The time leading up to menopause is called perimenopause. Some people think it is called premenopause, which is actually not the correct term.

This stage of the menopausal transition can last from two to 10 years before menopause. It’s characterized by changes to the menstrual cycle, as well as other physical and mental symptoms.

Premenopause or Perimenopause?

Although both premenopause and perimenopause occur before menopause, the two terms mean different things.

The term perimenopause is sometimes mistaken for the term premenopause. Although both occur before menopause, they mean different things. Premenopause is the stage between puberty and perimenopause.

In medicine, “pre” refers to “before” while “peri” refers to “around.” Perimenopause means “around menopause” and is the time leading up to the last menstrual period. This often occurs in a woman’s mid to late 40s.

Premenopause literally means “before menopause,” but in reality refers to the time between a girl’s first period and the onset of the perimenopause stage.

When physicians refer to the time shortly before menopause when changes start occurring, they usually use the term perimenopause.

Symptoms

Premenopause can stretch for decades between the time of a woman’s first period and the onset of perimenopause. Women will still menstruate during this time.

Symptoms relating to menopause begin during the perimenopausal period. During this time, women may experience a variety of symptoms. Each woman will have her own experience of perimenopause and may have a combination of the symptoms.

Changes to Periods

In premenopause, women will often have periods as normal until they reach perimenopause. In perimenopause, women start to experience changes to their menstrual cycle.

During perimenopause, hormone levels change, and the body makes different amounts of estrogen and progesterone. Menstrual cycle change is a result and may include:

  • Periods that are longer or shorter than normalSkipping periods for a few monthsHaving a period for an unusually long amount of timeIrregular periodsLighter periodsHeavier periods

Mood Changes

Ten percent to 20% of women in perimenopause experience mood-related symptoms. Hormone changes during this time can make women feel anxious or irritable.

Vaginal Dryness

Particularly in the later stages of perimenopause, the tissue in the vagina can thin and become dry due to falling levels of estrogen. This can cause itching or irritation. Some women may also experience painful sexual intercourse due to vaginal dryness, which may contribute to a loss of libido.

Sleep Problems

Roughly 40% of women who are perimenopausal experience sleep disturbances. Some of this may be attributed to changes in hormone levels, but sleep cycles can also change with age.

Hot Flashes

It is estimated between 35% and 50% of women in the perimenopausal stage experience a sudden wave of heat in their body accompanied by sweating and flushed feelings that can last for up to five or 10 minutes. This can happen at any time, but is most common during the night.

The intensity of hot flashes can vary among women, with some feeling only a slight increase in temperature while others are dripping in sweat. Typically, hot flashes last for a year or two following menopause, but in 10% of women, they continue beyond that time.

Bleeding Problems

Along with changes to periods, women in the perimenopausal stage may experience some unusual bleeding. This may be due to the uterine lining becoming thicker, creating heavier periods, but also for other reasons.

Fibroids can worsen due to hormone fluctuations during perimenopause and may cause bleeding. Endometriosis is a disease fueled by estrogen, and this may also worsen during perimenopause, causing bleeding.

Other Symptoms

Some women may experience other symptoms during the perimenopausal period, including:

  • Difficulty concentratingSymptoms similar to PMSMuscle or joint painNeeding to urinate frequentlyShort-term memory problems

Causes

All stages of menopause are a natural part of the aging process.

Perimenopause occurs because the amount of estrogen made by the ovaries begins to fluctuate. This causes ovulation to become erratic before stopping completely. The menstrual cycle is also impacted.

Symptoms of perimenopause are caused by fluctuating hormone levels in the body. Higher levels of estrogen may cause symptoms similar to PMS, while low levels of estrogen can cause night sweats.

The stages of menopause can begin at different times for different women. Factors that may influence onset include:

  • IllnessGeneticsSmokingRemoval of the ovaries in surgeryMenopause that is medically induced (e.g., through chemotherapy)

Diagnosis

Perimenopause can be hard to diagnose, as symptoms can be mistaken for other conditions. A physician will use symptoms, medical history, age, and a physical exam to reach a diagnosis. Blood tests may also be used.

Treatment

Perimenopause might not need treatment, unless symptoms are causing problems. There are a number of treatment options for women who are perimenopausal.

Hormone Therapy

Estrogen—on its own or coupled with progestins—may be used to help even out hormone levels.

Antidepressants

Some women in the perimenopausal stage may experience mood changes that are difficult. Antidepressants may help to stabilize moods. Certain antidepressants may also be used to help with symptoms of hot flashes.

Lifestyle Changes

Changes to diet and exercise may help with symptoms of perimenopause.

Lifestyle changes include:

  • Exercising regularlyEating a healthy diet with whole grains, fruits, and vegetablesConsuming 1,000-1,200 mg of calcium every day either through diet or supplementsNoting triggers for hot flashes (e.g., coffee, alcohol)

Herbal Supplements

Advertisements may claim herbal supplements can help with hot flashes, but these supplements are not regulated by the Food and Drug Administration (FDA) and there is no proof of their efficacy and safety. Always consult a physician before taking any herbal supplement.

Coping

The changes during perimenopause can be challenging, but there are ways to cope.

Managing Symptoms

Taking steps to combat some of the symptoms may help.

Poor concentration or memory problems can occur in perimenopause, and some activities can help improve concentration and memory. These include:

  • Working on crossword puzzlesSolving math problemsReadingExercisingCutting back on activities like watching TV

Hot flashes can be minimized by avoiding triggers, which can include:

  • SmokingSpicy foodsCaffeineAlcoholTight clothingStress or anxietyHot weather

Perimenopause may present a number of symptoms, ranging from poor sleep to a decreased sex drive. Some or all of these symptoms may be bothersome. Your healthcare provider will be able to provide solutions or management strategies for these.

Support Groups

Speaking with other women who are either currently in the perimenopausal phase, or who have already been through the perimenopausal phase, may be helpful.

Joining a support group enables women to connect with others experiencing similar challenges, get answers to their questions, and talk about their feelings. Established support groups include:

  • The Red Hot Mamas
  • The North American Menopause Society

A Word From Verywell

Menopause is composed of various stages. The term premenopause refers to the beginning of menstruation through to the onset of perimenopause. The period immediately before menopause is referred to as perimenopause. The two terms are not interchangeable and mean different things.

Those in the perimenopause stage may experience a range of symptoms that may be bothersome, including changes to periods, hot flashes, and mood changes. Perimenopause is a natural part of aging, and treatments and lifestyle changes may help with symptoms.

If you are concerned about any symptoms you are experiencing, or are unsure if you are experiencing perimenopause, you should speak with a healthcare provider.