When Does Perimenopause Start? Understanding the Transition Toward Menopause

by Charlotte

A lot has been said about menopause. There is a seemingly infinite number of books offering advice. Films and TV shows use it as a plot point. Thousands of memoirs, both humorous and serious, investigate this critical transition point in a woman’s life, and it’s a regular topic of conversation in lifestyle columns and magazine articles. In other words, menopause is an undeniable part of our cultural conversation.

But what about perimenopause? After all, the period before menopause is marked with many of the same symptoms as—and is often a more confusing and challenging experience than—menopause itself. It can also happen sooner and last longer than many people think and often takes a significant emotional and physical toll. 

So when does perimenopause start? What does it mean for your everyday life? Is there anything you can do about it? Answering these questions can help you understand what is happening to your body and help you regain a sense of control during a time of transformation.

What Is Perimenopause?

Simply put, perimenopause is the time before menopause. It’s the beginning of the hormonal changes that trigger your reproductive system to start winding down. 

Triggered by fluctuating estrogen levels and, to a lesser extent, progesterone, perimenopause is typically first identified by menstrual cycle irregularities, such as longer or shorter cycles and changes to your period itself, that become more pronounced with time. Eventually, your menstrual cycle will stop altogether and you will reach menopause. 

When Does Perimenopause Start?

Perimenopause usually begins when a woman is in her late 40s and typically lasts 4-8 years. 

However, this isn’t a hard and fast rule. Everyone’s body is different, and some women enter perimenopause in their early 40s or even late 30s. The duration of perimenopause can also be highly individual, with some experiencing perimenopause for only a few months while others notice symptoms for over 10 years. 

It is impossible to predict when perimenopause will start and how long it lasts for any individual woman, but your own mother’s experience could provide clues. Research also shows that women who smoke typically enter perimenopause earlier than women who do not. However, as The North American Menopause Society notes, “race, age at first period, use of birth control pills or fertility medications do not seem to be determining factors.”

What Are the Symptoms of Perimenopause?

As previously mentioned, perimenopause usually first becomes noticeable when you begin to experience menstrual cycle irregularities. But there can also be other, more subtle symptoms that signal the start of perimenopause, many of which progress over time. These include:

Unfortunately, many women have these symptoms but don’t realize they are caused by natural hormonal changes. Having greater awareness about perimenopause can help you understand the physical and emotional phenomena you are experiencing and get the support you need to feel your best. 

How To Ease the Symptoms of Perimenopause

As with menopause, making perimenopause easier means addressing the cause, the symptoms, or both depending on your personal preferences. 

For many, the first step toward feeling better is developing a healthier, more balanced lifestyle. In this time of transition, your body can feel uncomfortable and ill-fitting, like it isn’t really you anymore. The disruptions caused by physical symptoms like hot flashes and sleep disturbances can take a toll on your mind and your body, while mood swings can deeply impact both your emotional health and your connections with other people. Consistently taking meaningful steps toward self-care may help you achieve greater tranquility. These include:

  • Eating healthy
  • Cutting down on caffeine
  • Cutting down on alcohol consumption
  • Eliminating nicotine (always a good idea, anyway)
  • Developing consistent sleep habits
  • Regular exercise

All of these can help with mood and overall health, allowing you to minimize or more easily cope with the uncomfortable symptoms of perimenopause. It can also help you regain a sense of self-determination during a process that is largely out of your hands. 

However, a healthier lifestyle can only do so much. For many, easing the symptoms of perimenopause is best done by addressing their cause: hormones. And for a growing number of women, that means turning to bioidentical hormone replacement therapy (BHRT).

Under the guidance of an expert hormone health practitioner, BHRT uses hormones structurally and chemically identical to your own to compensate for your naturally falling levels of estrogen and progesterone. Many women find that the reintroduction of these critical hormones drastically reduces or even eliminates many of the physical effects—particularly vasomotor symptoms—brought on by perimenopause. What’s more, research suggests that hormone replacement therapy can significantly improve perimenopause-related depression, particularly when combined with antidepressant medication. 

Of course, these strategies don’t “end” perimenopause or prevent menopause from happening. But they can make the transition easier. 

Where to Get Support

If you don’t expect menopause to come for many years, entering perimenopause can be jarring. It can feel like someone hit fast-forward on your life. But while perimenopause might be a surprise, it doesn’t need to be unwelcome. 

If perimenopause is causing uncomfortable or distressing symptoms, don’t hesitate to reach out for help. A practitioner who specializes in hormone health can answer all of your questions and create a treatment plan designed for your individual needs and preferences. By targeting your symptoms with a combination of lifestyle changes and hormone replacement therapy, you can take charge of your well-being and feel your best for years to come.

BodyLogicMD-affiliated practitioners are among the top medical professionals in the country specializing in hormone health and can provide the guidance you need to maintain balance during perimenopause. With expertise in bioidentical hormone replacement therapy and integrative medicine, the practitioners in the BodyLogicMD network will help you address your symptoms and achieve your wellness goals. Contact a local practitioner in your area to start your journey toward optimal health, or take the BodyLogicMD Hormone Balance Quiz to learn more about how your hormones may be affecting you.

Disclaimer: These statements have not been evaluated by the Food and Drug Administration. All content on this website is for informational purposes only. The content is not intended to diagnose, treat, cure or prevent diseases.


  • Charlotte

    Charlotte is a patient care coordinator specializing in bioidentical hormone replacement therapy. She is committed to helping patients who struggle with the symptoms of hormonal change and imbalance explore their treatment options and develop effective strategies to optimize wellness.