Your monthly cycle has become unpredictable, you’re having trouble sleeping and, wait … was that a hot flash? You’re too young for menopause, so what in the world is going on?

You may be experiencing perimenopause — the change before The Change.

Dr. Laura Ramsay

The early signs of perimenopause — which means “around menopause” — tend to appear during a woman’s early 40s, according to Dr. Laura Ramsay, an ob-gyn at Novant Health WomanCare in Winston-Salem and Kernersville. Over time, the symptoms can range from barely noticeable to frustratingly severe.

To learn more, we spoke with Ramsay, who explained what perimenopause is and how long it lasts. She also discussed symptoms women may experience and offered tips for coping with the effects of hormonal ups and downs.

What is perimenopause?

“Perimenopause is the process women’s bodies go through as they transition out of having periods,” Ramsay said. “It often starts during the early to mid-40s.”

The process occurs as the production of estrogen made by the ovaries declines “in a roller-coaster fashion,” repeatedly dropping and leveling off — with increasingly steep drop — until a woman reaches menopause (defined as going 12 months without having her period).

How long does perimenopause last?

“While it can last from 10 to 15 years, this does not mean that women will go through 10 to 15 years of horrendous symptoms,” Ramsay said. “Most women only start to notice symptoms as the drops grow steeper, which tends to last about three to five years.”

During these years, symptoms become more noticeable, sometimes negatively impacting quality of life. And, because symptoms of perimenopause differ from woman to woman, knowing what’s “normal” may be challenging.

What are the symptoms of perimenopause?

“During the three- to five-year period when things are the most ‘roller-coastery,’ women can experience irregular periods, hot flashes and night sweats, which are like hot flashes but they wake you up at night,” Ramsay said.


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Waking with night sweats every night can leave you chronically fatigued, which may affect both physical and mental health. Other symptoms of perimenopause can include:

  • Urinary frequency or urgency.
  • Pain during sex due to vaginal dryness.
  • Moodiness, anxiety, or depression.
  • Skin dryness or sagging.
  • Changes in sexual desire or arousal.
  • Weight gains that's distributed in new ways.

“Of course, I’m painting the absolute worst-case scenario,” Ramsay said. “Rather than experiencing all these symptoms, most women only notice bits and parts."

Can I get pregnant during perimenopause?

As long as you have your period, even if it’s irregular, it’s possible to get pregnant. If you have questions about fertility or contraceptives, talk with your healthcare provider.

Also, you can acquire sexually transmitted diseases, or STDs, throughout your life, even after your periods have stopped. Using protection like condoms can help you and your partner stay safe if you’re not in a monogamous relationship.

What can women do to lessen the symptoms of perimenopause?

When dealing with systemwide symptoms, Ramsay suggests a holistic approach. She offered the following suggestions.

Eat for health. Boost your energy with a healthy eating plan that delivers lots of fresh produce, whole grains, lean protein and fiber. Lower estrogen levels are linked to reduced bone density, so include calcium-rich foods like low-fat milk and yogurt.

Reap the rewards of exercise. Physical movement ramps up your metabolism, staves off weight gain, boosts energy and triggers the release of feel-good endorphins that may make it easier to cope with symptoms of perimenopause.

Make time to destress. Whether you prefer meditation or reading a good book, scheduling time to relax can help alleviate perimenopausal symptoms, which can be exacerbated by stress. Other helpful alternatives: yoga, hypnosis and acupuncture.

Keep cool. Common sense approaches like staying out of the hot sun, taking a cool shower or sleeping with a bedroom window open may not prevent hot flashes, but keep you comfortable when one strikes.

Consider plant estrogens. Plant estrogens (or phytoestrogens), like those found in black cohosh supplements and other over-the-counter products, mimic estrogen in the body and may alleviate the intensity of hot flashes and other symptoms. Other foods high in plant estrogens: soy, legumes and flaxseed.

Because the long-term safety of dietary supplements has not been clinically proven and herbal products are not regulated by the Food and Drug Administration, it’s best to discuss possible side effects and drug interactions with your healthcare provider before starting a new regimen. Also, always buy supplements from reputable sources.

When should women seek help for perimenopause symptoms? What treatments are available?

Some women experience mild symptoms and never require medical attention. If perimenopause is affecting your quality of life, mental health or sexual well-being, it’s time to call your healthcare provider.

Among the options available are hormone therapy, antidepressants, medications for urinary incontinence or vaginal dryness.

“There are certain health risks associated with prolonged use of hormones and other medications, so deciding whether it's the right thing for you depends on your current health, your medical history, your family history and your overall goals,” Ramsay said. “The process is very individualized.”

Also, while irregular bleeding is a normal part of perimenopause, women should call their healthcare providers if they experience very heavy bleeding (soaking through a pad or tampon every hour for more than two hours, bleeding that lasts more than seven days or bleeding between periods).