October 2025
Perimenopause refers to the time during which a woman’s body makes the natural transition to menopause, when women completely stop menstruating. Women start perimenopause at different ages. Signs of progression toward menopause, such as menstrual irregularity, may begin in your 40s. But some women notice changes as early as their mid-30s.
Once you’ve gone through 12 consecutive months without a menstrual period, you’ve officially reached menopause, and the perimenopause period is over.
During perimenopause, your estrogen level rises and falls unevenly. Your menstrual cycles may lengthen or shorten, and you may begin having menstrual cycles in which your ovaries don’t release an egg (ovulate).
Learn more about the common symptoms of perimenopause — and how to treat them.
Symptoms of Perimenopause
In addition to irregular periods, you may experience some or all of these menopause symptoms during perimenopause:
- Hot flashes
- Sleep problems
- Mood changes and/or trouble concentrating
- Vaginal dryness
- Urine leaking when exercising, coughing, or laughing
- Weight gain
- Changing cholesterol levels
Because estrogen and progesterone begin to decrease during perimenopause, women may experience decreased fertility and bone loss (which can manifest as osteopenia or osteoporosis later on).
Managing Perimenopause Symptoms
Lifestyle changes are a great place to start if you’re experiencing symptoms of perimenopause. Here’s how to get started.
Hot flashes
Hot flashes can be uncomfortable at any time, and especially problematic if they disrupt your sleep. The National Institute on Aging (NIA) recommends the following for minimizing hot flashes: Dress in layers so you can remove one or more of them when a hot flash begins. Avoid — or limit — caffeine, alcohol, and spicy foods. Quitting smoking and maintaining a healthy weight can also help.
If hot flashes are disrupting your sleep, try setting the temperature a couple of degrees cooler than usual, and use multiple layers of lighterweight blankets on your bed (instead of one or two heavier ones) so you can adjust the layers as needed.
Sleep problems
Insomnia is a common complaint women have during perimenopause (and menopause). The NIA also offers good tips for improving sleep, including practicing good sleep hygiene. Get up and go to bed at the same time every day. Develop a bedtime routine. Some people read a book, listen to soothing music, or soak in a warm bath.
Engage in at least 30 minutes of exercise daily. Avoid caffeine and alcoholic beverages later in the day.
Keep screens (such as TVs, laptops, smartphones, and tablets) out of the bedroom. The light from these devices can make it harder for you to fall asleep. It’s best to stop using devices one to two hours before the time you want to fall asleep.
Mood problems and problems concentrating
The hormonal changes that happen during perimenopause can cause problems with mood and concentration. But there are some lifestyle changes you can make to counteract mild issues with depression, anxiety, and concentration. Getting a good night’s sleep, regular exercise, meditation or yoga, and cognitive behavioral therapy (CBT) may help.
Vaginal dryness
If vaginal dryness is making sexual intercourse painful or uncomfortable, try using a water-based lubricant before having sex.
Urine leakage
Some women may experience urine leakage during perimenopause. This tends to happen during exercise or when sneezing, coughing, or laughing. Kegel exercises — where you repeatedly contract and relax the same pelvic muscle you use to stop the flow of urine when peeing — can help strengthen the pelvic floor, making leakage less likely. A thin protective pad (like a menstrual pad but smaller and thinner) can help catch any accidental dribbling.
While some women only experience mild perimenopause symptoms or respond well to lifestyle changes, other women may experience more severe symptoms. If lifestyle changes aren’t enough, consider discussing medical approaches with your doctor to manage your symptoms.