There is a significant hormonal transition that takes place between your reproductive years and your postmenopausal years…and most people have never heard of it. This transition is called perimenopause (also sometimes referred to as the menopausal transition), and it lasts on average four years—not an insignificant blip by any means! Every menstruating person deserves to know about perimenopause and what to expect during this time—so let’s dig into tell-tale perimenopause signs and what menstrual cycle changes you can expect!
What is perimenopause
From a bird’s-eye view, perimenopause is the bridge between our reproductive stage and our postmenopausal stage.
Reproductive stage: Starts from menarche (our first period as an adolescent). Generally speaking, people will ovulate and have a period with every menstrual cycle during this stage.
Postmenopause stage: Starts from menopause, which is the permanent loss of periods and is determined after 12 consecutive months without a period.
Therefore, perimenopause transitions us from a stage when we ovulate and menstruate every month to a stage when we stop ovulating and menstruating entirely. It is neither a time of relatively predictable estrogen and progesterone production (like the reproductive stage) nor a time of explicitly low estrogen and progesterone production (like the postmenopausal stage). Perimenopause is a completely unique hormonal experience.
In perimenopause, ovulation becomes haphazard and unpredictable and because of that, estrogen and progesterone production throughout these years becomes erratic. This can significantly affect how you feel, and it will also significantly affect your menstrual cycles.
How your menstrual cycle changes
As you enter early perimenopause, your menstrual cycle length will become variable. In fact, early perimenopause is identified by a seven-day or greater difference in the length of your menstrual cycles. This can be either a shortening or lengthening of cycles. For example, if your standard menstrual cycle was always 32 days, and now they are 25 days (or less) or 39 days (or more), it could signal that you are in perimenopause.
Moving into late perimenopause, you’ll start skipping cycles altogether; you’ll go 60 days or longer without a period, and more frequently your cycle will be anovulatory (meaning you did not ovulate).
Period changes to expect
The first change to expect is unpredictability. Prior to perimenopause you probably had a sense of when to expect your period but now you really don’t know when it might start! Some find it helpful to stash a few period care products in your bag, car, work desk, etc.
You can also expect a change in bleeding. For some, this looks like lighter periods and for others, heavier periods or prolonged periods. People with heavy bleeding (more than 80 ml/5.4 tbsp blood loss) or prolonged bleeding (more than 7 days) should speak to a doctor to receive further evaluation and support.
Are you perimenopausal?
The average age at menopause is 51, which means that the average age of perimenopause is 47—but these ages are simply an average. Your age of perimenopause, and the number of years you spend in perimenopause, will be unique to you. This is why menstrual cycle tracking is a wonderful tool!
Remember that perimenopause is not defined by your age, it is defined by changes to your menstrual cycle. Tracking will help you understand your menstrual cycles and identify changes as they arise.
Basics of menstrual cycle tracking in perimenopause
Day 1 of your menstrual cycle is the first day of your period (this is the first day you properly bleed, not the first day of spotting)
Track your periods
⊳ How many days you bleed for
How many period products you use each day (will help identify heavy bleeding)
Track ovulation by noting the presence/absence of pre-ovulatory cervical mucus changes.
⊳ Pre-ovulatory cervical mucus changes: Just prior to ovulation there will be increased production of cervical mucus and its consistency will change to that of a raw egg white (clear and slippery). You’ll likely notice this as a change in your vaginal discharge when wiping after using the toilet.
⊳ Remember that ovulation becomes haphazard in perimenopause and that you’ll have more menstrual cycles in which you do not ovulate as you approach menopause.
(For more menstrual tracking tips, read How to Track Your Menstrual Cycle.)
Other changes in perimenopause to expect
Menstrual cycle changes are just one aspect of perimenopause. Other common symptoms include:
Hot flashes, night sweats
Sleep disturbances
Mood changes such as depression
Brain fog, forgetfulness, difficulty with word retrieval
Changes in body composition (loss of lean mass and gain of fat mass)
Vaginal dryness, pain with intercourse
Seeking support
Perimenopause can have a significant impact on quality of life. It can feel overwhelming. But please know that you do not need to go through perimenopause alone or unsupported. There are many ways to be supported through this transition, and it starts with education and an understanding of what is happening from a physiological perspective so that you can have greater compassion for the way you are feeling.
I strongly recommend connecting with a healthcare practitioner who is well-versed in perimenopause and can look at the full scope of your health story, thoroughly assess for other health conditions that may be mimicking or exacerbating your perimenopause experience, and discuss all of your treatment options in an unbiased manner.
References
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Hall JE. Neuroendocrine physiology of the early and late menopause. Endocrinol Metab Clin North Am. 2004;33(4):637-659. doi:10.1016/j.ecl.2004.08.002
Harlow SD, Gass M, Hall JE, et al. Executive summary of the Stages of Reproductive Aging Workshop + 10: addressing the unfinished agenda of staging reproductive aging. J Clin Endocrinol Metab. 2012;97(4):1159-1168. doi:10.1210/jc.2011-3362
Santoro N, Brockwell S, Johnston J, et al. Helping midlife women predict the onset of the final menses: SWAN, the Study of Women's Health Across the Nation. Menopause. 2007;14(3 Pt 1):415-424. doi:10.1097/gme.0b013e31802cc289
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Woods NF, Mitchell ES. Symptoms during the perimenopause: prevalence, severity, trajectory, and significance in women's lives. Am J Med. 2005;118 Suppl 12B:14-24. doi:10.1016/j.amjmed.2005.09.031