem, see your doctor if:

• Your periods come close together
• You have heavy bleeding
• You bleed or spot after sex or between periods
• Your periods last more than a week
• You start bleeding or spotting again after not having a period for more than a year

The NHS³ says to contact your doctor about palpitations as well, and that postmenopausal bleeding, any bleeding after a year without a period, needs to be checked even if it’s a small amount, because it can be a sign of cancer. Get that one seen soon.

The NIA¹ also suggests seeing your doctor every year to talk through your plan and any concerns.

Write the date down next time it happens. The kitchen thing, you can’t fix. The date, you can bring.