Perimenopause: Beginning the transition into menopause

An OB/GYN offers guidance on signs, how long it lasts, and when to call your doctor

Perimenopause: Beginning the transition into menopause

Perimenopause, or the menopausal transition, marks the end of a woman’s reproductive years and signals the natural transition into menopause.

This typically occurs in most women during their 40s.

Women can experience a fluctuation in hormones for some time leading into menopause, which is defined as not having had a period for 12 months.

Find primary care: Search Sanford Health women’s, family medicine or internal medicine providers

“Things can change pretty wildly leading up to that transition and women will notice significant changes in their periods,” said Erica Schipper, M.D.

Dr. Schipper is an OB/GYN at Sanford Heath specializing in minimally invasive gynecologic surgery.

She said women will either have lighter and less frequent periods or more frequent, heavier, longer periods.

“All of that has to do with the fact that our hormones are starting to diminish overall, estrogen levels are dropping, and in the meantime, we see peaks and valleys in hormones as the body adjusts to these changes.”

The average age of menopause itself is 51 years old, while perimenopause begins, on average, four years before that.

But in her many years of practice, Dr. Schipper has seen signs that perimenopause most often begins sooner as women start to notice more changes in their body, their mood, their sex drive and other symptoms for up to 10 years before menopause.

Perimenopause looks different for everyone

Timing for perimenopause, the first stage of menopause, will depend on a few different factors.

One is family history.

“If the women in your family go through menopause a little earlier or a little later than average, and that happens to you, that’s less concerning,” Dr. Schipper said.

“If you’re starting to experience perimenopausal symptoms in your late 30s or before age 40 – but your family member experienced them much later – that is worth evaluating.”

On the flip side, she added, if you’re having periods into your late 50s, that’s also worth evaluating.

“Periods should get lighter and less frequent as we approach menopause.”

Signs of perimenopause

Perimenopause can last anywhere from four to 10 years and there’s a broad list of symptoms, according to Dr. Schipper. They include:

  • Irregular bleeding. Periods can become more frequent, less frequent, lighter, or heavier.
  • Hot flashes and night sweats.
  • Mood changes like irritability.
  • Difficulty sleeping.
  • Vaginal dryness and decreased libido.
  • Bladder issues. Oftentimes, bladder instability, urinary frequency or urgency can be part of perimenopause.
  • Bloating and difficulty with weight management.

You may be wondering when any of those symptoms become concerning enough to seek care.

Dr. Schipper said heavy, painful or prolonged periods aren’t normal. Additionally, a woman should seek care if her mood changes are severe, possibly leading to depression in the perimenopause or menopause stages.

“Our quality of life is important,” she said. “If any of those symptoms are bothering you, affecting our day-to-day, our families, marriage and longevity, it’s time to get in and be seen.”

Perimenopause health care (and self-care)

Patients are encouraged to call their health care provider and not wait for that routine wellness exam or screenings.

Listen now: Integrative care for women in midlife

“Every woman goes through this and we don’t often talk about it,” she said. “So it can be very isolating and make you feel separated from your spouse or others.”

In the meantime, she suggests logging symptoms using a calendar or symptom tracker app for your smart device.

The transition to menopause is different for each woman, Dr. Schipper added.

“Some women are not bothered by perimenopause and don’t experience a lot of symptoms while it can be more difficult for others,” she said.

“It can happen at a time in our life when there are other big changes like taking care of children and aging parents at the same time, children leaving home, and other responsibilities and emotions that come along with those years.”

She encourages women to find support in other women, friends and family to talk about these stages and avoid feeling isolated.

Learn more

Posted In Family Medicine, Internal Medicine, Menopause Care, Women's