Many of us grow up with a very limited understanding of menopause, a seemingly far away life event until you find yourself in the throes of it. Interestingly, “menopause” occurs on one calendar day—the day by which you have not had a period in one year. The lead up to that day is called “perimenopause,” though its symptoms are often referred to as menopausal symptoms, which I know is confusing. So, let’s start with the basics: the symptoms experienced in that lead-up to missing your period for an entire year are perimenopause symptoms. While just about everyone will experience symptoms, they can and will vary by type, severity and frequency. 

The good news is, simply recognizing something as a perimenopause symptom can help you have the right conversations with your doctor and discover the best treatment(s) for you. 

At what age does perimenopause typically start?

Just like you may have gotten your first period at age 12 and your best friend had no need for tampons until she was 16, women may experience perimenopause symptoms for the first time at different ages. On average, early perimenopause begins in a woman’s early forties, with late perimenopause in her late forties and menopause occurring at an average age of 51. 

In early menopause, estrogen becomes erratic and progesterone declines and is often marked by symptoms like shorter cycles, heavier bleeding, worsening PMS and breast tenderness, sleep disruption, and weight gain. Late perimenopause, marked by more rapid decline in estrogen, usually comes with skipped cycles, more “traditional” symptoms like hot flashes, night sweats, and vaginal dryness. Low libido and weight gain may accompany both early and late perimenoapuse. But don’t worry—it’s not all bad. This hormonal transition is completely normal. There is much to be gained from accumulated life experience, and of course, there are solutions, which we’ll cover later. 

Perimenopause can last for up to 10 years and is a completely normal transition, just like puberty. If you’re hoping to zero in on your specific timing, while it’s not a crystal ball, your best bet is asking your mom, aunts, sisters or other close female relatives because the timing of the menopausal transition is often genetic. 

Perimenopause and pregnancy

It’s no secret that women are choosing to have children later than ever, and you may have questions around trying to get pregnant in your late thirties or forties. Let’s take a look at the facts. 

Can you still get pregnant in perimenopause?

In short, yes, but the odds aren’t in your favor. Fertility decreases as women age, and statistically speaking, a woman has an approximately 5% chance of pregnancy at age 40, a less than 3% chance at age 45, and less than 1% chance at 50. While many women still ovulate and have periods during perimenopause, infrequent cycles and declining egg quality make it more difficult to conceive naturally. 

Common menopause symptoms

There’s one common menopause symptom that’s been popularized over and over again in pop culture: hot flashes. While the jokes have gotten old, hot flashes also come up a lot because they’re common: Around 80% of women will experience hot flashes during menopause. While the experience is common, women may experience different triggers. Common culprits include stress, spicy food, caffeine, tight clothes, smoking, heat and alcohol (especially red wine). 

Another common menopause symptom? Low libido. One in three women report experiencing low sexual desire or interest. Coupled with another common symptom, vaginal dryness (30% of women experience it in perimenopause and 75% postmenopause), and many women are left with little sex drive. 

I always encourage women to remember that sex: 1. Does not have to be with a partner, and 2. Does not solely mean intercourse. Masturbation can be an excellent way to get in touch with sexuality and intimacy while relieving stress, helping you sleep better and even relaxing cramps. 

Less common menopause symptoms

As I mentioned before, it’s important to be aware of menopause symptoms outside of the ones you may come to expect. Knowing that certain symptoms can be related to perimenopause can help you identify them sooner and arm yourself with knowledge so you and your doctor can work to resolve issues sooner. 

Here are some less common menopause symptoms to look out for as well as the percentage of women who experience them:

  • Heart palpitations (25% of women report “distress” related to a racing or pounding heart)
  • Brittle nails (compared to premenopausal women, postmenopausal women experience a 30% reduction in blood flow to nail beds)
  • Weight gain (Over a 3-year study following 3,000 women, researchers found that women between the ages of 42 and 52 gained an average of 4.6 pounds)

For more details, symptoms and treatment ideas, Elektra Health, where I serve as founding physician, put together a great list you can find here

Treatment options

If your perimenopause symptoms are affecting your quality of life, there’s no need to suffer in silence. Luckily, we’ve come a long way in terms of treatment options. 

Holistic therapies

It’s always best to talk with your doctor about what treatment options are best for you. That said, many women, even those using hormonal therapy treatment, find relief with holistic therapies like supplements and lifestyle changes. Diet is really important here—try to avoid sugar and prioritize self-care and movement. 

Your doctor will be able to tailor treatment to your specific needs, but may recommend things like acupuncture, therapy and/or targeted supplements. There are a lot of supplements marketed for menopausal symptoms, some with evidence behind them and some without. Helpful supplements may include magnesium, vitamin B complex, ashwagandha, vitamin D and melatonin. Their uses and targets should be discussed with a healthcare provider.

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Hormonal therapies

Common perimenopause treatments may include temporary low-dose birth control (the Pill) and other hormone therapies like hormone replacement therapy (HRT). Essentially, these treatments replace hormones that may be naturally depleted as you approach menopause. These treatments should be individualized to you, and like all treatments, HRT has benefits and risks. 

Additionally, there are also non-hormonal medications that are sometimes prescribed for perimenopause and menopause symptoms as well. The bottom line? If you’re experiencing symptoms, I encourage you to talk to your doctor. Keep track of your symptoms and their intensity and frequency so you’re armed with knowledge about your own body and can find the best possible care and treatment to help you feel your best. 

Featured expert

Dr. Anna Barbieri, Elektra Health's founding physician and co-founder of TaraMD, an integrative gynecology practice, is a board-certified gynecologist and a North American Menopause Society-certified practitioner. She serves as Assistant Clinical Professor of Obstetrics and Gynecology at Mount Sinai School of Medicine in New York. Dr. Barbieri is also trained in integrative medicine through the Center for Integrative Medicine at the University of Arizona.