Signs Perimenopause Is Ending and What To Expect

When Does Perimenopause Start and How Long Does It Last?

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Perimenopause is the transition period before menopause when your ovaries start gradually producing less estrogen. Irregular periods, hot flashes, sleep disturbances, and changes in mood are all signs that you have entered perimenopause (1, 2).  This phase can last months to years, though it typically spans about four years (3).

‍When it’s been 12 months since your last period, you have officially left perimenopause and entered into the postmenopause phase. The average age of menopause is 51, though it can typically start anywhere between 45-55 years old. Though early menopause is uncommon, some women may hit menopause before age 45. If you’re under the age of 40 and experiencing irregular periods with symptoms of menopause, you may be going into premature menopause due to a condition known as “primary ovarian insufficiency” (3). 

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Harlow, 2012

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If you're experiencing symptoms and are unsure if you're in perimenopause, consulting with a healthcare provider can provide clarity and guidance.

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Symptoms of Perimenopause & How to Manage Them

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Changes in menstrual cycles 

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As your hormones fluctuate with age, menstrual cycles will become less predictable. Menses may become less frequent. For example, you may have 5-6 weeks between periods instead of 4 weeks. You may experience bleeding that is lighter or lasts for a shorter amount of time than usual. You may even skip periods altogether. 

While changes in your menstrual cycle are expected, pay attention to any concerning signs of bleeding, such as having unusually heavy periods or spotting between periods. These changes don’t always signal something more serious but could be linked to endometrial cancer or a polyp (3). 

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Symptoms of Menopause 

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As your ovaries produce less estrogen, hormonal imbalances trigger unpleasant symptoms of menopause, like hot flashes or mood swings. 

‍These are the most common symptoms of perimenopause:

• Hot Flashes: This common side effect of perimenopause affects up to 60-80% of women (2). 
• Night sweats: Hot flashes occurring at night are commonly called “night sweats.” Because night sweats can be quite unpleasant, they make getting a good night’s sleep difficult. As a result, many women experience other problems such as fatigue, irritability, and mood swings. 
• Vaginal dryness: As levels of estrogen drop, the tissues inside the vagina can become thin and dry causing discomfort or pain during intercourse. 
• Depression: During perimenopause, many women develop changes in mood including feelings of sadness, uninterest in things that usually bring them joy, and difficulty concentrating (3). 

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Treatment Options For Symptoms and Signs Perimenopause Is Ending

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Hormone Replacement Therapy (HRT): HRT can be very effective in treating hot flashes, night sweats, vaginal dryness, and even feelings of depression. HRT generally includes a combination of estrogen and progestin, or estrogen alone for those without a uterus. HRT is available by pill, vaginal ring, skin patch, gel, cream or spray. 

There are numerous factors to consider before starting HRT including risk for cardiovascular disease and breast cancer (4). Talk to your provider if you’re interested in learning more about this. 

‍Antidepressant Therapy:  This is worth considering if you’re experiencing changes in mood that are affecting your everyday life. Both hormone therapy and antidepressants, such as an SSRI (serotonin-reuptake inhibitor), can be effective solutions (5). Many women require both hormone therapy and an SSRI for adequate relief of all symptoms (6). While estrogen can improve mood in perimenopausal women, it does not work in postmenopausal women so an SSRI is especially beneficial (5).

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This post was written by our team of health writers for informational purposes only and does not constitute medical advice. Always consult your doctor or healthcare provider for personalized guidance regarding your health. Ozempic®, Wegovy®, Mounjaro®, and Zepbound® and their delivery device are registered trademarks. Mochi Health is a telehealth clinic that offers prescriptions for these products by medical necessity only as determined by a licensed health provider.

Sources

1. Taffe, John R. PhD1,2; Dennerstein, Lorraine PhD1. Menstrual patterns leading to the final menstrual period. Menopause 9(1):p 32-40, January 2002.
2. Santoro, N., Roeca, C., Peters, B. A., & Neal-Perry, G. (2021). The Menopause Transition: Signs, Symptoms, and Management Options. The Journal of clinical endocrinology and metabolism, 106(1), 1–15. https://doi-org.offcampus.lib.washington.edu/10.1210/clinem/dgaa764
3. Casper, Robert F. “Clinical Manifestations and Diagnosis of Menopause.” Edited by Robert L Barbieri et al., UpToDate Clinical Manifestations and Diagnosis of Menopause, UpToDate, 23 June 2023, www-uptodate-com.offcampus.lib.washington.edu/contents/clinical-manifestations-and-diagnosis-of-menopause?search=menopause+&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1. Accessed 18 Apr. 2024. 
4. Martin, Kathryn A, and Robert L Barbieri. “Treatment of Menopausal Symptoms with Hormone Therapy.” Edited by Peter J Snyder and Jean  E Mulder, Shibboleth Authentication Request, UpToDate, 20 Nov. 2023, www-uptodate-com.offcampus.lib.washington.edu/contents/treatment-of-menopausal-symptoms-with-hormone-therapy?search=menopause+hormone+therapy&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1#H3178370787. Accessed 18 Apr. 2024. 
5. Maki, P. M., Kornstein, S. G., Joffe, H., Bromberger, J. T., Freeman, E. W., Athappilly, G., Bobo, W. V., Rubin, L. H., Koleva, H. K., Cohen, L. S., Soares, C. N., & Board of Trustees for The North American Menopause Society (NAMS) and the Women and Mood Disorders Task Force of the National Network of Depression Centers (2018). Guidelines for the evaluation and treatment of perimenopausal depression: summary and recommendations. Menopause (New York, N.Y.), 25(10), 1069–1085. https://doi-org.offcampus.lib.washington.edu/10.1097/GME.0000000000001174
6. Graziottin, A., & Serafini, A. (2009). Depression and the menopause: why antidepressants are not enough?. Menopause international, 15(2), 76–81. https://doi-org.offcampus.lib.washington.edu/10.1258/mi.2009.009021
7. Harlow SD, Gass M, Hall JE, Lobo R, Maki P, Rebar RW, Sherman S, Sluss PM, de Villiers TJ; STRAW + 10 Collaborative Group. Executive summary of the Stages of Reproductive Aging Workshop + 10: addressing the unfinished agenda of staging reproductive aging. J Clin Endocrinol Metab. 2012 Apr;97(4):1159-68. doi: 10.1210/jc.2011-3362. Epub 2012 Feb 16. PMID: 22344196; PMCID: PMC3319184.

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