If you’re in your 40s and starting to have hot flashes, irregular periods, and mood changes, you may think you’re hitting early menopause. But in reality, what you’re going through is perimenopause.

Virtua obstetrician and gynecologist, Bruce J. Levine, MD, who is very involved in national research studies looking at options to treat woman experiencing menopausal issues, explains: “Perimenopause is the time between when a woman’s regular period begins to change (shorten, lengthen, get heavier or spotty) and when she loses her period for an entire year. During this time, hormone levels begin to fluctuate, and that’s what can cause symptoms like abnormal periods, skipped periods, vaginal dryness (or painful intercourse), mood swings or night sweats.”

The definition of menopause is the absence of a period for one full year. But until that happens, you still may ovulate, and it's still possible to become pregnant.

How to Manage Perimenopause Symptoms

Of course, one way to manage perimenopause symptoms and avoid pregnancy is to use birth control, such as the pill. It’s only in the last 15 to 20 years that doctors have been willing to prescribe birth control pills for women over age 35. The birth control pill can be safely used until menopause, but it may mask its onset. The dilemma of knowing whether or not to continue on birth control pills is only resolved by going off of them and then having your menopausal hormone levels checked to see whether or not it has begun.

According to Dr. Levine, “If you're totally through menopause and still taking birth control pills, your body gets a high dose of hormones — much higher than it should. After a certain age, this can increase the risk of stroke, heart attack, blood clots, and possibly breast cancer.” This is a very important time to discuss options with your doctor.

A modern approach to birth control is long-acting reversible contraception such as IUDs (intrauterine devices) or implants. IUDs are “T-shaped” devices that are implanted into the uterus. They can be hormonal, meaning they release small amounts of progestin and last about 5 years, or non-hormonal, meaning they’re copper/plastic devices that last about 10 years. A contraceptive implant is a small rod that’s inserted just under the skin of a woman's upper arm that releases hormones over 3 years. Unlike birth control pills, these long-acting reversible contraceptives generally have a lower risk of side effects such as heart attacks and blood clots.

Perimenopause and Premature Menopause Are Not the Same

Perimenopause can be confused with another, unusual, condition called premature menopause (or ovarian failure). In fact, premature menopause is a significant medical condition that occurs with the onset of menopause in women age 35 and younger. The incidence of premature menopause is as low as 1 in 100 and can be detected with a simple blood test. If you're under age 35, aren’t pregnant and haven’t had your period for 90 days, it’s important to see your gynecologist to be tested.