What Is Perimenopause? Signs, Symptoms, and When to Get Support

Hello, I’m Dr. Marci Nelson. For more than twenty years I have walked with women through adolescence, pregnancy, postpartum, and now peri and menopause. If you are noticing new changes in your body and you are not sure why, you are not alone. Many women experience the earliest signs of menopause years before their final period. This stage is called perimenopause, and understanding it can help you get relief sooner and make confident decisions about your health.

According to leading medical organizations, perimenopause is the transition leading up to menopause when hormone patterns become irregular and symptoms often begin. You reach menopause only after twelve months without a menstrual period. (The Menopause Society)

What exactly is perimenopause?

Perimenopause is a multi-year transition where the ovaries release eggs less regularly and estrogen levels fluctuate. Cycles may shorten and then become irregular. This is a normal biological process that precedes menopause and it affects each woman differently. A respected medical review describes perimenopause as a state with wide hormonal variability that often shows up first as changes in bleeding patterns.

How long does perimenopause last?

Research suggests the transition can last several years. Large cohort data estimate a typical range of about four to eight years, with duration influenced by age at onset and other factors. Some women experience a shorter course and others longer.

Common signs and symptoms

Every woman’s experience is unique. Some notice only cycle changes. Others experience several symptoms that affect sleep, work, relationships, or mood. Common symptoms include:

• Irregular periods or missed cycles

• Hot flashes or night sweats

• Sleep disruption or early waking

• Brain fog, difficulty concentrating, or forgetfulness

• Mood changes such as irritability or anxiety

• Vaginal dryness or discomfort with intimacy

• Fatigue, joint aches, and weight changes

These are well documented across clinical guidance and medical summaries. If you see yourself in this list, you may be in perimenopause even if your periods have not stopped.

Why perimenopause is often misunderstood

Many women tell me they felt rushed during visits or left with more questions than answers. It is also common to find conflicting advice online, which adds to the confusion. Authoritative organizations emphasize that the first sign is often a change in menstrual cycles, followed by symptoms like hot flashes and sleep problems, yet the course and intensity vary. Understanding that variability is the first step toward making a plan that fits you.

Perimenopause vs menopause

It helps to be precise with terms. Perimenopause is the transition. Menopause is a point in time defined after twelve consecutive months without a period. Postmenopause is everything after that milestone. Clear definitions reduce confusion and help you and your clinician choose next steps.

When to seek help

Please reach out if any of the following are true for you:

• Your symptoms are interfering with sleep, work, relationships, or daily life

• Changes in bleeding patterns are concerning to you

• You feel dismissed or unsure after previous visits

• You are overwhelmed by conflicting information and want an evidence-based roadmap

Changes in bleeding as you near menopause deserve a conversation with your clinician to rule out other causes and to plan appropriate evaluation. Coaching can complement that care by helping you track symptoms, understand options, and prepare focused questions for your next appointment.

How perimenopause coaching helps

Medical care addresses diagnosis and treatment. Coaching supports you between visits so you can move from confusion to clarity. In my practice, we create a Personal Menopause Plan that includes:

1. Symptom and cycle mapping so trends become visible

2. Education on evidence-based options, including hormonal and non-hormonal approaches

3. Sleep, stress, movement, and nutrition strategies that match your stage

4. Collaboration with your physician when you want alignment across your team

Perimenopause is not one size fits all. An individualized plan respects your history, risk factors, and preferences while staying grounded in the best available evidence from reputable organizations and peer-reviewed research.

What to do today if you think you are in perimenopause

• Start a simple symptom and cycle log for six to eight weeks

• Note sleep quality, hot flashes, mood shifts, and any bleeding changes

• Gather your personal and family medical history

• If bleeding is heavy, very frequent, occurs after intercourse, or happens after menopause, contact your clinician promptly

• If you are not sure where to start, schedule a brief discovery call. We will talk through what you are experiencing and outline your next steps

Dr. Marci’s perspective

I have partnered with thousands of women across preventive care, pregnancy, postpartum, sexual health, and menopause. I completed my MD at the University of California San Diego in 2001, residency at Swedish Family Medicine in Seattle, and I am board-certified in Family Medicine and Obstetrics. I am also a Menopause Society Certified Practitioner. My mission is to bring intention and clarity to this stage of life so you can make choices that fit you. When medicine and compassion meet, women feel heard and supported.

Helpful, credible resources

If you like to read more, these are trustworthy starting points:

• The Menopause Society’s perimenopause overview

• ACOG patient education on the menopause years and perimenopausal bleeding

• Mayo Clinic and MedlinePlus summaries for symptoms and definitions

• Review articles on the biology and duration of the transition

I reference these sources when building your plan so the information guiding you is reliable. (The Menopause Society)

FAQs

How long does perimenopause last?

It varies. Many women experience four to eight years, though shorter and longer courses happen. (PMC)

Can perimenopause start in your thirties?

Sometimes, yes. Most women notice changes in their forties, but earlier onset can occur. The pattern of symptoms and cycles helps guide evaluation. (MedlinePlus)

Is hormone therapy always needed?

Not always. Treatment is individualized and may include lifestyle strategies, non-hormonal options, or hormones when appropriate after a personalized risk-benefit discussion. Start with your clinician and use coaching for education and support. (ACOG)

What is the first sign for many women?

Cycle changes are common early clues, followed by hot flashes and sleep disruption for many. (ACOG)