Perimenopause symptoms may start up to 10 years before entering menopause. Upon entering the postmenopausal stage, symptoms may continue for 4 to 5 years but typically decrease in frequency and intensity.

Many people confuse menopause with perimenopause. Perimenopause marks the start of your transition into menopause.

During perimenopause, your body begins to make less estrogen. This continues until the last one or two years of perimenopause, until your hormone levels drop rapidly.

Perimenopause can start up to 10 years before you enter menopause. It often begins in your 40s, but some people enter perimenopause in their 30s.

Doctors will determine that you’ve reached menopause when you haven’t had a period for 12 consecutive months. After that, you will enter the postmenopausal stage.

If you’ve had your ovaries surgically removed, you’ll experience “sudden” menopause.

Perimenopausal symptoms last four years on average. Symptom frequency, intensity, and duration vary widely from person to person. However, they usually begin to ease during menopause and postmenopause.

Hot flashes, also known as hot flushes, are a common symptom of perimenopause, menopause, and postmenopause.

One 2012 study found that moderate to severe hot flashes could continue past perimenopause and last for a median of 10.2 years. That’s longer than the generally accepted timeframe for the duration of hot flashes.

Researchers also found that Black women and women of average weight experience hot flashes for a longer period than white women and women who are considered overweight.

The most common symptoms include:

  • Hot flashes: These cause a sudden rush of warmth in your face and upper body. They can last a few seconds to several minutes or longer and occur several times a day or a few times a month.
  • Night sweats: Hot flashes during sleep can cause night sweats, waking you up and making you feel extra tired during the day.
  • Cold flashes: You may experience chills, cold feet, and shivering after your body cools down from a hot flash.
  • Vaginal changes: Vaginal dryness, discomfort during sexual activity, low libido, and an urgent need to urinate are symptoms of genitourinary syndrome of menopause (GSM).
  • Emotional changes: These may include depression, frequent shifts in mood, and irritability.
  • Trouble sleeping: Sleep problems such as insomnia can occur because of night sweats.

Less common symptoms include:

Some people also experience:

  • headaches
  • racing heart
  • muscle and joint pain
  • difficulty focusing
  • hair loss or thinning
  • weight gain

Going through perimenopause and menopause can be uncomfortable and sometimes painful. But there are things you can do to find relief.

Hot flashes

Try these options to help you prevent and manage hot flashes:

  • Identify and avoid hot flash triggers like spicy foods or alcohol.
  • Use a fan at work or home.
  • Take slow, deep breaths when a hot flash starts.
  • Remove some layers of clothing when you feel a hot flash coming on.

Vaginal dryness

Vaginal dryness can be managed by using a water-based, over-the-counter (OTC) lubricant during sex or by using an OTC vaginal moisturizer used every few days.

A healthcare professional can also prescribe medication to help with more severe vaginal discomfort.

Difficulty sleeping

Try these options to avoid sleep problems:

  • Avoid large meals, smoking, coffee, or caffeine after noon.
  • Avoid napping during the day.
  • Avoid exercise or alcohol close to bedtime.
  • Drink warm milk or warm caffeine-free tea before bed.
  • Sleep in a dark, quiet, and cool room.

Easing stress, eating a balanced diet, and staying physically active can help with mood changes and sleeping problems. A healthcare professional may also prescribe medication to help alleviate these symptoms.

Your healthcare professional may also prescribe HRT to help treat your symptoms. HRT may also help slow bone loss and reduce mood swings and mild depressive symptoms.

Side effects may include:

  • vaginal bleeding
  • bloating
  • breast swelling or tenderness
  • headaches
  • mood changes
  • nausea

It’s natural to experience irregular periods when you’re perimenopausal. However, other conditions, like polycystic ovary syndrome (PCOS) or cervical cancer, can also cause irregular bleeding.

Consult a healthcare professional to rule out other causes if you:

  • suddenly experience very heavy periods or periods with blood clots
  • have periods lasting longer than usual
  • spot or bleed after sexual activity
  • spot or bleed after your period
  • have periods close together

Osteoporosis and heart disease are long-term health risks associated with menopause. That’s because estrogen plays a significant role in protecting your bones and your heart. Without estrogen, you’re at an increased risk for both diseases.

You’re also at an increased risk of urinary tract infections because menopause can cause your urethra to become dry, irritated, or inflamed. Vaginal infections may also occur more frequently as your vaginal tissues become dryer and thinner.

Report menopausal symptoms when visiting your healthcare professional. Get assessed by a healthcare professional if you continue to have menopausal symptoms that are unbearable or last more than five years after your last menstrual period.

When and how long symptoms of menopause last vary for each individual. It’s common for these symptoms during the entire time of perimenopause and into postmenopause to last about seven years.

Life after menopause isn’t much different than life during your reproductive years. Do what you can to eat well, exercise, and stay on top of routine healthcare, including dental and eye exams.