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What you Need to Know About Perimenopause

The Start and End of Menopause in a Hot Flash


If you’re like most women, you’ll start experiencing changes in your menstrual cycle in your mid-late forties.Signs of menopause could be in the form of: a period that lasts longer than normal, mood swings or general fatigue.2 All of these menopause symptoms are caused by a drop in estrogen, but you won’t be officially in menopause until you haven’t had a period for 12 months.1

Perimenopause Age and Causes of Early Menopause 

What are the signs of early menopause? Early menopause occurs when your menopause age is younger than 45 for any reason. If you enter menopause before the age of 40, that’s considered premature menopause. Sometimes genetics can cause early or premature menopause; if you have a family history of early menopause, you might have the condition.3 However, smokers and cancer survivors also have an increased chance of entering menopause early. If you have a hysterectomy or oophorectomy, the effect on your body may trigger early or premature menopause.4

Perimenopause Symptoms

The transition into menopause is called perimenopause. The Cleveland Clinic estimates that you may start perimenopause 8–10 years before you enter menopause.5 However, the average perimenopause length is four years.2 Women enter menopause between the ages of 45 to 55, with an average age for menopause in the United States of 51,4 , so you can expect to enter perimenopause in your 30s or 40s. The answer to the question when does menopause start is that it’s impossible to know unless a medical condition causes it to start abruptly.

Signs of perimenopause and menopause are the same, but you can expect more symptoms and a possible increase in severity as you enter menopause. Below are some of the most common symptoms of perimenopause:

  • Mood swings
  • Night sweats
  • Irregular periods and spotting
  • Decreased libido
  • Vaginal dryness
  • Hair loss
  • Hot flashes
  • Weight gain3

Hot Flash Causes

Perhaps one of the most well-known symptoms of menopause is the hot flash. Hot flashes occur when the blood vessels in your head and neck open to allow more blood than usual. Women with normal estrogen, but low progesterone can experience hot flashes, but low testosterone, high FSH, increased cortisol, low beta-endorphin levels or higher-than-normal luteinizing hormone levels can also cause the sensation of overheating. There's also evidence that increased stress and low antioxidants can increase the chances you'll experience hot flashes.6

If you experience a hot flash, you’ll start to feel hot around your neck and head region. The feeling will spread and may last only 30 seconds to several minutes. Your skin may also flush and get red. Symptoms of menopause such as hot flashes last for an average of 4.9 years, but some women could have them for as long as 10 years.7

Night sweats have the same cause as hot flashes. If you only get hot flashes at night, you might be inadvertently triggering them. Eating spicy foods, drinking alcohol or smoking before bed can all trigger night sweats.8

What Should be Part of the Perimenopause Diet

During perimenopause, your hormone levels will fluctuate significantly. While many doctors diagnose perimenopause based on your age and symptoms, your physician can also diagnose perimenopause by doing hormone testing over the course of several visits. Fluctuations in hormones could give you a definitive diagnosis.

Perimenopause is a good time to renew your commitment to good bone health. Women will lose an average of 25 percent of their bone mass between menopause and the age of 60. Estrogen therapy, a diet with calcium and strength-training can all help prevent osteoporosis and preserve valuable bone mass.3

Transitioning Out of Perimenopause

Once you haven’t had a menstrual period in a year of perimenopause, you’re in menopause. Your doctor can test your hormone levels to determine if you’ve entered menopause, but many doctors deliver the menopause diagnosis without hormonal tests.

Many people ask "Can you get pregnant during perimenopause?" While you can get pregnant during perimenopause in some circumstances, you cannot get pregnant once you enter menopause because your ovaries no longer release eggs.2

Understanding Postmenopausal Syndrome

Some women won’t experience many perimenopause symptoms, but once they enter menopause, they may experience more symptoms. Postmenopause symptoms are the same as those many women have during perimenopause.9 In addition to the symptoms listed above, women may also experience mental confusion, stress or urge incontinence, depression, headache, insomnia and difficulty concentrating.

Knowing what menopause is, how long menopause lasts, the average age of menopause, and perimenopause and menopause symptoms can all make your journey through menopause easier. Consult your doctor to make sure your symptoms are caused by perimenopause and to discuss possible treatment options to minimize symptom effects.