Perimenopause—the gradual lead-up to menopause—is a transition marked by a number of physical and mental changes. For many people, that means hot flashes, night sweats, mood changes, insomnia, vaginal dryness, and more. But how do you know when perimenopause is coming to an end? And when can you expect these symptoms to alleviate?
The short answer is that perimenopause is different for everyone, and it’s hard to predict when exactly it’s going to end. We know that uncertainty can be frustrating, and we’re here to help you make sense of the data. After all, everyone wants clear answers where health is concerned.
The good news is that there are some common experiences that many people share—especially around menstruation, which gets less frequent as you approach menopause. In this piece, we’ll explore what you can expect as perimenopause draws to a close.
Perimenopause is the transitional phase between your reproductive years and menopause, after which you’re no longer able to get pregnant. (“Peri” means “around”; perimenopause thus means the time “around menopause.”) It is a gradual process with no bright lines to delineate its beginning or end. But generally speaking, perimenopause happens when your body starts running out of eggs.This leads to fluctuations in your hormone levels, most notably estrogen.
Estrogen is an incredibly important hormone that can influence almost every part of your body, including your heart, brain, skin, bladder, vulva, and vagina. And as we’ll see, you may experience changes in some or all of these organs as you move through perimenopause into menopause.
Perimenopause typically begins in your mid to late 40s, though it may occur earlier or later. The typical duration is four to five years, though this too varies considerably.
The beginning of perimenopause seems to be fairly consistent across race and ethnicity, though some research has found that Hispanic women and Black women are more likely to experience perimenopause earlier than other ethnic groups. There is also some research suggesting that lifestyle factors like cigarette smoking correlate with reaching perimenopause at a younger age.
Perimenopause ends one year after your Final Menstrual Period (FMP). At that point, you’ve reached menopause. There’s a tremendous variation in the signs and symptoms of perimenopause. The most reliable variable is menstrual cycle regularity. If you’re in your mid to late 40s and your menstrual cycles are beginning to vary by a few days, you may be approaching perimenopause. When they begin varying by a week or more, you’re probably in early perimenopause. If they are separated by 60 days or more (i.e. you’re skipping occasional cycles), you’re most likely in late perimenopause, and you may reach menopause soon.
Everyone’s experience with perimenopause is different, thanks to our unique genetics and environments. Symptoms that are very prominent for you may be a non-issue for someone else—and vice versa. Additionally, some perimenopause symptoms continue beyond menopause (and may even accelerate), while others are generally temporary. In this section, we’ll review seven of the most common perimenopause symptoms and describe how they tend to evolve as you approach menopause.
As described above, menstruation tends to become more irregular as your body’s supply of eggs runs low. This cycle irregularity typically grows over the course of perimenopause until your periods finally stop altogether. Researchers have broken this transition up into four rough stages:
Hot flashes are one of the most common signs of perimenopause, affecting three out of four North American women. They are typically experienced as an intense wave of heat, mainly affecting the head, face, and upper chest. For some people, hot flashes taper off after the menopause transition. For others, they continue for many years afterwards. This means it’s not possible to know exactly where you are in the perimenopause journey simply by observing your hot flash frequency.
That said, one of the largest menopause studies—the Study of Women’s Health Across the Nation (SWAN)—found that hot flashes tend to rise in prevalence during perimenopause. While roughly 39% of participants reported hot flashes early on, that number nearly doubled with the approach of menopause. So if you’re already in perimenopause and have recently begun having hot flashes, it may mean that menopause is approaching.
The brain is rich in estrogen receptors. That means falling estrogen levels can dramatically affect its function, possibly leading to depression and anxiety. Several major studies have found the risk of a major depressive episode grows 2-5X as you enter perimenopause. This risk remains high until two to four years after your final menstrual period, when it returns to a normal level. One recent Chinese study found that the risk of anxiety is slightly higher during perimenopause than during menopause itself, though this hasn’t yet been replicated by other studies.
As estrogen levels fall, the vulva and vagina undergo significant physical changes. These tissues contain many estrogen receptors and are extremely sensitive to your hormone balance. With less estrogen present, blood flow to the genitals is diminished, natural vaginal lubrication decreases, and the tissues themselves grow thinner and more fragile. This can lead to itching, irritation, painful sex, and bleeding—a phenomenon called the genitourinary syndrome of menopause (GSM).
GSM (formerly known as vulvovaginal atrophy or atrophic vaginitis) tends to begin during perimenopause and continues beyond menopause, becoming ever more prevalent with age. Unlike hot flashes and mood changes (which eventually improve), GSM will often worsen over time if not treated.
Insomnia becomes more common as people enter perimenopause. This is due to several factors. First, falling estrogen levels may directly impact the brain in a way that triggers insomnia. Second, the spike in depression and anxiety can make sleep more difficult. And third, hot flashes or night sweats can interrupt your sleep for long periods of time.
Entering perimenopause raises the risk of sleep difficulties from 30% to 50%. It’s currently unclear whether this risk stays high or diminishes over time. Some studies have found that insomnia prevalence is higher after menopause than during the reproductive years, while other research has found that the risk only increases temporarily during perimenopause.
It’s long been recognized that headaches have a hormonal component, given how many people experience them during or just before menstruating. And while they still aren’t fully understood from a medical perspective, it’s clear that headaches also become more common during perimenopause and beyond.
As you enter perimenopause, tension headaches (i.e. normal, garden-variety headaches) seem to increase in frequency and remain high into menopause. Migraine headaches, on the other hand, seem to temporarily worsen during perimenopause but then fall back to a normal level afterwards.
Estrogen is one of the major sex hormones, so it’s no surprise that estrogen fluctuations can shake up your sex drive. As you enter perimenopause, your estrogen levels fall and your estrogen-testosterone ratio changes. For many people, this seems to reduce the desire to have sex. Additionally, the vaginal changes described above can make penetrative sex uncomfortable or painful, which can further stymie your sex drive.
Sexual desire seems to begin decreasing late in perimenopause and continue gradually decreasing thereafter. The rate of low sex drive after menopause is about 50%—roughly double its prevalence prior to menopause. It’s important to note, however, that some people actually report a higher sex drive during menopause. This may be due to the lower anxiety they feel about accidental pregnancy as well as a heightened sense of comfort with their bodies.
Knowing where you are in your perimenopause journey can be tricky. The signs, symptoms, and timing of your experience may be quite different than they are for other people. So if you’re struggling to figure out when exactly you’ll reach menopause (or if you’ve reached it already), you’re not alone.
There are some broad patterns—such as growing menstrual irregularity—that can help you loosely estimate your progress toward menopause. But for now, the best strategy is to simply be patient, observe the changes in your body, and maintain open lines of communication with your healthcare provider. Research in this area is ongoing, and we hope that the future brings new tools and techniques for more accurately tracking menopause status. When that day comes, Evernow will be there to help you stay in the know.