Perimenopause, huh?

May 21, 2024

If you’re wondering what exactly perimenopause is, you’re in the right place. Perimenopause is the time during which your body begins the menopause transition.

On average, it starts around 45 (think Kate Hudson, not Golden Girls) and can last for up to 14 years1 before you enter menopause—which occurs when you’ve gone 365 days without a period (spotting counts). So basically, menopause doesn’t start at menopause; the “menopause transition” or perimenopause actually begins in the years leading up to it. This is the phase of the menopause transition when you may start to feel like you’re losing it.

You may hear yourself say:

“All of a sudden…”
“I swear it happened overnight!”
“But, I didn’t change anything. Why is this happening?”
“I’m not anxious, yet I feel like I’m going to jump out of my skin.”

At menopause, your ovaries have pretty much stopped producing estradiol, a type of estrogen, and progesterone (see the Vagtionary in the navigation bar for their definition). We’ll get more into the science of it later on, but the gist for now, in a polite way, is that your egg basket is getting empty and Cadbury has moved on.

Menopause can also occur if you get your ovaries removed, like during a hysterectomy, or for medical reasons, like suppressing your hormones for cancer treatment.

The average age of menopause is 52 in the US2. This means that 50% of women will be menopausal by age 52. Really though, how do they know? It’s not like there’s some magic portal in the sky collecting the age we turn menopausal. If you’re older, like me, there’s nothing to worry about. Count your blessings that you get a few bonus periods before everything wraps up. Menopause most commonly happens between the age of 45 - 58.3 By age 55, 90% of women will be menopausal. Perimenopause begins 2 - 14 years prior to menopause, typically.

Why haven’t I heard about all of this before?

This period of transition affects every woman differently. During perimenopause, your hormones are all over the place - up and down minute by minute. It’s quite the rollercoaster. As the body tries to adjust to the new normal of not having its predictable pattern of hormones, it can create all sorts of symptoms and mayhem. Some women are so debilitated by the constant hormonal fluctuations of perimenopause that they impact every aspect of their lives (me me me), and some women breeze through it (so not me).

These uncomfortable and often embarrassing symptoms are not ones women want to share openly. They are hard to talk about, and generations of past women were often told they were “crazy” if they shared what was going on. Researchers and doctors didn’t really understand the science behind this until starting just recently. Consider that estrogen was only discovered in the late 1930s, and it wasn’t until the 1990s that it was better understood. There’s still so much we don’t know. We didn’t know how far-reaching perimenopause was.

But, the narrative around perimenopause is positively changing for a variety of reasons. The more we talk about it, the more we can influence the conversation and awareness globally about it.

So, what is perimenopause, exactly?

We’ve all heard about hot flashes and night sweats jokes, but did you know there are about 100 symptoms of perimenopause? And they are no joke. But we’ll still have fun here, and I’ll explain everything about what is going on so you can be better informed about this process. Knowledge is power!

Perimenopause is not just about periods and fertility. Perimenopause are the years prior to reaching that one day called “menopause,” where you haven’t had a period for 365 days. But what’s really happening is that your ovaries are shutting down, which includes the production of a type of estrogen called “estradiol.” Your body is smart and won’t let you go cold turkey, so it gradually switches to making a different type of estrogen called “estrone,” which is made by your adrenal glands. It’s still estrogen but is less potent than estradiol.

Again, menopause can also be reached surgically or medically, as described above and with a question below.

As women, our bodies love estradiol, not just our reproductive organs but our entire bodies, including our brains. Your brain and your endocrine system (your hormonal pathway, including your ovaries and adrenal glands) are two of the places that are greatly affected by the perimenopause transition. The whole thing is the body’s adjustment from the old process to the new process. Don’t worry, it seems overwhelming at first, but you’ll get the hang of it. We’ll cover a lot of info on this site, but for now, read through my list of FAQs below.

I’m excited to share all that I know about this topic to help you in your health journey so please consider subscribing to receive each gem-filled article right to your inbox.

This site is NOT a thinly veiled attempt to get you to buy products that I earn money for; this is my life’s work… my sweat and blood (literally…remember, I’m still perimenopausal).

Frequently Asked Questions about Perimenopause

Am I going crazy?

Most likely not. Perimenopause can upset the delicate balance of your hormones, temporarily affecting your brain and nervous system. It can sometimes make you feel like you’re “losing your marbles." Anxiety, depression, and panic attacks are also common and can begin or worsen during this time. I’ll review on this site what is happening within your body so you can understand the changes and know what to expect.

Who gets perimenopause?

Anyone born with ovaries.

Wait, so menopause is only just 1 day?

Yes, it’s just one day, the day that you’ve gone 365 days without a period. See the graphic above. The years of your menopause transition are called “perimenopause,” and the one day that you made it 365 days without a period is called “menopause,” and what comes after that one day is “post-menopause.” However, for ease of use, most people just say they are “menopausal” once they hit that one day in time and beyond.

Can I skip it?

