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When Does Perimenopause Start?

At midlife, women transition from their reproductive years to the natural end of monthly menstrual cycles. This transition — called perimenopause — usually begins in our 40s and ends by the early 50s, although any age from the late 30s to 60 can be normal.

Menopause is the time when a woman’s menstrual periods stop permanently. Menopause is confirmed after 1 year of no periods. The average age of menopause is 51 years, but the normal range is 45 years to 55 years.

It can be difficult to know whether you’ve entered perimenopause, because the hormonal fluctuations begin while menstrual periods are still regular.

During a normal menstrual cycle, the levels of the hormones estrogen and progesterone increase and decrease in a regular pattern. However, during perimenopause, hormone levels may not follow this regular pattern. As a result, you may have irregular bleeding or spotting.

Some women breeze through the transition. For many others, the hormonal changes create a range of mild discomforts including nausea, migraines, weight gain, sore breasts, severe night sweats, and/or sleep trouble. For this group, perimenopause can be enormously disruptive both physically and emotionally.

How Perimenopause Can Affect Your Periods

One common menstrual change in early perimenopause is shorter cycles, usually averaging two or three days less than usual but sometimes lasting only two or three weeks. It can feel as though you’re starting a period when the last one has barely ended. In later perimenopause, you may skip a period entirely, only to have it followed by an especially heavy one.

Occasionally, menstrual periods will be skipped for several months, then return as regular as clockwork.

Perimenopause symptoms can last anywhere from 1 to 10 years. During this time, the hormones estrogen and progesterone are in flux. Your levels will fluctuate from month to month. These shifts can be erratic, affecting ovulation and the rest of your cycle. You may notice anything from irregular periods to different bleeding patterns to missed periods.

Other Symptoms of perimenopause include:

  • hot flashes
  • night sweats
  • sleep troubles
  • memory issues
  • difficulty urinating
  • vaginal dryness
  • changes in sexual desire or satisfaction

If you notice some blood on your underwear between periods that doesn’t require the use of a pad or tampon, it’s likely spotting. Spotting usually results from your body’s changing hormones and endometrium buildup.

Many women spot before their period starts or as it ends. Mid-cycle spotting around ovulation is also common.

If you’re regularly spotting every two weeks, it may be a sign of hormonal imbalance. You may want to speak with your healthcare provider.

When your estrogen levels are low, your uterine lining is thinner. Bleeding, as a result, may be lighter and last fewer days. Short cycles are more common in the earlier stages of perimenopause.

For example, you may have a period that’s two or three days shorter than normal. Your whole cycle may also last two or three weeks instead of the standard four. It isn’t uncommon to feel like your period just ended when the next one comes.

In the later stages of perimenopause, your cycles may become much longer and farther apart. Longer cycles are defined as those longer than 36 days. They’re related to anovulatory cycles, or cycles in which you do not ovulate.

Your fluctuating hormones may also be to blame for a missed cycle. In fact, your cycles may become so far apart that can’t recall the last time you bled. After you’ve missed 12 consecutive cycles, you’ve reached menopause.

But if your cycles are still making an appearance — however delayed — ovulation is still occurring. This means you can still have a period, and you can still get pregnant.

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