How To Tell You’re Near the End of Perimenopause

Menopause occurs when you haven’t had a period for 12 consecutive months. But before that, you go through a transitional stage called perimenopause.

How can you tell when you’re in perimenopause, and is there any way to know when it will end? We asked women’s health specialist Pelin Batur, MD.

How long does perimenopause last?

On average, perimenopause lasts about four years. But there’s no way to tell in advance how long it’ll last for you specifically.

“Perimenopause can start as early as a decade before menopause,” Dr. Batur says. That isn’t the case for most people, but as the saying goes, your mileage may vary.

Stages of perimenopause

For some people, perimenopause is uneventful, while others have a more extreme, unpleasant experience.

Dr. Batur walks us through the symptoms you may encounter. Bear in mind that you could experience all or none of them, or some may be worse than others.

Irregular periods

Changes in your menstrual cycles are one of the biggest signs that your hormones are in flux. Your periods may also come with new or worsening symptoms, like tender breasts, mood swings and bad PMS (premenstrual syndrome).

Your periods are irregular if they are:

• Closer together or farther apart than normal
• Longer or shorter than usual
• Heavy one month and lighter the next

When to see a doctor: “If you’re skipping months and months at a time, and then your next period is really heavy, like your body’s trying to compensate, get a checkup,” Dr. Batur advises. “The same is true if you’re having a lot of spotting in between cycles, or if there’s lots more cramping or blood clots.”

Hot flashes

One of the most infamous symptoms of menopause is hot flashes, where you suddenly feel warm or flushed. They’re thought to be caused by shifts in estrogen production, though some people are more sensitive to them than others.

“Stress can make hot flashes worse, as can lifestyle factors, like consuming a lot of caffeine and alcohol,” Dr. Batur says. You can manage hot flashes and night sweats by:

• Wearing breezy fabrics, like cotton and linen, especially to bed
• Replacing caffeinated beverages with caffeine-free or decaf options
• Scaling back on sugar, spicy foods and alcohol

When to see a doctor: You don’t have to grin and bear it through terrible bouts of hot flashes, especially if you feel like they’re getting in the way of everyday life. That’s a good reason to see a provider. You may benefit from hormone therapy.

Vaginal dryness

During perimenopause, you might start to experience vaginal dryness that makes sex uncomfortable or even painful. Your odds of having severe vaginal dryness go up if you have, or have had, breast cancer.

Lubricants can help. Use them just before sex to reduce painful friction and chafing.

When to see a doctor: If natural or store-bought lubricants aren’t making a difference, it’s time to ask for extra help. A doctor can prescribe vaginal hormones in the form of creams, vaginal rings or suppositories.

“These treatments deliver the hormone right where you need it,” Dr. Batur says. “And they’re oftentimes more effective at treating vaginal dryness than even systemic hormones that you would put on your skin or take by mouth.”

And try not to feel nervous asking your doctor about such a personal issue.

“People with vaginal dryness oftentimes think they’re alone,” she shares. “It’s actually a common concern, and there’s a lot we can do — but we need to talk about it.”

Hair changes

As we get older, most of us experience some hair thinning. Estrogen loss in perimenopause can accelerate that process. You may also notice a decrease in hair on your arms, legs and pubic area.

Meanwhile, you might start to see unwanted hairs in new places, like on your chin.

“As your estrogen drops, some of your testosterone may have a more dominant effect,” Dr. Batur explains.

If you’re concerned about hair loss, over-the-counter (OTC) products are a good first stop. As for the occasional chin hair, a good pair of tweezers can go a long way.

When to see a doctor: If hair loss is making you self-conscious and OTC products aren’t doing the trick, a healthcare provider can tell you about your treatment options.

Weight gain and redistribution

Weight changes are a normal part of aging for many people.

“The weight gain, specifically around our waistlines, happens for a variety of reasons, including slowing metabolism, decreased activity, changing hormones and increased difficulty building muscle mass,” Dr. Batur explains.

When to see a doctor: It can be difficult to combat weight gain in menopause, given the role that hormones play. If you aren’t reaching your goals, ask a provider whether you could be dealing with a compounding issue, like a thyroid problem or medication side effects.

Additional symptoms of perimenopause

Other possible signs of perimenopause include:

• Depression and anxiety
• Dry skin, dry eyes or dry mouth
• Sleep problems
• Irritability and moodiness
• Low sex drive
• More frequent need to pee
• Memory lapses

But these symptoms aren’t always connected to perimenopause.

“In midlife, plenty of other factors can affect your physical and mental health and may mimic the signs of this time of life,” Dr. Batur says.

Your best bet? Tell your provider about any new or worsening symptoms, even if you suspect they’re related to perimenopause.

What’s the average age for perimenopause to end?

Dr. Batur says that perimenopause typically ends — and menopause begins — in your early 50s. But how long it lasts can vary. And there are important exceptions to be aware of.

Early menopause happens before age 45. When menopause comes this early, you no longer ovulate or menstruate, and you can no longer become pregnant.

Another possibility is primary ovarian insufficiency (POI), a condition where your periods stop suddenly in your 30s, or sometimes even in your 20s.

“Losing estrogen before age 40 is associated with an increased risk of heart disease, lung disease, neurological conditions and osteoporosis,” Dr. Batur warns. “So, if you’re younger than 40 and it seems like you’re perimenopausal, it’s really important to talk to your doctor.”

Menopause can also come late. If you’re 55 or older and still haven’t started menopause, that’s known as late-onset menopause.

How do you know if it’s your last period before menopause?

When you’re going through perimenopause, there’s just no way to know for sure which period will be your last.

“If you’re in your early 50s, you’re having hot flashes and you’ve been skipping periods for the last few years, it’s likely that you’re headed into menopause,” Dr. Batur says.

Does life get better after perimenopause?

Transitioning from perimenopause to menopause may mean a change in your symptoms. But that doesn’t always mean you’ll be symptom-free. You may trade one symptom for another, or see some get worse as others improve.

Bottom line? We don’t all experience menopause and post-menopause the same way.

When should you see a doctor?

Menopause is a natural phase of life, so if you’re of standard menopausal age and your symptoms are mild, you don’t necessarily need to see a healthcare provider.

If your symptoms are impacting your quality of life, reach out to your primary care physician, an Ob/Gyn or a provider who is certified in menopausal medicine by The Menopause Society.

“You don’t need to live with uncomfortable symptoms, whatever their cause,” Dr. Batur reassures. A healthcare provider can help figure out what’s going on and how best to manage it.