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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.

8 min readUpdated Oct 2026Evidence-checked · sources listed

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 Not everyone gets all of them, and some women get very few.

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?

Longer than many of us were told. 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 sex, or any bleeding after menopause should be checked out.1 So should anything 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.