An empowering guide to 

What is perimenopause?

By Tequia Burt, who’s going through perimenopause right now

everything you need to know

Even doctors say perimenopause is under-studied

On top of that, my digestive system was a wreck and my anxiety levels continued to mount. I couldn’t figure out what was wrong with me. So, I went to my doctor and was prescribed anti-anxiety meds and told to take fiber supplements and get more exercise. But my diet nor lifestyle had changed. What was happening? Why was my body starting to betray me?

What my doctor didn’t mention was that I, like millions of women my age — 43, btw — was probably experiencing symptoms related to perimenopause. But also like most American women my age, I didn’t know much about perimenopause, what it was, or what it meant.

All of a sudden, about a year ago, I couldn’t get any sleep. Every night, like clockwork, I’d wake up at 3 am, tossing and turning. This was super distressing because, for most of my life, I could sleep anytime, anyplace. Upright in a chair. After a cup of coffee. At a punk concert. Now, I had no idea what kept waking me up in the middle of the night. And I needed sleep to function well.

Stephanie S. Faubion, author of the Mayo Clinic’s The Menopause Solution, is the director of the Women's Health Clinic at the Mayo Clinic where she has practiced for more than 10 years. She says that for her patients, sometimes perimenopause is shrouded in mystery. 

“We get the talk when we’re in 5th grade when we’re about to start our periods, but nobody gives us the talk when we're about to stop our periods,” she explains. “And this is a problem because women are blindsided by some of the symptoms. I have patients who come to the Mayo Clinic thinking that they’re dying because they’re gaining weight, losing hair, are irritable and anxious, and have acne for the first time since they were a teenager. They think something is horribly wrong because we as women haven’t been educated about the perimenopausal stage of life.”

A number of Gen-X women grew up as feminists and are used to kicking ass and taking names. It’s tough to admit that we don’t know everything. (I know.) Now, that we’re grown-ass ladies, though, we’re starting to realize that we still have things to learn — about our own bodies.

Author of the Mayo Clinic's The Menopause Solution

“We get the talk when we’re in 5th grade when we’re about to start our periods, but nobody gives us the talk when we're about to stop our periods.” 


If you Google the “average age for perimenopause,” you’ll likely find it starts “sometimes in your 40s.” But wait a minute, sometimes you’re a late bloomer and you won’t start experiencing symptoms until your 50s. Or maybe you like to get a head start on things so you may even begin dealing with perimenopause in your 30s. So, essentially, women have to be on the lookout for vague perimenopausal symptoms for three decades of their lives.

So, let’s start with the basics. 

What’s the difference between perimenopause, pre-menopause, menopause, and post-menopause?

Pre-menopause vs. perimenopause

First of all, I had no idea there was such a thing as pre-menopause. If I did hear a term like that, I’d probably just assume it was the same thing as perimenopause. However, though the terms are sometimes used interchangeably, there are differences between pre-menopause and perimenopause. 

Pre-menopause is when some hormonal changes may be occurring, but there are no noticeable changes in your body, and you have no discernible symptoms of going through perimenopause or menopause. 

In contrast, during perimenopause, you will start to experience symptoms of menopause, like, for example, shifts in your menstrual cycle, insomnia, and mood swings. During perimenopause, your body is beginning the transition into menopause as your ovaries produce less and less estrogen. Your menstrual cycle may become irregular, but it won’t stop completely during perimenopause. This stage may last anywhere from two to eight years (or more).

Menopause vs. post-menopause

Once you completely stop having a menstrual cycle for 12 consecutive months, you’ve officially entered menopause. This happens when the ovaries produce so little estrogen that eggs are no longer released. Most women reach menopause between the ages of 40 and 58, though the average age is 51.

Post-menopause, on the other hand, is the stage that occurs after you’ve ceased menstrual bleeding for an entire year. During this stage, menopausal symptoms, such as hot flashes, may improve for many women. However, some women may continue to experience menopausal symptoms for a decade (or longer) after menopause.

What are the symptoms of perimenopause?

