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Perimenopause

What Is Perimenopause? Age, Symptoms, and Treatment

Zoe Kaplan
Zoe Kaplan

Perimenopause, often referred to as the “menopausal transition,” is a natural biological process that happens before menopause. Here's what to look out for and how to handle any symptoms that flare up.

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Perimenopause, often referred to as the “menopausal transition,” is a natural biological process that happens before menopause. Here's what to look out for and how to handle any symptoms that flare up.

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Perimenopause, often referred to as the “menopausal transition,” is a natural biological process that happens before menopause. Here's what to look out for and how to handle any symptoms that flare up.

Perimenopause is the transitional phase before menopause when your body gradually produces less estrogen and progesterone, typically starting in your 40s and lasting 4-10 years. This hormonal shift causes symptoms like hot flashes, irregular periods, mood swings, and sleep disturbances.

Hot flashes, mood swings, and irregular periods are hallmark signs of perimenopause, the transitional phase before menopause. Often called the "menopausal transition," perimenopause can feel confusing and overwhelming due to fluctuating hormones. But it's a completely natural stage in every woman's reproductive journey.

In this guide, we’ll explore:

  • What perimenopause is
  • When perimenopause typically starts
  • What symptoms you may experience
  • Whether pregnancy is still possible
  • How to manage perimenopause naturally and medically

What Is Perimenopause?

Perimenopause is the time leading up to menopause, marked by declining estrogen and progesterone levels. These hormonal shifts can cause a wide range of emotional and physical symptoms.

Key Differences:

  • Menopause: Defined as 12 consecutive months without a period
  • Perimenopause: Can begin years earlier, often in your late 30s or early 40s

Learn more: What Are the Stages of Perimenopause?

When Does Perimenopause Start?

Perimenopause usually begins between ages 38–45 but varies greatly. Some experience changes earlier, while others notice symptoms much later. This phase can last anywhere from 2 to 10 years, gradually leading to menopause.

Common Signs and Symptoms of Perimenopause

Perimenopause doesn’t feel the same for everyone—but here are the most common symptoms:

Physical Symptoms

  • Hot flashes & night sweats
  • Irregular menstrual cycles
  • Vaginal dryness or discomfort
  • Weight gain & bloating
  • Breast tenderness
  • Joint and muscle pain

Emotional & Cognitive Changes

Skin, Hair, and Bone Health

  • Thinning hair or dry skin
  • Changes in bone density
  • Acne or itchiness

See also: How to Manage Perimenopause Skin Problems

PMS vs. Perimenopause Symptoms

It’s easy to confuse PMS with perimenopause. The key difference? Timing.

  • PMS symptoms occur predictably before your period.
  • Perimenopause symptoms can appear anytime in your cycle and persist or fluctuate unpredictably.

Can You Get Pregnant During Perimenopause?

Yes, pregnancy is still possible during perimenopause—even if it's less likely.

Why?

  • Ovulation becomes irregular, but not absent
  • Egg quality declines with age
  • Fertility drops to about 5% per cycle after age 40

More on this topic: Symptoms of Ovulation During Perimenopause

How Long Does Perimenopause Last?

The duration varies, but perimenopause typically lasts between 4 and 10 years. For some, it’s short-lived; for others, symptoms can linger well into their 50s.

Managing Perimenopause Symptoms

While there’s no “cure” for perimenopause, many treatments—natural and medical—can help ease symptoms.

Lifestyle Modifications

Read next: The Ultimate Perimenopause Diet Plan: 12 Essential Nutrients

Natural Remedies

  • Herbal Supplements: Black cohosh, evening primrose oil (with medical guidance)
  • Acupuncture: May reduce hot flashes and anxiety
  • Vaginal Estrogen: Creams or rings for dryness and pain during intercourse

Medical Treatments

Hormone Replacement Therapy (HRT)

  • Alleviates severe hot flashes, mood swings, and vaginal discomfort
  • Comes with risks—consult a physician before starting

Non-Hormonal Medications

  • SSRIs/SNRIs: May help with mood and hot flashes
  • Gabapentin: Sometimes used to relieve hot flashes or sleep issues

Emotional Health & Support

Mental wellness matters. Join perimenopause support groups or talk to a licensed therapist. Emotional symptoms are valid—and manageable.