Nope. Everyone born with ovaries will have to go through it at some point. Maybe in the future, scientists will find a way to skip the entire thing, but for now, we have to live through it. But don’t worry, it’s not all bad. This is a time of personal growth as well.

Even if you’re on birth control pills, you can’t skip the menopause transition. The birth control pill may be helping you with your symptoms and masking what is going on with your body, but this process towards menopause is still going on behind the scenes.

Why can’t my body just make new eggs?

Unfortunately, it doesn’t work that way. You’ve had your eggs for a long, long time. You’ve had your eggs as far back as when you were a little baby in your mother’s womb. When you’re born you have 1 - 2 million eggs, but only about 1,000 left when you reach menopause.4

Why is nature doing this to us?

We already have the 3 other p’s: puberty, periods, and pregnancy; why not add on another one?! I’ll explain this further later on, but for now, I’ll flippantly say, “Who wants to have a baby in their 70s?”

How do I know that I’m starting perimenopause?

If you’re over 40 and you notice that your body is behaving differently than your normal way, you may want to consider perimenopause as the reason. It could be very subtle things like starting to burn in the sun, getting a rash from the soap you’ve used for years, a bit more anxiety and tension, a sudden intolerance to coffee or alcohol, developing a supersonic sense of smell, your hair and skin being drier than normal, and starting to lose interest in things that you love, to name a few. These suggestions are not scientific; they are just what I’ve heard from women.

The real clue is when your periods start coming closer together, not further apart. If you have an IUD or are using birth control, you won’t be able to use your periods as a clue, so start to pay attention to subtle changes in your body. Ovarian aging is still happening behind the scenes, although an IUD or being on birth control may mask some symptoms.

Skipping periods and hot flashes usually come later in perimenopause - having these happen will confirm your suspicions. If you notice anything serious going on, please consult a doctor and don’t assume it’s just perimenopause.

Is there a test available to see if I’m in perimenopause?

There is no one test that will tell you if you’re in perimenopause. Doctors traditionally diagnose the menopause transition based on “age, menstrual irregularity, and the presence of vasomotor symptoms.5” This definition is limited because we know now that perimenopause starts long before these symptoms appear, but doctors certified by The Menopause Society6 and those who have received additional training know what to look for. Doctors will rule out anything else that may be causing symptoms similar to perimenopause, such as thyroid issues.

Your doctor may run a hormone panel via blood work to check your hormone levels, but it’s not recommended by The Menopause Society to do so. They recommend that doctors address the symptoms and not the hormone test result. Hormones during perimenopause, especially estrogen, are constantly changing, so the test tells the story from one moment in time when your blood was drawn.

A non-certified GYN drew my blood (ok, ok, I was curious and this was before I knew better) and then told me that she wouldn’t prescribe HRT because my estrogen was too high. At that moment, maybe it was, but by the time I reached my car after the appointment, it could have crashed. Furthermore, the hormone levels do not correlate with the symptoms.7 You can have high estrogen and still feel like crap. I did at the moment of my blood work.

There is one FDA-approved test to predict if menopause is approaching, but according to the FDA should be used in conjunction with other measures like the doctor taking a full medical history. “The PicoAMH Elisa test measures the amount of Anti-Müllerian Hormone (AMH) in the blood. AMH levels represent one indicator available to clinicians to determine whether a woman is approaching or is likely to have reached her final menstrual period. The PicoAMH Elisa test is meant to be used only in conjunction with other clinical assessments and laboratory findings.”8 Although enticing to see the results of this test, please check your insurance for coverage as not all insurance companies will cover this.

Also available is a Clearblue Easy Menopause urine test, but I do not trust the validity of this. This test tests FSH levels in your urine. While it’s true that FSH levels will rise overall during this time, FSH levels fluctuate during perimenopause and it is unreliable to use this as a marker for your perimenopause status.

Is perimenopause all one phase, or are there different phases?

There are different phases to perimenopause before reaching menopause. You can read about it here.

I’m already healthy, eating right and exercising; I bet my experience will be better, right?

Sort of. There’s no way of knowing how perimenopause is going to affect an individual, but you will be better off because these habits are already a part of your daily routine. I’ve found that another factor in determining the severity of perimenopause symptoms is how resilient you are to stress. Another great topic we’ll cover here.

Some women are just more sensitive to the drastic hormonal changes during this time and will have more symptoms. We haven’t yet figured out what causes this.

Will I feel like this forever??

No. The further out from your menopausal day the better you should start to feel overall as your body re-calibrates to the new normal. I don’t know this firsthand since I haven’t reached that point yet, but countless women tell me to hang in there because things get better later. For the meantime, there are plenty of options and things to do to help yourself feel better.

How will I know when I’ve reached menopause?

