The years leading up to menopause can feel long and unpredictable. Marked by irregular
hormone levels and the many side effects that come along with this shift, there’s no crystal ball that tells you how long
perimenopause will last before you can finally ditch the pads, tampons, and cramps for good.
“The timing is so highly variable because it's different for every woman,” says Stephanie Faubion, MD, the director of the Mayo Clinic Center for Women’s Health in Jacksonville, Florida, and the medical director of the Menopause Society. “If you go 60 days without a period, you’re probably getting closer,” she says.
Here are some signs that your reproductive years might be winding down — and how to find relief for as long as your menopausal transition lasts.
1. Your Periods Become More Irregular
Changes to your
menstrual cycle are the hallmark sign of late-stage menopause. While some women will have periods that come less frequently and are lighter in flow, others may have periods that come more often and are heavier than they once were.
But whichever direction the timing or intensity of your bleeding is headed, the irregularity itself is a sign your reproductive system is winding down.
“Some women’s periods just end and they don’t have another one, and some women have occasional periods for a long time,” says Dr. Faubion.
By definition, the menopausal transition is definitively concluded one year after the last menstrual period, which marks the end of perimenopause, says Mary Rosser, MD, PhD, an ob-gyn, menopause expert, and the director of Integrated Women's Health at Columbia University’s Irving Medical Center in New York City.
If you are bleeding more instead of less, it can leave your body depleted. Heavy, prolonged menstrual bleeding causes fatigue that’s unrelated to sleep disturbances associated with perimenopausal symptoms. Heavy menstrual bleeding can also lead to
iron deficiency, which is linked to fatigue.
Talk to your doctor about taking an
iron supplement if you’re concerned about how much blood you’re losing.
2. Hot Flashes and Night Sweats Could Ramp Up
Menopausal vasomotor symptoms, which include both hot flashes and night sweats — the middle-of-the-night overheating episodes — may also kick into higher gear in the waning years of your period. But that’s not how it happens for everyone.
“Hot flashes and night sweats vary in frequency and duration throughout the menopausal transition,” says Dr. Rosser. “There is substantial variability among women in both when symptoms begin and how long they persist.”
As many as 8 in 10 women will experience hot flashes, which can involve the upper body suddenly heating up for a few seconds to minutes, along with some of these other symptoms.
- Chills
- Clammy skin
- Flushing
- Heart palpitations
- Sweating
- Anxiety
If your body temperature is disrupting your life while you’re awake or asleep, you can discuss treatment options with your healthcare provider. Beyond lifestyle changes such as dressing in layers or
eating certain foods that may turn down the heat, hormone therapy is the main treatment prescribed for women.
Those who don't want to take hormones may want to consider certain
antidepressants, or elinzanetant (Lynkuet) or
fezolinetant (Veozah), which are both daily pills approved by the U.S. Food and Drug Administration to treat hot flashes and night sweats.
3. Vaginal Dryness and Changes in Libido May Become More Noticeable
“Vaginal dryness results directly from low levels of estrogen associated with the decline in ovarian function during the menopausal transition,” says Rosser. “The lining of the genitourinary tract (vulva, vagina, and urinary tract) becomes thin and loses elasticity, and the vaginal pH changes, altering the vaginal flora and increasing the risk of infection, such as urinary tract infections.”
If your symptoms are undermining your comfort or sexual relationships, talk to your healthcare providers about treatments. Options include vaginal moisturizers — both inserted into the
vagina and external ones made for the vulva — or hormone treatments like estrogen creams, tablets, or vaginal rings. These options deliver less estrogen than oral hormone therapy and have fewer risks.
4. Mood Swings and Sleep Disruptions May Increase
One of the more debilitating midlife changes for women are
mood swings that can make you feel like an entirely different person. Women who were once easygoing may quickly become irritated or angry, while others may ruminate with worry or experience symptoms of
depression.
And a lack of
quality sleep that often comes during this stage of life can bring on the same types of unfamiliar symptoms.
Faubion says mood swings are likely caused by hormonal variability — not exact levels of hormones — and women who experienced mood issues throughout their fertile years may be more likely to have this issue during the menopausal transition, too.
“Mood swings and sleep disruptions tend to increase in many women as perimenopause progresses, with an abrupt increase as women approach the later stages of the menopausal transition and experience longer times without menses,” says Rosser.
Beyond mood-improving prescription medications,
stress reduction, quitting smoking, and limiting alcohol intake can all help your mood, as can the health fundamentals of more exercise and a well-balanced diet abundant in fruits, vegetables, whole grains, and lean proteins.
5. Changes in Skin and Hair Texture Become Apparent
Fluctuating hormone levels can also begin to create changes in how you look in the mirror. Estrogen helps the skin produce
collagen and elastin, which helps keep skin firm and smooth.
Hair is also impacted by the lack of female hormones, leading to thinning, loss of volume, and textural changes.
Growing — and looking — older is a natural part of aging. But if these changes are dramatic and concerning to you, talk to your dermatologist about options to minimize their appearance. Protecting your skin from the sun and using skin products that contain retinol or peptides can help, as can hair-loss drugs such as minoxidil or laser treatments. Clinical guidelines don’t currently support hormone therapy solely for estrogen-deficient skin, because of a lack of robust clinical trials.
Rachel Green
Rachel Davis
Derek Schulz
Sophia Martinez
Dr. Amara Okafor