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Perimenopause: the signs and the stages

If your periods, sleep, or moods have started doing things they never used to, you’re in good company. Here’s the lay of the land.

Updated Oct 2026Evidence-checked · sources listed

Information for better conversations, not a diagnosis. This is research with sources, not medical advice. Talk to your clinician about your situation.

The words, defined

  • Perimenopause is the transition leading up to menopause, when hormone levels fluctuate and periods become irregular.12
  • Menopause is confirmed after 12 months in a row without a period (when no other cause explains it).12
  • Postmenopause is everything after that.2

When does it happen?

In the US, the average age at menopause is around 51, and the transition can start years earlier.1 The NIA notes that most women begin the transition between ages 45 and 55, and that it may last several years.2

Common signs

Commonly reported changes include irregular periods, hot flashes and night sweats, trouble sleeping, vaginal dryness, mood changes, and changes in sexual desire.12 The NIA notes that some women have no or only mild symptoms.2

The stages researchers use

The STRAW+10 framework splits the transition into an early stage (cycle length starts varying by 7 days or more) and a late stage (60+ days between periods), followed by the postmenopause stages.3 Your clinician may not use these labels, but they’re useful for describing what you’re noticing.

How long do hot flashes last?

In the large US SWAN study, the median total duration of frequent hot flashes and night sweats was about 7.4 years.4

When to call your clinician

Very heavy bleeding, bleeding between periods or after intercourse, or any bleeding after menopause should be checked out.12 It’s also worth raising any symptom that is disrupting your life. Our symptom tracker can help you describe it.

Sources

  1. ACOG. The Menopause Years (FAQ). www.acog.org
  2. National Institute on Aging. What Is Menopause? www.nia.nih.gov
  3. Harlow SD et al. Executive summary of STRAW+10. Menopause, 2012. pubmed.ncbi.nlm.nih.gov
  4. Avis NE et al. Duration of menopausal vasomotor symptoms over the menopause transition (SWAN). JAMA Intern Med, 2015. pubmed.ncbi.nlm.nih.gov

Information for better conversations, not a diagnosis. We’re not clinicians; we read the research and show our sources. See our disclaimer.