Years before the end of a woman's periods, her body will go through a natural transition called perimenopause. This change occurs as a woman's hormones gear down from the high levels needed for reproduction. This can take between one and 10 years, but the average is about three years. During perimenopause, many menstrual cycles do not include ovulation, and estrogen levels can sharply rise and then quickly drop. This causes menstrual periods to become shorter and more irregular until they stop. The fluctuations in hormones are responsible for many of the symptoms of perimenopause. These symptoms may include:

  • Irregular menstrual periods (light or heavy bleeding, skipping periods, shorter or longer)
  • Hot flashes and night sweats
  • Insomnia
  • Mood swings
  • Vaginal and bladder problems
  • Decreasing fertility
  • Changes in sexual function
  • Loss of bone density
  • Changes in cholesterol levels

Although it is common to experience changes in your menstrual cycle during perimenopause, you should not assume that all changes are due to menopausal symptoms. Contact your health care provider if you experience:

  • Bleeding is extremely heavy
  • Bleeding lasts longer than seven days
  • Bleeding occurs between periods
  • Periods regularly occur less than 21 days apart

Mood Swings

As with most symptoms of perimenopause, mood swings tend to be short-lived. They can often be controlled with healthy lifestyle choices, which include daily exercise, eating a healthy diet and getting enough sleep.


Some perimenopausal women have trouble sleeping. This can be a challenge, but by making a few lifestyle changes, you can sleep better at night. Here are a few suggestions:

  • Minimize noise
  • Turn lights off or on a low setting
  • Keep the bedroom at a cool, comfortable setting
  • Exercise earlier in the day
  • Don't drink alcoholic beverages before bedtime
  • Avoid caffeine
  • Don't smoke
  • Don't eat a big meal before bedtime

Lower Sex Drive

Declining estrogen levels may cause women to develop physical problems such as vaginal dryness and/or pain during intercourse, which may cause a decrease in sexual desire. Many factors contribute to sexual function and desire.

  • As a woman ages, it is normal to experience a gradual decline in sexual interest
  • A woman's self-image is an important factor in feeling good about her sexuality
  • Women who have night sweats often have a diminished desire for sex
  • Many drugs used to treat medical conditions, such as high blood pressure or depression, can lessen a woman's sexual desire
  • Vaginal dryness can make sexual intercourse painful

Fertility Changes

Women are born with all the eggs they will ever have. Even though a woman's fertility has declined by her late 30s and early 40s, she can potentially conceive until she reaches menopause. It is important to continue birth control throughout perimenopause to avoid an unwanted pregnancy.