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Perimenopause symptoms: early signs, timeline, and options for relief
Published · Editorial team
Medical review pending · Last updated
Perimenopause is the transition before menopause, when ovarian hormone levels rise and fall unevenly. It often begins in the 40s and can last several years. Menopause itself is confirmed after 12 months without a period.
Common perimenopause symptoms
- Irregular periods (shorter, longer, heavier, or skipped cycles)
- Hot flashes and night sweats
- Sleep problems
- Mood changes, anxiety, or irritability
- Vaginal dryness and discomfort with sex
- Brain fog and trouble concentrating
- Joint aches, headaches, and changes in libido
When to see a provider
See a clinician for very heavy bleeding, bleeding after sex, periods closer than three weeks apart, or any bleeding after menopause; these need in-person evaluation.
Treatment options
Options include lifestyle strategies, non-hormonal prescription medicines, vaginal estrogen for genitourinary symptoms, and systemic menopause hormone therapy (MHT). The Menopause Society's 2022 position statement concludes that for healthy people under 60 or within 10 years of menopause without contraindications, the benefits of hormone therapy for bothersome symptoms generally outweigh the risks. In 2025, FDA moved to remove boxed warnings from many menopause hormone therapy labels. Your provider will weigh your personal and family history. See menopause hormone therapy.
Sources
- The 2022 hormone therapy position statement of The North American Menopause Society. Menopause 2022 (PubMed)
- FDA: Labeling changes to clarify benefit/risk considerations for menopausal hormone therapies (Nov 2025)
- NIH (National Institute on Aging): What is menopause?
Sources are listed for reference and do not imply endorsement. Regulatory status can change; check the date above.
This article is for education only and is not medical or legal advice. A licensed clinician decides whether any treatment is appropriate for you.