Perimenopause: What every woman should know before menopause

Aug 21, 2025

Menopause is the absence of your period for one year. Perimenopause is the time prior, usually a few years, where ovarian function is more erratic, and hormone levels can lead to a high estrogen to progesterone ratio and wide fluctuations in estrogen levels.

three women sitting down laughing about perimenopause symptoms — Women go through many life changes, but menopause symptoms don’t have to control your life.

Understanding perimenopause

Perimenopause is the transitional phase leading up to menopause, often beginning in a woman’s 40s but sometimes as early as the mid-30s. It can last anywhere from a few months to over a decade.

During this time, the ovaries gradually produce less estrogen, leading to hormonal fluctuations that can cause a wide range of symptoms. Symptoms of perimenopause include:

Irregular periods
Hot flashes or night sweats
Mood changes
Sleep disturbances and fatigue
Vaginal drying or discomfort during intimacy
Decreased fertility
Changes in libido
Brain fog or memory lapses

Some of those symptoms can disturb daily life and lead to worry about what is “normal.” Misti Lavin, obstetrics & gynecology nurse practitioner at Marshfield Medical Center-Minocqua, reminds her patients that you don’t just have to “deal with it.”

Learn more about menopause symptoms from Dr. Joshua Sampson, OB-GYN at Marshfield Clinic, in this video.

Pay attention to your body

Each woman is going to experience perimenopause and menopause differently. Some women may have little to no symptoms, while others experience them all at same time.

“Pay attention to your body and mind,” Lavin said. “Make note if you experience any changes and talk to your doctor.”

Some risks like osteoporosis or ovarian and breast cancer increase during the same time as menopausal changes. Understanding symptoms, risks and treatment options can help you feel more prepared and at ease through the changes.

Abnormal bleeding

Perimenopause can lead to irregular bleeding. Lavn said the challenge with abnormal bleeding is to rule out other serious causes, prevent anemia if it is excessive and relieve the nuisance of abnormal uterine bleeding (AUB).

“Treatment is individualized depending on diagnosis and severity of AUB,” Lavin said. “Treatments could involve hormone therapy, an IUD containing progestin or possible surgery.”

In your 30s and 40s, irregular periods can be bleeding or spotting between periods, bleeding after sex, periods that last longer than usual, bleeding that occurs more frequent than every 21 days and bleeding after menopause (12 months without a period).

Abnormal bleeding can occur because of hormonal fluctuation, especially declining estrogen. This disrupts the regular buildup and shedding of the uterine lining. This can lead to skipped ovulation or thicker or thinner uterine lining.

While changes in your period are expected during perimenopause, you should never ignore bleeding that feels unusual to you as it could be a sign of polyps, fibroids, ovulatory dysfunction and endometrial disorders. Early evaluation can rule out serious conditions and help you manage symptoms more effectively.

Intimacy concerns

Perimenopause and menopause can often cause some form of sexual dysfunction for women. Most common is the vaginal dryness caused by low estrogen. Your women’s health provider may suggest over-the-counter lubricants, local vaginal estrogen, DHEA or systemic estrogens.

Recent studies show that regular sexual activity may reduce vaginal dryness and preserve sexual function.

Lavin said androgen hormones also diminish with menopause, affecting libido.

“Age-related changes can affect blood flow and nerve sensation to the vagina and clitoris, which may also affect sexual function in women,” Lavin said.

Daily disturbances

Hot flashes, night sweats and sleep disturbance are common symptoms of menopause. Lavin said sometimes, these could be treated conservatively by dressing in layers, using a fan or drinking cool beverages. However, they also may be helped with non-hormonal medications and hormone replacement (HRT).

“HRT needs to be individualized depending on one’s personal degree of discomfort, personal and family risk factors,” Lavin said.

Treatment is available

The important thing to know is that treatment is available for any concerns or symptoms you experience while you go through life changes. Talk to your women’s health provider to get a specific treatment for you, but this may include:

Lifestyle changes: Diet, exercise, and stress management.
Hormonal therapies: Low-dose birth control pills or hormone replacement therapy (HRT).
Non-hormonal options: A neurokinin-3 receptor antagonist called fezolinetant, an antidepressant called Paroxetine, an anticonvulsant medication called Gabapentin, an antimuscarinics called Oxybutynin, or cognitibe behavioral therapy, or herbal supplements (under medical guidance).

Talk to your women’s health provider to discuss any concerns and find the treatment that’s right for you.

For women’s health care, visit Marshfield Clinic Health System.

Find a women’s health provider Message your primary care provider

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