Understanding your body
Perimenopause, explained
It starts earlier than most women expect, and periods keep coming — which is why it is so often missed.
See if you’re eligibleFree clinician review. If treatment is not right for you, you pay nothing.
The years nobody warned you about
Perimenopause is the transition into menopause. It commonly starts in your forties, sometimes in your late thirties, and lasts four to eight years. Your periods keep coming — which is exactly why so many women do not connect what they are feeling to their hormones.
The defining feature is not decline. It is fluctuation. Estrogen can run high one week and low the next, and those swings are what produce symptoms that seem to arrive from nowhere and then disappear again.
- 40sis when perimenopause most commonly begins.
- 4–8 yearsis the common length of the transition.
- Still bleeding— periods continue, often becoming irregular, heavier or closer together.
Early signs women tend to miss
- Cycles that shorten, lengthen or skip, or bleeding that changes character.
- New anxiety, irritability or tearfulness that does not match what is going on in your life.
- Waking at 3am, even without obvious night sweats.
- Losing words mid-sentence, or rereading the same paragraph.
- Weight settling around the middle on unchanged habits.
Why a blood test often does not settle it
Because hormones fluctuate through perimenopause, a single FSH or estradiol reading can look normal on a day when you feel terrible. Clinicians generally diagnose perimenopause from your symptom pattern and cycle changes, using labs where they add something. Your clinician will tell you whether testing is useful for you.
What treatment can look like
Treatment during perimenopause is aimed at the symptoms you actually have. A licensed clinician reviews your history, your cycle and your symptoms, then determines whether treatment is appropriate. How hormone therapy works.
Questions women ask
Can I be in perimenopause if I still get my period?
Yes. Perimenopause is the stage before your final period, and regular or irregular bleeding continues throughout it. Symptoms often begin while cycles are still fairly predictable.
Can I still get pregnant during perimenopause?
Yes. Fertility declines but does not stop until menopause is complete, so contraception is still relevant. Discuss it with your clinician.
Is treatment different in perimenopause than after menopause?
It can be, because you are still cycling and hormone levels swing. That is one of the things a licensed clinician weighs when deciding what, if anything, to prescribe.
Find out what is right for you
Answer a few questions about your health. A licensed clinician reviews your history and tells you whether treatment is appropriate — at no cost.
See if you’re eligibleSources & important information
This page is general education, not medical advice, and it does not replace an evaluation by a licensed clinician. Individual experiences vary. Prescription treatment is only provided when a licensed clinician determines it is appropriate for you; a prescription is not guaranteed. Compounded medications are not FDA-approved. The FDA does not review compounded medications for safety, effectiveness or quality before they are made available.
General background from ACOG, The Menopause Society, the National Institute on Aging and the SWAN cohort.