Tip: Use hormone-tracking tools like the Oova Kit to monitor patterns and guide conversations with your doctor.

FAQs About Perimenopause

What’s the earliest age perimenopause can start?

Some women begin experiencing symptoms as early as their mid-30s.

Can perimenopause start in my 30s?

Yes. New research from the University of Virginia reveals that more than half of women aged 30 to 35 experience moderate to severe perimenopause symptoms, challenging the misconception that symptoms only begin in the mid-40s. Many women experience symptoms decades earlier than expected but often delay seeking help.

Does perimenopause affect mental clarity?

Yes. Brain fog and difficulty concentrating are common during hormone fluctuations.

How do I know it’s perimenopause and not something else?

Research has identified key cycle, vasomotor, and urinary symptoms that are most associated with a perimenopause diagnosis. The profile of symptoms may change over time, with mood symptoms often worse early in perimenopause while urogenital symptoms may become progressively more impactful as women approach their final menstrual period.

Are there tests to confirm perimenopause?

Yes. Tests measuring estradiol, LH, and FSH levels can indicate hormonal shifts, but diagnosis is often symptom-based.

Why is my doctor dismissing my perimenopause symptoms?

Physical and emotional symptoms associated with perimenopause are understudied and often dismissed by physicians. This research highlights an alarming gap in the understanding of perimenopause, with many younger women suffering in silence because healthcare providers may not recognize symptoms in women under 40.

What helps relieve hot flashes quickly?

Cool environments, layered clothing, herbal teas, and gabapentin or HRT may help depending on severity.

Will perimenopause affect my memory and concentration?

Yes. Studies show that poor concentration affects 44% of women and poor memory affects 40% of women during perimenopause. These cognitive symptoms are among the most common experienced at work, alongside fatigue and difficulty sleeping.

How long does perimenopause last?

Perimenopause is a transition phase that typically develops when a woman is in her 40s, but can begin up to ten years before menopause. During this time, the ovaries gradually produce less estrogen and progesterone, though this decline is not steady and hormones fluctuate unpredictably.

Final Thoughts

Perimenopause is a unique phase that affects every woman differently. The more you know, the more empowered you'll feel to manage the changes.

Start tracking your hormones today with the Oova Kit backed by science, built for your body.

About the author

Zoe Kaplan
Zoe Kaplan is a writer and content strategist passionate about creating content that helps people navigate the world a little more easily. Zoe has worked across verticals, from women's career development to reproductive health. You can check out more of her work at zoeakaplan.com.