Since hot flashes are often associated with menopause, it was a big surprise to find that usually hot flashes show up earlier, during perimenopause. In fact, hot flashes is the most common symptom of perimenopause.

But not everyone gets hot flashes. Karin Newton, who lives in Berkeley, California, was 45 when she first started experiencing perimenopause. Her symptoms included an unpredictable sex drive, sleep disturbances and mood swings, but there was not a hot flash in sight.

“What happens in perimenopause is that you wake up one day and you’re in a rocket ship,” she says. “And you’re the only one in it. And you have a manual, but it’s not a manual to the rocket ship you’re in, but a general rocket ship manual. You just have to learn how to fly the damn thing yourself and try not to crash into an asteroid.”

The symptoms of menopause vary widely and are individual to each woman, says the Mayo Clinic’s Dr. Faubion. What may look like perimenopause to one doctor may look like a thyroid problem to the next. “You’re not crazy,” she says. “The symptoms women experience are very real but very variable.” 

Some of the most common symptoms of perimenopause

• Irregular periods
• Sleep disruption or insomnia
• Hot flashes
• Mood swings
• Weight gain
• Brain fog
• Decreased sex drive
• Worse PMS
• Breast tenderness
• Skin changes (acne or dry skin)
• Hair thinning
• Headaches
• Change in heartbeat
• Anxiety 
• Irritability
• Depression
• Night sweats
• Fatigue
• Peeing when you sneeze
• Frequent urination
• Vaginal dryness
• Discomfort during sex
• Cold intolerance

So, is it perimenopause or a thyroid disorder?

When I went to my doctor and told her about some of my perimenopausal symptoms, she immediately ordered a thyroid test. Often, because they are so similar, symptoms of perimenopause can point to hypothyroidism, which occurs when the thyroid no longer produces enough crucial hormones to keep the body functioning properly. To make matters more complicated, perimenopause can also contribute to an underactive thyroid. Common symptoms of both perimenopause and hypothyroidism include fatigue, forgetfulness, mood swings, weight gain, irregular menstrual cycles, and cold intolerance. 

If left untreated, hypothyroidism can lead to high cholesterol, osteoporosis, heart disease, and depression. However, there is a test for this and if you experience any of these symptoms, talk with your doctor.

Is there a test for perimenopause? 

In a nutshell, no, there is not a definitive hormone test for perimenopause — yet, anyway. There is no hormone test to diagnose perimenopause because hormonal cycles are so erratic and unpredictable during this stage. Further muddying the waters, perimenopause symptoms are so variable and mimic so many other possible things, it can be hard for doctors to pinpoint.

Jill Clements, 44, had a baby after 40 and now she says she can’t tell the difference between what may be perimenopausal symptoms from postpartum symptoms.

“Are the mood swings, breast tenderness, and anxiety the result of me having a baby or of me going into perimenopause? At my age, it’s hard to tell,” she says.

Surprisingly, sometimes doctors aren't prepared to help women recognize the start of this life phase, and women aren’t really taught how to recognize it themselves, either.

Amy Cuevas Schroeder, Jumble & Flow’s cofounder, was 42 when she first started experiencing perimenopause symptoms. Like Jill, she had trouble distinguishing whether her symptoms were related to perimenopause or were postpartum as she had delivered twins a couple of years before. After researching her symptoms – anxiety, mood swings, weight gain in the midsection — she felt strongly that she was experiencing perimenopause. However, because her period was not yet irregular and she was still in her early 40s, both her general doctor and her gynecologist dismissed her claims. 

“I felt like I wasn’t being listened to and my concerns were just written off really quickly even though I kept experiencing symptoms,” she says. “I had all the tell-tale signs of perimenopause, so I continued to do online research and talk to friends who were experiencing the same thing. What I found was that there were a lot of women going through the same thing I was going through, so I knew I was not alone.”

What are perimenopause treatment options?

As perimenopausal women approach menopause, the chance for depression increases significantly. Certain SSRI antidepressants may help alleviate depression and anxiety as well as temper menopausal hot flashes.

