Signs and Stages of Perimenopause and Menopause 

Millions of women are in active perimenopause or reach menopause each year. Menopause officially occurs 12 months after a woman’s last menstrual period when the ovaries stop making estrogen, a hormone that guides the menstrual cycle.   

Menopause means the end of a woman’s reproductive years. Perimenopause is the stretch that occurs before a woman reaches menopause and can last for several years. During perimenopause, a woman’s body will vary in how much estrogen and progesterone are produced by her ovaries. This stage can begin for some women in their 30s, but typically occurs between ages 40 to 44.  

Society has come a long way from dismissing perimenopause and menopause as “the change.” Even with the increased transparency today, there is still a need for women to educate themselves and talk to their health care providers for accurate information about this phase of their life that includes both physical and emotional transitions. 

Signs of perimenopause 

During the years right before their period ends, women may notice a few – or several – symptoms tied to perimenopause. These can include: 

  • Changes in monthly menstrual cycle 
  • Hot flashes 
  • Trouble sleeping 
  • Sweating 
  • Weight gain 
  • Vaginal dryness 
  • More frequent urination 

Stages of perimenopause 

Fluctuating hormone levels signaling the start of perimenopause can occur anywhere from seven to 14 years before actual menopause is reached. Typically, a woman will experience perimenopause for four to eight years.   

During perimenopause as estrogen levels begin to drop, periods become more irregular or erratic; but a woman can still become pregnant. As a woman grows older and prepares to enter menopause, her body is preparing to stop releasing eggs – which means she will lose the ability to become pregnant. This is a normal part of a woman’s reproductive cycle.  

According to the American College of Obstetricians and Gynecologists, sometimes these hormonal changes can begin in a woman’s 30s. Although it rarely happens this early, it’s important for women to talk to their health care provider about any physical or emotional changes they may start experiencing, even if they feel they are too young to experience perimenopause.  

Signs of menopause  

Once a woman has gone 12 months without having a period, she has entered menopause. Menopause can bring a host of additional new symptoms for women to manage, as their bodies adjust to the hormonal change. Here are some symptoms that women commonly report:  

  • Hot flashes  
  • Night sweats and/or cold flashes. 
  • Vaginal dryness that causes discomfort during sex 
  • Urinary urgency 
  • Difficulty sleeping  
  • Emotional changes  
  • Dry skin, dry eyes or dry mouth 
  • Breast tenderness 

Some individuals may also experience these symptoms:  

  • Racing heart 
  • Headaches 
  • Joint and muscle aches and pains 
  • Changes in libido  
  • Difficulty concentrating or memory lapses  
  • Weight gain 
  • Hair loss or thinning

Stages of menopause 

Each woman experiences the symptoms leading up to menopause differently. The average age women reach menopause is 51, but some women might not reach that stage until their mid-50s or later. If it’s unclear if a woman has reached menopause, a doctor may order hormone testing to check estrogen or progesterone levels. 

When to talk to a doctor 

Women should start conversations early with their health care providers, even before they notice the first perimenopause symptoms. Asking questions about what to expect can help them manage the transition years once they begin. During perimenopause, if any symptoms seem concerning, it is worth contacting a physician to review symptoms. These could include menstrual bleeding that lasts longer or is heavier than normal, headaches, or any physical or emotional issues that cause concern.  

Managing perimenopause symptoms 

Just like every woman has their own combination of perimenopause symptoms, they have their own ways of managing the physical and emotional side effects. Here are some tips to manage the symptoms:   

  • Consider hormone therapy, if recommended by a doctor  
  • Dress in layers and keep water on hand to deal with hot flashes 
  • Eat a well-balanced diet with plenty of fiber, whole grains, fruits and vegetables 
  • Exercise regularly 
  • Limit foods with saturated fats, oils and sugars 
  • Make sleep a priority 
  • Reduce alcohol and caffeine intake 
  • Try meditation and deep breathing to relax

Martha Walsh, M.D., is a senior medical director and associate chief medical officer at Blue Cross Blue Shield of Michigan. For more health tips and information, visit 


Photo credit: Getty Images


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