Sources

https://www.oova.life/blog/progesterone-supplementation-guide
Can I take progesterone if I'm breastfeeding?
Yes, progesterone is generally safe while breastfeeding and doesn't significantly affect milk supply. However, always discuss with your healthcare provider before starting any hormone supplementation while nursing.
https://www.oova.life/blog/progesterone-supplementation-guide
Is it safe to take progesterone throughout pregnancy?
Yes, when prescribed by your healthcare provider. Progesterone supplementation in early pregnancy is safe and can reduce miscarriage risk in women with low progesterone or a history of pregnancy loss. Most providers continue supplementation through the first trimester (weeks 10-12) when the placenta takes over.
https://www.oova.life/blog/progesterone-supplementation-guide
Can progesterone supplementation cause weight gain?
Progesterone can cause temporary water retention and bloating, which may show up as a few pounds on the scale, but it doesn't cause true fat weight gain. Most women don't experience significant weight changes from progesterone supplementation.
https://www.oova.life/blog/progesterone-supplementation-guide
Can I switch from pills to suppositories or vice versa?
Yes, but only under your doctor's guidance. The dosing and timing may need adjustment when switching between forms since they're absorbed differently. Never switch on your own, especially if you're pregnant or undergoing fertility treatment.
https://www.oova.life/blog/progesterone-supplementation-guide
Will progesterone supplementation delay my period?
Yes, progesterone keeps the uterine lining intact, so if you're not pregnant and continue taking progesterone, your period will be delayed. Once you stop taking it, your period should start within 2-10 days. If you are pregnant, progesterone helps maintain the pregnancy and you won't get a period.
https://www.oova.life/blog/progesterone-supplementation-guide
Should I take progesterone pills orally or vaginally?
For fertility and pregnancy support, vaginal progesterone is usually preferred because it delivers higher concentrations directly to the uterus. For perimenopause or general hormone balance, oral progesterone often works well and is more convenient. Your doctor will recommend the best route based on your specific needs.
https://www.oova.life/blog/progesterone-supplementation-guide
When should I start taking progesterone after ovulation?
Typically, progesterone supplementation for luteal phase support starts 2-3 days after ovulation (confirmed by LH surge or temperature rise). Your doctor will give you specific timing based on your protocol. Some women start immediately after a positive ovulation test.
https://www.oova.life/blog/progesterone-supplementation-guide
What's better: progesterone cream or pills?
Pills (oral micronized progesterone) are generally more effective and reliable than creams because absorption from creams is inconsistent. For medical conditions like fertility issues, low progesterone, or HRT, prescription pills or suppositories are strongly recommended over over-the-counter creams.
https://www.oova.life/blog/low-vs-high-progesterone-symptoms
How can I tell if I have low or high progesterone?
The only definitive way to know is through hormone testing via blood tests or at-home urine tests that measure progesterone metabolites. However, symptom patterns can provide clues: anxiety and irregular periods suggest low progesterone, while bloating and extreme fatigue suggest high progesterone.
https://www.oova.life/blog/low-vs-high-progesterone-symptoms
When during my cycle should I test progesterone levels?
Test progesterone levels during the luteal phase, typically 7 days after ovulation or around day 21 of a 28-day cycle. This is when progesterone should be at its peak, making it easier to identify if levels are too low or too high.
https://www.oova.life/blog/low-vs-high-progesterone-symptoms
What are the main differences between low and high progesterone symptoms?
Low progesterone typically causes irregular or heavy periods, anxiety, hot flashes, and sleep issues. High progesterone causes bloating, fatigue, intense breast tenderness, and depression-like mood changes. Low progesterone symptoms persist throughout your cycle, while high progesterone symptoms are most intense during the luteal phase.
https://www.oova.life/blog/low-vs-high-progesterone-symptoms
Can you have symptoms of both low and high progesterone?
Some symptoms like breast tenderness and mood changes can occur with both low and high progesterone, making it confusing. However, the timing, intensity, and accompanying symptoms differ. Hormone testing is the best way to determine which imbalance you're experiencing.
https://www.oova.life/blog/10-dpo
Can stress affect 10 DPO symptoms?
Yes, stress can worsen or mimic 10 DPO symptoms. Stress increases cortisol, which can cause cramping, fatigue, and mood changes similar to both PMS and early pregnancy. During the two-week wait, try stress-reduction techniques like gentle exercise, meditation, or spending time with loved ones.
https://www.oova.life/blog/10-dpo
