Perimenopause raises a lot of questions. When does it start? What does it feel like? How long does it last? The truth is, everyone’s experience is different. You and your friend might be the same age, but your symptoms and timing could look nothing alike.
It’s also important to know that women of color may start menopause earlier, have a longer transition, and experience more intense symptoms than white women. This comes from more than 30 years of research through the Study of Women’s Health Across the Nation (SWAN). Researchers believe this may be linked to the chronic stress that comes with experiencing racism and poverty, both of which disproportionately affect people of color.
This article is here to help, whether you’re just starting to wonder about perimenopause, going through it now, or looking back on it.
What is perimenopause?
Perimenopause is the phase when your body starts getting ready for menopause. Menopause is when you’ve gone 12 months in a row without a period.
During perimenopause, your body makes less estrogen. Estrogen is a hormone, and when it drops, it throws off the balance with another hormone called progesterone. This causes your hormone levels to rise and fall, sometimes quite a bit.
Think of it like a roller coaster. Estrogen goes up, then drops, then climbs again, over and over. Your symptoms tend to follow the same pattern, shifting as your hormones change.
What are the symptoms?
One of the first signs of perimenopause is a change in your period. Your periods may become irregular, lighter, heavier, or you might skip one entirely.
Other common symptoms include:
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- Heavier or lighter periods than usual
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- Irregular or missed periods
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- Mood changes like irritability, depression, or mood swings
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- Lower sex drive
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- Hot flashes
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- Night sweats
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- Vaginal dryness, which can make sex uncomfortable
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- Needing to pee more often
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- Trouble falling or staying asleep
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- Anxiety
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- Depression
When should I be concerned?
Some symptoms warrant a call to your doctor rather than waiting until your next scheduled visit. Reach out sooner if you notice:
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- Very heavy bleeding, or bleeding that lasts much longer than usual
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- Severe mood changes that are affecting your relationships or daily life
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- Any bleeding after you’ve already gone 12 months without a period
You know your body best. If something feels off, trust that instinct and reach out.
When does perimenopause start?
Perimenopause usually begins in your mid-40s, but it can start earlier or later for some people. It typically begins about 8 to 10 years before menopause. Research from the SWAN study suggests that for women of color, both perimenopause and menopause may begin earlier than average.
How long does it last?
For most people, perimenopause lasts anywhere from 4 to 10 years, and it varies from person to person. The SWAN study also found that Black women tend to have a longer transition from perimenopause to menopause. This is partly because irregular bleeding, one of the early signs of perimenopause, often starts at a younger age for Black women.
How can you manage your symptoms?
There’s no way to stop perimenopause, but there are ways to feel better. Some people make lifestyle changes, while others work with their doctor to find the right medication. Many find that a mix of both works best.
Medications your doctor might suggest:
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- Low-dose birth control pills help balance hormone levels and ease symptoms
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- Hormone Replacement Therapy (HRT) uses estrogen or estrogen and progesterone to bring hormone levels back up
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- Antidepressants can help with hot flashes, mood swings, anxiety, and depression
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- Vaginal moisturizers or lubricants may help with dryness and discomfort
Lifestyle changes that may help:
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- Cut back on sugary drinks, sweets, and foods high in saturated fat, as these can trigger hot flashes and lead to weight gain. When a sweet craving hits, try fruit instead.
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- Do weight-bearing exercise like walking, hiking, or strength training to help keep your bones strong.
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- Dress in layers so you can adjust quickly when a hot flash comes on.
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- Use a fan while you sleep to stay cooler at night.
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- Avoid screens before bed. Try a calming activity instead, like reading, gentle stretching, or listening to soft music.
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- Limit alcohol and caffeine when you can. Both can trigger hot flashes and make sleep harder.
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- Find a stress-relief practice that works for you; meditation, deep breathing, journaling, or even a short daily walk can all help.
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- If you use tobacco, talk to your doctor about quitting. Tobacco use is linked to earlier menopause, weaker bones, and worse vaginal dryness.
What should I ask my doctor?
Don’t hesitate to bring up anything you’re feeling or curious about. Here are some questions to get you started:
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- Do my symptoms sound like normal perimenopause?
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- What can I do to feel better?
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- Is hormone therapy a good option for me?
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- Are there any additional tests I should be given?
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- Are there any specific risks I should be aware of based on my background or health history?
If your symptoms are getting in the way of your daily life, call your doctor. You don’t have to just push through it; there are options to help, and you deserve to feel like yourself again.
Resources
Study of Women’s Health Across the Nation (SWAN)
Perimenopause: Age, Stages, Signs, Symptoms & Treatment- Cleveland Clinic
Navigating Perimenopause: 5 Tips from a Women’s Health Provider- Johns Hopkins Medicine