• Mayo Clinic Q & A

    Mayo Clinic Q and A: Perimenopause transitions and concerns

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DEAR MAYO CLINIC: I am 41 years old, and at my last women’s health appointment, I was told I was in perimenopause. What exactly does that mean? I haven't had any symptoms. What should I expect? Is there anything I should be doing to prepare?

ANSWER: Perimenopause refers to the time of your life when your body starts making the natural transition to menopause, marking the end of the reproductive years. Perimenopause can begin as early as your mid 30s. As you go through perimenopause, your body's production of estrogen — the main female hormone — rises and falls. These fluctuations can bring on symptoms such as irregular periods, hot flashes and vaginal dryness. Once you have gone 12 consecutive months without a menstrual period, you have officially transitioned from perimenopause to menopause. Menopause can happen in your 40s or 50s, but the average age is 51.

Perimenopause is a natural biological change. Because symptoms can come and go, many women feel like they are on an emotional roller coaster. Though not every woman will experience every symptom, the most commonly reported issues include common ailments that women might not realize are associated with menopause. It is important for you to know this is normal. It helps to understand more about the symptoms you may be experiencing.

Hot flashes and sleep problems

When a hot flash happens, you might feel a sudden sensation of warmth or heat, most often in your upper body around your face and neck. This can cause your face to become red and flushed, and you may begin sweating. Hot flashes also can happen when you are sleeping. These "night sweats" can interfere with getting a good night's sleep.

Mood changes

Changes in mood are common and can include irritability, fatigue, sadness or anxiety. These mood swings can be a result of declining estrogen levels. Depression also is a common side effect of menopause. It is important to share how you're feeling and the changes in your mood with your healthcare professional.


During perimenopause, you might also begin to notice you are having difficulty with your memory and concentration. You might find it hard to remember simple things, like where you placed your keys or why you walked into a room. This is sometimes called "brain fog," and it is quite common. I often have women express concerns that this could be an early sign of dementia, which is not typically the case. Many studies have shown that brain fog associated with menopause is temporary, and cognitive function returns. Brain fog also can result from lack of sleep and proper rest. When sleep improves, we often see memory improvements as well.

Weight gain

Often women notice they are eating the same and exercising the same, yet suddenly they are gaining weight. It is common for women to notice weight gain during the perimenopause and menopause transition, particularly around the midsection. Metabolism changes and muscle loss often cause this as we age. Weight gain can seriously affect your health, so now is an important time to lean into your healthy lifestyle habits.

Next steps

Again, since not every woman will experience the same symptoms — or experience them with the same severity — perimenopause is the perfect time to devise a plan to manage the changes you are, and will be, going through. There are many books and resources available online as well, which you may want to review and use to connect with others.

During menopause, your risk of certain diseases and conditions increases, including heart disease, osteoporosis and urinary tract infections. You can do many things to ease your symptoms and protect your health.

Make sure you are incorporating healthy lifestyle habits, including:

  • Getting regular exercise that includes cardiovascular and resistance training. This will help prevent muscle loss, boost metabolism and strengthen bones. Resistance training can include lifting weights or doing exercises using your own body weight.
  • Eating a healthy, balanced diet and avoiding processed foods and excess sugar.
  • Limiting or eliminating alcohol use.
  • Maintaining a healthy weight.
  • Quitting smoking or any use of tobacco products.
  • Reducing your stress and paying attention to your mental health.

Although it is often a source of concern, hormone therapy also can help improve symptoms of menopause. Estrogen therapy is still the most effective treatment option for relieving hot flashes. Estrogen also helps prevent bone loss. There are also nonhormonal options. It is important to talk to your healthcare team about the risks and benefits of each treatment, and which one is right for you.

Every woman's experience during perimenopause and menopause is different. It is not uncommon for women to feel insecure and isolated as these changes occur. Know you are not alone. Seek out support from family, friends and other groups that can offer you a safe place to share what you are going through. If you feel like you can't cope, seeking help and consulting your care team is important. — Dr. Juliana (Jewel) Kling, Women's Health, Mayo Clinic, Phoenix


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