Is it better to test at 10 DPO or wait?
It's better to wait until 12–14 DPO for more accurate results. Testing at 10 DPO often leads to false negatives because hCG levels may still be too low. If you absolutely can't wait, use a sensitive early detection test with first morning urine, and be prepared to retest in 2–3 days if negative.
https://www.oova.life/blog/10-dpo
What does implantation bleeding look like at 10 DPO?
Implantation bleeding at 10 DPO is typically light pink or brown, much lighter than a period, and lasts 1–2 days. It's often just spotting when you wipe or a few drops on a panty liner. However, only 15–20% of pregnant women experience implantation bleeding—most don't have any bleeding at all.
https://www.oova.life/blog/10-dpo
Why am I cramping at 10 DPO?
Cramping at 10 DPO can be caused by elevated progesterone (whether you're pregnant or not), implantation (if you're pregnant), or premenstrual cramping. Unfortunately, cramping alone can't tell you if you're pregnant since progesterone causes similar symptoms in both scenarios.
https://www.oova.life/blog/10-dpo
What are the chances of a BFP at 10 DPO?
If you're pregnant, you have about a 50–60% chance of getting a positive test at 10 DPO. This means there's a 40–50% chance of a false negative even if you conceived. Chances improve significantly by 12–14 DPO.
https://www.oova.life/blog/10-dpo
What DPO is most accurate for pregnancy testing?
14 DPO (the day of your missed period) is the most accurate time to test, with 99% accuracy. 12 DPO offers 80–90% accuracy. 10 DPO has only 50–60% accuracy. For best results, wait as long as you can—ideally until 12–14 DPO.
https://www.oova.life/blog/10-dpo
Is 10 DPO too early to test?
10 DPO is considered early for pregnancy testing. While some women get positives at 10 DPO, accuracy is only 50–60% if you're pregnant. For best results, wait until 12 DPO (80–90% accuracy) or 14 DPO/missed period (99% accuracy).
https://www.oova.life/blog/10-dpo
Can you have implantation at 10 DPO?
Yes, implantation can still occur at 10 DPO, though 84% of women have already implanted by this point. Late implantation at 10–12 DPO is normal. If implantation happens at 10 DPO, you won't get a positive pregnancy test for another 2–3 days.
https://www.oova.life/blog/10-dpo
What does a negative test at 10 DPO mean?
A negative test at 10 DPO does not mean you're not pregnant. It's very common to get negatives at 10 DPO even if you conceived. Your hCG levels may still be too low, or implantation may have occurred later. Wait until 12–14 DPO to retest for more accurate results.
https://www.oova.life/blog/10-dpo
Can you get a positive pregnancy test at 10 DPO?
Yes, but only about 50–60% of pregnant women will get a positive at 10 DPO. The other 40–50% have hCG levels that are still too low to detect. If you test negative at 10 DPO, wait 2–3 days and test again.
https://www.oova.life/blog/high-progesterone-symptoms
Can high progesterone cause weight gain?
Yes, elevated progesterone can cause temporary weight gain through water retention and bloating. This is a normal part of the luteal phase and early pregnancy.
https://www.oova.life/blog/how-to-increase-estrogen
Does stress affect estrogen levels?
Yes, chronic stress elevates cortisol, which can suppress estrogen production and disrupt hormonal balance. Stress reduction through meditation, yoga, adequate sleep, and self-care practices helps maintain optimal estrogen levels.
https://www.oova.life/blog/how-to-increase-estrogen
When should I consider medical treatment for low estrogen?
Consider medical intervention if natural methods don't improve symptoms after 3 months, if symptoms severely impact quality of life, if you're experiencing early menopause (before 40), or if you have fertility concerns. Hormone replacement therapy may be appropriate in these cases.
https://www.oova.life/blog/how-to-increase-estrogen
What are the signs that my estrogen is increasing?
Signs of rising estrogen include more regular menstrual cycles, reduced hot flashes, improved vaginal lubrication, better mood stability, increased energy, and improved skin elasticity. You may also notice reduced symptoms that originally indicated low estrogen.
https://www.oova.life/blog/how-to-increase-estrogen
Can exercise increase estrogen levels?
Yes, moderate exercise stimulates estrogen release and helps maintain hormonal balance. Aim for 150 minutes of moderate cardio weekly plus strength training twice per week. However, excessive exercise can actually lower estrogen, so balance is key.
https://www.oova.life/blog/how-to-increase-estrogen
How long does it take to increase estrogen naturally?
With consistent dietary and lifestyle changes, you may notice improvements in symptoms within 4-8 weeks. However, significant hormonal changes typically take 2-3 months. Tracking your cycle and symptoms can help you monitor progress.
https://www.oova.life/blog/how-to-increase-estrogen
What foods increase estrogen levels naturally?
Foods high in phytoestrogens can help increase estrogen naturally. The best options include flax seeds (high in lignans), soy products (tofu, tempeh, edamame), lentils, chickpeas, whole grains (oats, quinoa, brown rice), and garlic. These plant compounds mimic estrogen's effects in the body.