Cuevas Schroeder experiences just about all the common symptoms — except for hot flashes. “But that’s probably because I’m taking Prozac for depression,” says my doctor, Dr. Traci A. Kurtzer, MD, a member of Northwestern Medicine Center for Sexual Medicine and Menopause in Chicago.

12 things I tried to help with symptoms of perimenopause

Vaginal estrogen
To help relieve vaginal dryness, vaginal estrogen can be inserted as a vaginal tablet, ring or applied as a cream. Vaginal estrogen can help ease vaginal dryness, discomfort during sex and some urinary symptoms.

The frontline treatment that doctors often recommend for perimenopause is hormone therapy. Essentially, this means taking a low-dose birth control pill in the stage before menopause.

“Perimenopause is a hormonal condition, so it makes sense to treat it with hormones — bottom line you aren’t going to treat these symptoms 100% without taking hormones,” says the Mayo Clinic’s Dr. Faubion. “On low-dose oral contraceptive pills, you won’t have hot flashes and night sweats. They help limit abnormal bleeding, prevent pregnancy, and control acne.”

However, for smokers, women carrying a little bit of extra weight, or for those who aren’t comfortable with hormonal treatments, there are other options including other medications, cognitive behavioral therapy, meditation, and vitamins and herbal supplements.

Vitex (also called chaste berry)
I’ve personally used vitex with great success for helping to regulate my menstrual cycle and even out my moods. Vitex helps treat various conditions related to a woman’s reproductive system, including menopause. According to one study in which women were given vitex, 33 percent experienced major improvements, and another 36 percent reported moderate improvements in symptoms, including night sweats and hot flashes. 

Vitamin B-6
Taking a vitamin B-6 supplement during perimenopause may help ease symptoms caused by low serotonin levels, including loss of energy and depression. It can also help regulate cycles.

Black Kohosh
One of the most popular and studied supplements to help treat hormonal imbalances and hot flashes during all stages of menopause.

Wild Yam
Some of the natural compounds in these yams appear similar to estrogen and progesterone and pills and creams made from certain species are popular alternatives to hormone therapy.

Flax seeds
Flax seeds contain phytoestrogens (lignans, to be exact) that have estrogen-like qualities to help balance hormones. Whether they work, however, is widely debated.

Dehydroepiandrosterone (DHEA)
This is natural steroid is produced by your adrenal gland and supplements can help boost your libido, which is sometimes reduced during perimenopause.

Red clover
Also contains another plant estrogen purported to help regulate female hormones. I like to drink it as tea.

This may be helpful for alleviating perimenopause symptoms as ginseng has been shown to boost mood and improve sleep.

Maca root has been cherished by Peruvians for its medicinal properties for ages. It is a highly nutritious food supplement for women in all stages of menopause as it contains high levels of vitamin C, potassium, copper, and B-6. Several studies found that it helps alleviate perimenopause symptoms like hot flashes and sleep disruptions.

Looking for more information about perimenopause?
You've come to the right place. Jumble & Flow is a new lifestyle brand for women over 40 and we're growing to become one of the most helpful sources of information for women in perimenopause.

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About the author

Tequia Burt is a writer and gardener based in Chicago. She works for LinkedIn and has two kids.

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Among women aged 40–59, perimenopausal women (56%) were more likely than postmenopausal (40.5%) and premenopausal (32.5%) women to sleep less than seven hours, on average, in a 24-hour period.

Source: The Centers for Disease Control and Prevention (CDC).

Race, age at first period, use of birth control pills or fertility medications do not seem to be determining factors of when women enter menopause.

Source: The North American Menopause Society

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While most American women have hot flashes as a symptom of perimenopause, studies of other cultures suggest this experience is not universal, according to the Harvard Medical School. Far fewer Japanese, Korean, and Southeast Asian women report having hot flashes, while in Mexico's Yucatan peninsula, women appear not to have any at all. These differences may reflect cultural variations in perceptions, semantics, and lifestyle factors, such as diet.

FAST FACT: Are hot flashes an American phenomenon?

FAST FACT: Smokers begin menopause about two years earlier than nonsmokers

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