What to Expect During Perimenopause
Discover what to expect during perimenopause—from hot flashes to mood changes—and how to manage symptoms and stay healthy through your 40s and beyond.
By Monica Agar, MD, Obstetrician and Gynecologist—Virtua OB/GYN
For many women, the transition to menopause begins in the early 40s. Known as perimenopause, or the "menopause transition," this life stage is defined by a roller coaster of physical, emotional, and psychological changes. You'll know you've reached menopause when you haven't had a menstrual period for 12 consecutive months.
In perimenopause, your hormone levels fluctuate, and you may have symptoms you’d typically associate with menopause, such as:
- Periods that are heavier, lighter, shorter, or longer than you're used to
- One or more missed periods followed by a regular period
- Hot flashes, irritability, decreased sex drive, difficulty concentrating, and trouble sleeping
Think about when you hit puberty and got your first period—the change didn't happen all at once.
It's the same with perimenopause. You may see some of these changes in your early 40s or later. Every woman is unique, but here are some symptoms you may experience.
Perimenopause signs and symptoms
Menstrual cycle changes
It's important to know what a normal menstrual cycle is for you. Frequent bleeding, bleeding between periods, or prolonged bleeding may be perimenopause-related. However, if you have these symptoms, you should be evaluated by your OB/GYN.
Hot flashes and night sweats
Many women experience hot flashes, suddenly feeling a blast of heat from inside, followed by skin flushing and redness. Night sweats are similar, except you heat up when you’re asleep and wake in a sweat, which disrupts your sleep quality and ability to think and concentrate.
Mood changes, anxiety, or depression
As your hormone levels go up and down, so can your mood. You may experience anxiety, depression, racing thoughts, or find yourself easily irritated. There are many causes of mood changes, so it’s best to discuss your feelings with your OB/GYN or primary care provider.
Metabolism and weight changes
Weight gain and body changes are some of the most frustrating perimenopause symptoms. During this transition to menopause, your hormones start to dip, and your metabolism slows down. You may find that your weight gradually shifts from your hips and thighs to your waist, shoulders, and chest. Many women work hard to eat well and exercise and still can’t lose weight.
Meeting with a registered dietitian to discuss your nutritional needs during menopause can be helpful. You may also want to talk to a bariatric medicine specialist to see if weight-loss medication is right for you. Your doctor may also want to evaluate your thyroid levels to see if you may have an underactive thyroid, which contributes to weight gain.
Bone loss and osteoporosis
Perimenopausal estrogen loss can put you at increased risk for bone loss and osteoporosis, which can then lead to bone fractures as you age. Your provider can advise if you need supplements or medications to help you meet your calcium needs and maintain your bone strength.
Increased risk for other medical conditions
As you go through your 40s, your risk increases for conditions like heart disease, high blood pressure, and diabetes. During perimenopause, it's more important than ever to have regular medical checkups, vaccinations, bloodwork, and screening tests, including an annual pelvic exam and mammogram.
What to do if you’re experiencing perimenopause symptoms
It's always a good idea to talk to your health care provider about physical or emotional changes you may be experiencing. Even if they’re typical for this stage of life, it doesn’t mean you have to put up with them.
There are many hormonal and non-hormonal treatment options available for women at this stage of life. You can also improve your symptoms by making lifestyle changes, such as eating a diet rich in fruits, vegetables, low-fat dairy, lean proteins, and whole grains, doing weight-bearing exercises like walking or strength training for about 30 minutes a day, and reducing stress.
We’re here to help you manage perimenopause symptoms
- Find a Virtua OB/GYN near you and schedule an appointment online today.
- You deserve to feel like yourself again, and bioidentical hormone replacement therapy might be the solution. Call 856-325-5601 to schedule your consultation with Exuberan by Virtua.
- Learn about all your perimenopause and menopause treatment options.
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