This is the first article in WHA’s new perimenopause and menopause series. Look for future articles about the 34 most common symptoms, hormone replacement therapy, menopause weight management and more.

Menopause eventually affects half of our population. Every person with ovaries will go through it. And yet, the months and years leading up to it are often a total struggle, where symptoms are misunderstood, misattributed, or worse–ignored.

Given the wide variety of perimenopausal symptoms—from neuro-endocrine to whole-body physical changes you might feel (and others that happen behind the scenes like bone and metabolic changes) to vulvovaginal symptoms—it’s understandable why so many people fail to make the connection between what they’re experiencing and the body’s natural decline in hormone levels. Couple that with a general lack of information about what “perimenopause” is and when it starts, and it’s no wonder many of us would just rather not talk about it – as if ignoring our symptoms will make them just go away or chalking them up to something else will mean menopause isn’t on the horizon.

But here’s the truth: we need to talk about it! While every person’s experience with perimenopause is different, every person does experience it. So if you’re just feeling different (and you know you best) you might be in perimenopause.

Typical ages and stages of perimenopause

Could I be perimenopausal?

Perimenopause is the transitional time leading up to menopause when hormone production changes, specifically by a decline in progesterone and estrogen, which can lead to a host of hormonal-related symptoms.

By definition, menopause is one year without a period. Fun fact: “menopause” itself is one day long! One day. Everything leading up to it is perimenopause, which can last for 4-10 years–and everything after that day is post-menopause.

Perimenopause is often the forgotten period, even though it’s the one we’re all hanging out in for years. The typical age at which perimenopause begins is early- to mid-40s. While it’s hard to know “for sure” if you’re in it since each person’s perimenopause experience is different, you can look for some clues.

Stages of perimenopause

Late 30s to early 40s

Hormone changes: Progesterone begins to decline

Potential symptoms:
  • Periods are still regular
  • Minor mood changes like increased irritability or emotional swings
  • Sleep issues like difficulty falling asleep
  • Breast tenderness

Mid 40s

Hormone changes: Progesterone continues to decline, estradiol may start to fluctuate wildly and decline overall

Potential symptoms:
  • Changes in your cycle
  • PMS-like symptoms, sleep issues, and mood changes all intensify
  • Weight gain and changes in body composition
  • Decreased libido (sex drive)
  • UTIs

Late 40s

Hormone changes: Estradiol and progesterone fluctuate and decline

Potential symptoms:

There isn’t a set timeline for perimenopause; it can vary widely from person to person. Similarly, the average age for menopause is 51, though people experience it both earlier and later.

The difficulty in diagnosing perimenopause

Because of how long perimenopause lasts, most symptoms don’t usually feel like sudden changes, making them easier to dismiss as one-offs. They are also often misattributed to stress and/or aging because this time is such a dynamic period of life. Maybe you’re juggling kids. Or aging parents. Or a demanding career. Or marital stressors. Maybe you’re dealing with everything all at once.

While there are common symptoms of perimenopause, they may present differently.

How do I know if I am in perimenopause?

One of the best things you can do to understand if you might be going through perimenopause is to track your symptoms, especially your periods, to see if there’s a cyclical correlation. A great clue is when all of these symptoms get worse right before your period because that’s when estrogen is at its lowest.

Know that hormone testing does not help make a perimenopause diagnosis; it’s not about monitoring specific numbers but rather your unique story.

Perimenopause symptoms can last for years. While it’s totally natural, like puberty in reverse, it’s understandable that many people wish for it to be anything but perimenopause. Having a positive mindset has been shown to help reduce the severity of symptoms. Easier said than done!

When to see a provider for perimenopause

You should see a provider to discuss perimenopause symptoms as soon as they begin to affect your daily life—and really, whenever the heck you want to.

If you’re within the average age range for perimenopause, and you’ve noticed a cyclical pattern to your symptoms, it may be best to assume it’s perimenopause before anything else. So rather than see a specialist for one symptom, first try discussing the big picture with a single provider.

When making an appointment, ask who has experience with perimenopause. You can see a nurse practitioner, OB-GYN or primary care physician—but you want someone who wants to be in it with you for the long haul that it is. Someone who will listen carefully. If your normal reproductive healthcare specialist or primary care provider doesn’t have the expertise or desire to work with you over time, ask if there’s someone to whom they can refer you within or outside their practice who has a true passion for helping people through this stage of life. You’ll want a provider who will go on the journey with you. You can also search The Menopause Society’s on-line search function for Menopause Society Certified Practitioners (MSCP) and other member clinicians.

Know that for most people, perimenopause will likely be the time during this whole transition where you’ll feel the most symptomatic and volatile. This is the time when you’ll likely benefit the most from hormonal (HRT) and non-hormonal therapies (exercise, non-HRT medications, mindfulness practice, etc). A lot of people are under the misconception that they have to be “in” menopause (aka, after periods cease, or post-menopause) to seek help–and one of the many reasons women may unnecessarily suffer through it for years.

Menopause and mental health

We know that when you’re postmenopausal, symptoms tend to improve with time, as does one’s outlook on life. A couple of years after menopause people have reported feeling happier. So it’s not all doom and gloom, but can feel that way if you’re in the dark.

During this massive transition and change, allow yourself to feel all the feelings. Maybe it’s joy because there’s freedom from not being able to get pregnant anymore. Or maybe there’s grief for the same reason. Talk to your friends and family about it all—or anyone who will listen and validate your experience.

Like any change, once you go through it, it tends to be better on the other side.