https://www.oova.life/blog/perimenopause
What helps relieve hot flashes quickly?
Cool environments, layered clothing, herbal teas, and medical treatments like gabapentin or HRT may help—depending on severity. Lifestyle changes like reducing caffeine and alcohol can also provide relief.
https://www.oova.life/blog/perimenopause
Are there tests to confirm perimenopause?
Yes. Tests measuring estradiol, LH, and FSH levels can indicate hormonal shifts—but diagnosis is often symptom-based since hormone levels fluctuate widely during perimenopause.
https://www.oova.life/blog/perimenopause
How do I know it's perimenopause and not something else?
A doctor may recommend hormone testing (like LH, E3G, and PdG) and track symptom timing. Diagnosis is often based on symptoms combined with age and menstrual pattern changes.
https://www.oova.life/blog/perimenopause
What's the earliest age perimenopause can start?
Some women begin experiencing symptoms as early as their mid-30s, though perimenopause typically starts between ages 38-45.
https://www.oova.life/blog/perimenopause
Does perimenopause affect mental clarity?
Yes. Brain fog and difficulty concentrating are common during hormone fluctuations in perimenopause.
https://www.oova.life/blog/TBD-10-symptoms-and-how-to-get-relief
What happens after the last sign of perimenopause?
After your final period, you enter postmenopause. You'll need 12 consecutive months without a period to confirm menopause. Many symptoms gradually improve, though some like vaginal dryness may persist without treatment.
https://www.oova.life/blog/TBD-10-symptoms-and-how-to-get-relief
When do perimenopause symptoms finally stop?
Some symptoms like brain fog improve after menopause, while others like hot flashes may continue for up to 10 years post-menopause. Vaginal symptoms often persist or worsen without treatment. Each person's timeline is different.
https://www.oova.life/blog/high-progesterone-symptoms
Is high progesterone a sign of pregnancy?
Yes, high progesterone is one of the earliest indicators of pregnancy. Progesterone levels rise significantly after conception to support the developing embryo and reach their peak during the third trimester.
https://www.oova.life/blog/TBD-10-symptoms-and-how-to-get-relief
Can you still get pregnant in late perimenopause?
Yes, you can still get pregnant during perimenopause as long as you're having periods, even if they're infrequent. Continue using birth control until you've gone 12 consecutive months without a period and have officially reached menopause.
https://www.oova.life/blog/TBD-10-symptoms-and-how-to-get-relief
Do symptoms get worse before perimenopause ends?
Yes, most perimenopause symptoms intensify in the final 1-2 years before menopause. Hot flashes peak around your final period, vaginal symptoms worsen, and mood changes increase. However, brain fog typically improves in late perimenopause.
https://www.oova.life/blog/TBD-10-symptoms-and-how-to-get-relief
How long does late perimenopause last?
Late perimenopause typically lasts 1-3 years before your final period. However, the exact duration varies significantly from person to person. You've reached menopause after 12 consecutive months without a period.
https://www.oova.life/blog/high-progesterone-symptoms
What are the symptoms of high progesterone?
High progesterone symptoms include fatigue, bloating, breast tenderness, weight gain, anxiety, depression, headaches, and food cravings. During pregnancy, you may also experience increased nipple sensitivity and muscle aches.
https://www.oova.life/blog/TBD-10-symptoms-and-how-to-get-relief
What are the first signs that perimenopause is ending?
The earliest signs include longer gaps between periods (60+ days), intensifying hot flashes that peak around your final period, and worsening vaginal dryness. These symptoms typically increase in late perimenopause before you reach official menopause.
https://www.oova.life/blog/high-progesterone-symptoms
When should I be concerned about high progesterone?
Consult a healthcare provider if you experience high progesterone symptoms outside your luteal phase when not pregnant, or if symptoms include severe pelvic pain, abnormal vaginal bleeding, or rapid weight gain while on hormone therapy.
https://www.oova.life/blog/high-progesterone-symptoms
How do you test progesterone levels?
Progesterone can be measured through blood tests at your doctor's office or at-home urine tests that measure PdG (a progesterone metabolite). Testing is typically done during the luteal phase, about 7 days after ovulation.

About the Oova Blog:
‍Our content is developed with a commitment to high editorial standards and reliability. We prioritize referencing reputable sources and sharing where our insights come from. The Oova Blog is intended for informational purposes only and is never a substitute for professional medical advice. Always consult a healthcare provider before making any health decisions.

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