When Does Perimenopause Start and How Long Does It Last?

Most women expect perimenopause to start in their late 40s with hot flashes. The reality is, symptoms can begin in the mid to late 30s, and most women don't connect what's happening to their hormones until years later.

Perimenopause is the transition phase before menopause, when estrogen and progesterone start to fluctuate and decline. It typically lasts 4-8 years, though for some women it runs longer. Understanding when perimenopause starts, how long it lasts and what the symptoms actually look like is the first step to doing something about it.

Not sure if what you're experiencing is perimenopause? The free Perimenopause Symptom Guide breaks down the most common symptoms, what's driving them hormonally and how to start feeling better right away.

Download the Free Perimenopause Symptom Guide

What Is Perimenopause?

Perimenopause, often referred to as the menopausal transition, is the phase leading up to menopause when a woman's body gradually produces fewer hormones, particularly estrogen. This transition typically begins several years before menopause itself and continues until menopause is reached. During perimenopause, you may experience a range of symptoms as your body adjusts to fluctuating hormone levels, signalling the eventual end of your reproductive years.

With good nutrition and day-to-day habits that support your body, you can navigate perimenopause with ease and greatly reduce those unwanted symptoms.

When Does Perimenopause Start and How Long Does It Typically Last?

The onset of perimenopause can vary widely among women, but it generally starts in a woman's 40s, although it can begin earlier for some and later for others. The average duration of perimenopause is approximately 4-8 years, but this timeline can also vary significantly from individual to individual.

How Do You Know When You Are Going Through Perimenopause?

Irregular Periods:

They can be longer or shorter than what was experienced through adult life, and they may not show signs of consistency; one month may be longer than normal, and the next may be shorter. Many women have experienced period irregularities in the past and may not notice the change. Or, periods can become more of an issue with excessive bleeding, especially if fibroids are present. Every woman will have a different experience depending on many factors. Eventually, the periods start to become more infrequent, and often, monthly symptoms like PMS are less severe.

Hot Flashes:

A hot flash is an increased sensation of warmth or heat and can include sweating. It often comes on suddenly and can include symptoms such as warm skin, tingling in the fingers, faster heartbeat, and a flushed or red face. Hot flashes are an adrenal issue, and stress and anxiety are frequent triggers. Alcohol, smoking, and caffeine can also trigger a hot flash. They can last from 30 seconds to 10 minutes. Applying an ice pack or drinking ice water may provide some relief but the key is to prevent them altogether. Balancing hormones with a focus on managing stress and supporting the adrenal glands is the key.

Night Sweats:

Night sweats occur as fluctuating hormone levels disrupt your body's natural temperature regulation, leading to intense heat episodes followed by sweating during the night. Lifestyle adjustments and dietary changes can go a long way in bringing you relief.

Mood Swings:

Many women find that during this time, they become angrier more easily and often feel irritated. Depression is another symptom. Reduced hormone levels can affect the brain, especially the areas that control emotions. The nervous system can also be more agitated, especially if stress levels are high and blood sugar fluctuates up and down. Adrenal support, reducing stress and stabilizing blood sugar by eating whole foods and eating regularly all help.

Sleep Disturbances:

During both perimenopause and menopause, many women have trouble getting a good night’s sleep. They either have trouble falling asleep, cannot stay asleep, or both. They may also experience hot flashes in the middle of the night. Once again, the adrenals are involved as they control the production of our “awake” hormone cortisol. Cortisol is supposed to decrease steadily in the evening so that we can easily fall asleep. If there is too much cortisol, we do not sleep. Some women find themselves waking up at 3:00 or 4:00 AM and then are unable to fall back to sleep. This is also an adrenal problem. We secrete ACTH, a hormone produced in the pituitary to prepare the adrenals to release cortisol in the morning when we wake up. However, when the adrenals are not functioning properly, then cortisol can start pumping immediately, which means sleep is not going to happen for the rest of the night. Developing a relaxation strategy, going to bed at the same time every night, and supporting adrenal function can help.

Vaginal Dryness:

A decrease in estrogen can also cause a decrease in lubrication and blood flow, which can lead to vaginal dryness and make sexual intercourse difficult.

Decreased Libido:

As estrogen and testosterone levels decline, so can sexual desire, affecting intimacy. This reduction in libido is also influenced by other perimenopausal symptoms like mood swings, sleep disturbances, and vaginal dryness, which can further decrease interest in sexual activity.

Joint and Muscle Pains:

Hormones help maintain joint health and muscle function. So, it is quite common for women to feel more aches and pains. Balancing hormones and regular exercise, especially stretching and range of motion exercises, can be beneficial.

Weight Gain: 

Perimenopause weight gain is an issue many women experience during this transitional phase. If they are dealing with hormonal imbalances, stress, and sleep disruptions, it can lead to high cortisol levels, which can lead to weight gain, increased ghrelin (hunger hormone), and make weight loss very difficult without the right nutrition and lifestyle habits to support their body during this phase.

If you're experiencing some or all of these symptoms and are in your 40s, you may be entering perimenopause.

Here's exactly why perimenopause weight gain happens and what actually works to reverse it.

How Do You Know When You Are in Menopause?

Menopause is officially diagnosed when you have gone 12 consecutive months without a menstrual period, marking the end of your reproductive years. At this stage, the symptoms that you may have experienced during perimenopause, such as hot flashes and mood swings, may begin to subside, although some women continue to experience symptoms for several years after reaching menopause.

Do Things Get Better?

While the symptoms of perimenopause and menopause can be challenging, many women find that things improve once they reach postmenopause—the phase that follows menopause. During postmenopause, estrogen levels stabilize at a lower level, and many women experience a reduction in symptoms such as hot flashes and mood swings. However, it's important to note that every woman's experience is unique, and some may continue to experience symptoms for an extended period.

What Actually Helps During Perimenopause

The symptoms listed above all have a hormonal root cause — and they all respond to the right nutrition and lifestyle approach. The most impactful place to start is with what you eat.

Stabilizing blood sugar, eating enough protein at every meal and managing cortisol through consistent meal timing addresses the hormonal drivers behind weight gain, fatigue, sleep problems, mood swings and cravings all at once.

If you want to see exactly what that looks like in practice, here's how to lose weight in perimenopause when nothing else is working.