Perimenopause Symptoms: How Do I Know When Perimenopause Starts?

Menopause brings many significant physical and emotional changes. Some of these changes can begin long before you notice changes in your menstrual cycles. Perimenopause is the transition period that leads up to menopause. Hormone levels change during this time, which can cause symptoms similar to menopause. 

If you don’t know what’s happening to your body, these changes can be alarming or confusing. 

Let’s look at the most common symptoms of perimenopause so you can understand this natural change and know when it’s happening to you.

When does perimenopause start, and how long does it last?

Every person has a different biological and reproductive timeline. This means perimenopause starts at different times for different people. It usually begins in your 40s, but it may start earlier for some. 

The length of perimenopause is also different for every person. Usually it lasts for about 4 years on average. But this can be much shorter or much longer — sometimes 8 to 10 years. There’s no way to predict how long it will last for each person.

One study found that people who started menstruation at a younger age tended to have a longer perimenopause and menopause transition.

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What are the common symptoms of perimenopause?

People experience perimenopause in many different ways. Some people may not notice any symptoms. But others may experience big changes in their body. Most of these physical symptoms are caused by a slow drop in estrogen levels as you approach menopause.

Here are some of the most common physical symptoms. 

Hot flashes

These are brief episodes where you may feel very hot, sweaty, or flushed. Up to 80% of women have hot flashes or night sweats at some point during perimenopause or menopause.

Insomnia 

Insomnia is when you have difficulty falling asleep or wake more frequently during the night. It’s a common perimenopause symptom. In fact, almost half of people in perimenopause report having some difficulty sleeping. This may be due to:

• Hot flashes

• Mood changes

• Weight gain 

Decreased libido

This is a decreased desire in sex, and it can happen for a number of different reasons. It can be related to the change in hormones during perimenopause. But it can also stem from some of the other symptoms, including: 

• Insomnia

• Mood changes 

• Changes in your vagina’s natural lubrication

Genitourinary syndrome of menopause (GSM)

Lower levels of estrogen in perimenopause can cause you to have vaginal dryness and urinary symptoms. Collectively, these symptoms are known as genitourinary syndrome of menopause (GSM). These symptoms usually get worse as you enter menopause and can include:

• Pain, discomfort, or burning during sex

• Itchy, dry, or irritated vulvar tissues (the area outside your vagina)

• Vaginal tears

• Urinary incontinence (leaking urine)

• Peeing more often

• Discomfort with urination

• More urinary tract infections (UTIs)

Weight gain

Many people will notice a change in the shape of their bodies during perimenopause. This is related to a natural increase in body fat or possibly loss of muscle mass. Hormonal changes can play a part, but it’s also common to gain weight as you get older.

Changes in menstruation

You may also start to notice changes in your menstrual cycles during perimenopause. These can include:

• Heavier or lighter bleeding

• Less frequent menstruation or missed periods

• Longer or shorter periods

Sometimes, it’s hard to know if these changes are from perimenopause or another health issue. This is especially true for people who start perimenopause at a younger age. That’s why it’s important to talk to a healthcare professional about changes in your period. They can help rule out other possible causes. 

Mood changes

Perimenopause doesn’t just affect your body — it can affect your emotions too. Common mood-related symptoms include:

• Irritability

• Difficulty with concentration

• Mood swings

• Feelings of sadness or depression

• Increase in anxiety

Mood changes and depression may be more likely in women who experience perimenopause at a younger age.

Quiz: Are you in perimenopause?

Is there treatment for perimenopause symptoms?

Perimenopause is a natural and inevitable period in your life. Still, some of the symptoms can be uncomfortable. Luckily, there are ways to make the transition easier. 

Hot flashes

Hot flashes are one of the more bothersome symptoms of perimenopause. They can feel like a sudden rush of heat, usually in your face, neck, or chest. A hot flash usually lasts for 2 to 4 minutes. You may also experience other symptoms, including:

• Sweating

• Racing heart (palpitations)

• Flushing

• Chills

• Clammy skin

These symptoms can be easier to tolerate with simple changes. For example, you can wear light clothing or dress in layers that you can take off easily. You can also avoid common triggers like caffeine, alcohol, and spicy foods. 

For people with more severe episodes, some other medications may also help. For example:

• Fezolinetant (Veozah)

• Hormone therapy (like estrogen and progesterone)

• Antidepressants (like paroxetine)

Other medications, like gabapentin and clonidine, are sometimes used off-label to help with hot flashes. 

Vaginal health

There are multiple treatment options for vaginal dryness. You can purchase many of these over the counter — such as vaginal lubricants or moisturizers.

Vaginal estrogen is also an option. But this requires a prescription. It’s applied directly to your vagina as a cream, ring, or tablet. It involves very low doses of estrogen, and has less risk of side effects than other forms of medications that have estrogen. In addition to relieving vaginal dryness, this can also help with some of the urinary symptoms we mentioned. 

Mental health

If you’re experiencing mood changes, you don’t have to suffer through these symptoms. There are many treatment options that help with symptoms of depression and anxiety. Treatment options can include:

• Medications

• Stress management strategies

• Lifestyle changes in diet, exercise, and sleep

• Psychotherapy

You can search online for mental health resources near you. But it’s always a good idea to reach out to a healthcare professional to talk about how you’re feeling. They can help you find the right specialists in your area and discuss medication options with you.

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Written by:

Lois C. Bronstein, MD

Lois C. Bronstein, MD, is a licensed physician in New York with decades of experience in medicine. She graduated from SUNY Upstate Medical School in Syracuse, New York, and completed a residency in emergency medicine in Worcester, Massachusetts.

Edited by:

Karla Robinson, MD

Karla Robinson, MD, is a medical editor for GoodRx. She is a licensed, board-certified family physician with almost 20 years of experience in health through varied clinical, administrative, and educational roles.

Reviewed by:

Maria Robinson, MD, MBA

Maria Robinson, MD, MBA, is a board-certified dermatologist and dermatopathologist who has practiced dermatology and dermatopathology for over 10 years across private practice, academic, and telehealth settings. She is a fellow of the American Academy of Dermatology and the American Society of Dermatopathology.

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