Perimenopause: What’s Normal and What’s Not

Puberty, pregnancy and you guessed it – another life transition that starts with a ‘p’ – perimenopause. While you are probably familiar with the term menopause, what many women don’t realize is that there are several years prior to menopause that are defined as perimenopause. Just like other life transitions that you’ve already gone through, the symptoms and length of perimenopause can vary from woman to woman, so your experience may differ greatly from the experiences that other women have had.  

What is perimenopause?

Perimenopause is a time of life when a woman’s body changes in preparation for menopause. However, it can be a lengthy transition and women aren’t considered to be in menopause until they have had 12 consecutive months without a period. It’s important to note that pregnancy is still possible during perimenopause; the potential for pregnancy only goes away after a woman has gone through menopause.

At what age does perimenopause start and how long does it typically last?

Women enter perimenopause at different ages. Typically, women will begin to notice symptoms in their 40s, but some may experience them sooner, some as early as their 30s. Perimenopause can last as short as two years or as long as 10 years.

What are the symptoms of perimenopause?

  • Irregular menstrual cycles – they may become longer, shorter, heavier or lighter and sometimes more or less frequent
  • Hot flashes or night sweats
  • Sleep problems
  • Vaginal dryness, which can cause pain during intercourse
  • Moodiness
  • An increasing number of headaches or migraines
  • Weight gain
  • Heart palpitations


What is not normal during perimenopause?

  • Menstrual bleeding that is extremely heavy (changing tampons or pads every hour)
  • Menstrual bleeding with clots
  • Menstrual bleeding lasting longer than eight days
  • Bleeding between periods or after sexual intercourse
  • Periods often occurring less than 21 days apart
  • Depression
  • Incontinence


What are some treatment options that can help with the symptoms of perimenopause?

  • Diet: Avoid caffeine, alcohol and spicy foods. A diet rich in fruits, vegetables, beans, soy, flaxseed and fish oils can help keep symptoms at bay.
  • Exercise: There are many benefits to a regular exercise routine. Exercising during perimenopause and menopause can help decrease hot flashes, prevent weight gain and help with depression and sleep problems.
  • Oral contraceptives: Low-dose pills can help regulate periods and reduce hot flashes and vaginal dryness.
  • Progestin therapy: This therapy can be accomplished through medications or some intrauterine devices (IUDs). Progestin therapy can help with heavy bleeding during perimenopause.
  • Herbal products: There are many different herbal products available, but little data to support their effectiveness. Some women have found relief from menopausal symptoms by using the following herbal products: black cohosh, soy supplements, St. John’s wort and ginseng. It is important to try these under the direction of a physician as they can interact with other medications.
  • NovaSure® Endometrial ablation: This short procedure, which can be done in the office at Virginia Women’s Center, can help reduce or stop menstrual bleeding by permanently removing the endometrium, or the lining of the uterus. To learn more, visit our website.


As you enter perimenopause and menopause, the need for an annual visit to your OB-GYN is still an important aspect of your health regimen. Regular visits will help you stay up-to-date on age-appropriate screenings as well as evaluate different therapy options if you find menopausal symptoms to be disruptive to your life. Just as the symptoms and length of perimenopause vary from woman to woman, the treatment options also differ. It’s important to discuss different treatment options with your health care provider so that together you can create an individualized plan based on your health and medical history.