What exactly is perimenopause? Experts explain how to recognize symptoms.

The symptoms of perimenopause include fatigue
The symptoms of perimenopause include fatigue, irregular periods and hot flashes. (Getty Images)

There’s a lot of talk about menopause. But menopause doesn’t happen overnight. There’s a transitional period before the start of menopause that many women don’t know much about. It’s called perimenopause, and it’s “characterized by gradual decline in ovarian function,” Dr. Kecia Gaither, director of perinatal services at NYC Health + Hospitals/Lincoln in the Bronx, tells Yahoo Life.

Perimenopause “generally begins in the 40s,” says Gaither, “but may begin in the 30s or even earlier, depending on genetics or other medical conditions.”

It also lasts longer than you might expect. On average, perimenopause lasts about four years, according to the Cleveland Clinic. During this time period, a woman’s ovaries slowly make less and less estrogen until the onset of menopause — defined as going through 12 consecutive months without a period, according to the Mayo Clinic. Hormonal levels tend to fluctuate during perimenopause, going “up and down like a rollercoaster,” according to a Cleveland Clinic website.

What are the signs of perimenopause?

Every woman is different, but symptoms of perimenopause usually include irregular periods, hot flashes, lowered libido, fatigue and exhaustion, breast tenderness, discomfort during sex due to vaginal dryness, mood swings, insomnia and urinary urgency.

Irregular periods are one of the first signs that perimenopause has started. This can include longer or shorter days between periods, flow that’s lighter or heavier than usual periods or skipped periods, according to the Mayo Clinic. However, since abnormal periods can indicate other serious conditions, it’s important to see a doctor if your periods become very heavy including clotting, last several days longer than normal or you experience spotting or bleeding after a period or after sex.

That said, it’s possible to be going through perimenopause and not realize it. Women’s health expert Dr. Jennifer Wider tells Yahoo Life that “there have been reports of people not experiencing severe enough symptoms to recognize anything. In some women, symptoms are so subtle and gradual, they don't recognize them until their period completely stops.”

How to manage perimenopausal symptoms

While perimenopause is a natural process that signals the end of a woman’s reproductive years, some of the symptoms associated with this transition period may benefit from treatment.

“Low-dose birth control pills or other hormonal options are sometimes prescribed to help with the hot flashes,” explains Wider.

Estrogen therapy, which comes in several forms including gel, cream, vaginal ring or pill, can be prescribed in some cases to stabilize estrogen levels and help with symptoms such as hot flashes and vaginal dryness. Gabapentin, a seizure medication, can also help some women with hot flashes.

While hormone therapy is used in some instances, it’s worth noting that that option carries an increased risk of uterine cancer, stroke, heart attack, blood clots and gallbladder disease, so it’s important to weigh the risks and benefits with your primary care physician.

In some cases, your primary care physician may recommend an antidepressant, which research shows can help lessen the frequency and severity of hot flashes.

In addition, Wider says that some women benefit from using a vaginal lubricant to counter vaginal dryness. According to the North American Menopause Society, “During perimenopause, less estrogen may cause the tissues of the vulva and the lining of the vagina to become thinner, drier, and less elastic or flexible,” adding that “vaginal secretions are reduced, resulting in decreased lubrication.”

When it comes to managing most natural changes in our bodies, maintaining a healthy lifestyle by eating a balanced diet; exercising consistently (including strength training); and incorporating stress management techniques such as deep breathing, meditation or yoga into your life, can make a difference.

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