That’s easy, mostly. If you aren’t on any birth control pills, which are sometimes given to perimenopausal women, you’ll know that you are “menopausal” because you’ve gone 365 days without a period or seeing any drop of blood. If you see any blood, you need to reset back to day 1. It’s kind of like the children’s board game Chutes and Ladders (Snakes and Ladders in the UK, I’m up on my British lingo). You got to go back to the start…wah, wah, wah. Once you’ve gone 365 days without a period/blood, it’s time to throw out your period underwear and celebrate! Personally, I can’t wait.

If you’re on birth control pills, you won’t know if you’re menopausal until you go off of them. Most doctors will wean you off of them around 51 (every doctor is different, though) because the older you get while on them, the risk of consequences like blood clots increase.

I had a hysterectomy, medical menopause, ablation, PCOS, now what?

For hysterectomy “now what” depends on the type of hysterectomy you had. If you had your ovaries removed (oophorectomy), you’ll be in menopause immediately. Instead of a gradual decline of your hormones over years, your body will no longer be able to make any of the hormones the ovaries produce - estradiol, progesterone, and testosterone - following surgery.

Menopause symptoms, such as hot flashes and others, may occur immediately after surgery when the ovaries are removed during a hysterectomy. Please ask your doctor to discuss HRT/menopause hormone options with you to see if they are a right fit. Some women have asked their doctor to put an estrogen patch on them in the surgical suite to try to lessen the shock to their system and prevent menopause symptom discomfort.

If your ovaries are still in place, they will continue making hormones (may be slightly less than usual9) until you go through perimenopause and then menopause. However, this is where it gets confusing because you won’t be able to know when you’ve reached menopause without having a uterus. I recommend working with your physician for guidance on this.

If your uterus has been removed, you won’t have to deal with skipping periods, heavy bleeding, or too frequent periods. If your cervix has been left in place, you may have some spotting occasionally.10

For medical menopause and PCOS, please see The Musical Dynamics of Perimenopause for more information. I got you, friend!

If you’ve had an endometrial ablation, it’s important to work with your doctor to determine when you’ve reached menopause since you can’t use your menstrual cycle as a guide.

What are premature menopause, early menopause and premature ovarian failure/insufficiency?

If you develop perimenopause-type symptoms prior to the age of 40, there could be several reasons, including early menopause and a medical condition called “premature ovarian failure.” 11 Other medical conditions can also cause perimenopause-type symptoms in your 30s.

Early menopause is defined as reaching menopause prior to the age of 45. Premature menopause is reaching menopause prior to age 40. This means that your ovaries have stopped working and producing hormones prior to 40 (all periods have stopped). Premature ovarian failure (also called premature ovarian insufficiency) is when your ovaries don’t produce normal amounts of your hormones or skip ovulating. You may still have periods, and you may even get pregnant.

It’s important to see your doctor if you develop perimenopause-type symptoms or irregular periods in your 20s or 30s. There are some long-lasting risks involved with early loss of estrogen reaching menopause too early. Premature ovarian failure is a medical condition and should be evaluated by a doctor. A doctor can confirm the diagnosis, do a uterine/ovarian ultrasound as part of your diagnosis, check for other conditions that may be causing this to happen, and offer recommendations.

What do I do if I have more questions?

This new site is a work in progress, so please bear with me as I publish all the information I want to cover. There’s a lot! I promise you I’ll type as fast as I can. Although the site is new, I’m not new to health and the business of healthcare. I have over 30 years of experience as a non-practitioner in the industry. You can read more about me.

Please consider subscribing so that you get each article delivered right to your email inbox and don’t miss a thing. In the meantime, if you have a specific question not yet covered, feel free to reach out to me. Once you subscribe, you can reply to the welcome email you receive. If you’re already a subscriber (thank you!), reply to one of the newsletters you received.

Disclaimer and Content Use Policy

This number keeps climbing as we learn more about perimenopause. It was 7, then, 10, then 12 and now I’ve seen as high as 14 years. Ug.

Office of Women’s Health, U.S. Department of Health and Human Services assessed on 7/7/2024.

“Females are born with between one and two million eggs. The number decreases until a person stops ovulating and reaches menopause. At that point, fewer that 1,000 remain.” [sic] good article, poor grammar https://www.medicalnewstoday.com/articles/how-many-eggs-does-a-woman-have

Vasomotor Symptoms are hot flashes and night sweats. Crandall CJ, Mehta JM, Manson JE. Management of Menopausal Symptoms: A Review. JAMA. 2023;329(5):405–420. doi:10.1001/jama.2022.24140

The Menopause Society is a non-profit organization that researches and recommends menopause care as well as credentialing physicians and practitioners.

Lisa Mosconi, PhD. The Menopause Brain. Penguin, 2024.

Commissioner, Office of the. “FDA Permits Marketing of a Diagnostic Test to Aid in the Determination of Menopausal Status.” FDA, 24 Mar. 2020, www.fda.gov/news-events/press-announcements/fda-permits-marketing-diagnostic-test-aid-determination-menopausal-status.

Healthline, What Fills the Space After a Hysterectomy, March 2023

https://www.mayoclinic.org/diseases-conditions/premature-ovarian-failure/symptoms-causes/syc-20354683