Perimenopause: What can I expect?

Written by the Progyny Editorial Team. Reviewed by the Progyny Clinical Team — July 2026.

Perimenopause is the transitional period before menopause. It may last for years and can lead to physical and emotional changes as hormones fluctuate.

Let’s talk about what’s happening during this time, how perimenopause may affect you, and how to find support to feel your best.

What’s happening in my body?

During perimenopause, your body is preparing for menopause (defined as the time when you’ve stopped having a period for 12 months).

Overall, the hormones estrogen and progesterone trend down during perimenopause – and the course is unpredictable. Hormones can spike both up and down over these months and years, and the changes can be rapid. This affects your menstrual cycle and may cause a number of symptoms.

Everyone has a different experience, including when the transition starts and ends.

• Perimenopause often starts in our mid to late 40s. It’s possible sooner (early 40s) or later (early 50s).
• Menopause typically happens in our early 50s, with an average age of 51 or 52. It may be sooner or later.
• In all, perimenopause lasts an average of 4 to 7 years. It can range from 2 years to 10 years or more.

Early perimenopause

Early perimenopause signs might not be obvious.

Often, the earliest signs are changes from your period. Cycles may be shorter or longer, and the flow may be lighter or heavier. You may also skip your period. There’s a wide range of what’s expected, so the main thing is to track your periods and notice when something is different for you.

Other early signs may include:

• Sleep disruption and mood changes
• Hot flashes and night sweats
• Vaginal dryness
• Low libido
• Weight gain from hormone shifts, increasing belly fat, and loss of lean body mass

Late perimenopause

As perimenopause goes on, estrogen levels continue to fluctuate and trend down. Some people aren’t bothered much, while others have severe symptoms that affect their quality of life.

Common symptoms include:

• Period changes: As ovulation becomes less frequent, you’ll begin to skip more menstrual cycles.
• Hot flashes and night sweats: This may feel like a sudden wave of heat starting within your body and spreading over your face and chest. You may sweat or have chills.
• Vaginal and urinary changes: Increased vaginal dryness and less elastic vaginal walls can cause painful sex, discomfort, and issues like leaking urine and increased urinary frequency and urgency.
• Cognition problems (brain fog): Forgetfulness (“What’s that word again?”) and trouble focusing are common.
• Emotional changes: Hormone shifts may lead to mood swings or irritability. Depression or anxiety may be more likely, especially if you’ve had it before.
• Sleep disturbance: You may have trouble falling asleep, wake too early, or wake in the middle of the night.
• Low libido: Decreased estrogen may lead to lower sexual desire. Symptoms like poor sleep, mood disturbance, and vaginal changes can contribute as well.
• Joint pain and muscle aches: Along with aging and inflammation, lower estrogen may add to joint pain and muscle aches.

This isn’t a complete list (the joys!). Again, keep in mind that people have a wide range of experiences. Some people have few to almost no symptoms, or aren’t bothered by their symptoms.

Finding support for your perimenopause journey

Perimenopause is a natural time for everyone with ovaries. It’s always OK to talk about how you’re feeling, ask questions, and seek support.

It might be time to seek care if you’re bothered by symptoms or wonder if something is normal. Treatments are available to help you feel your best. These may include lifestyle changes, various types of medicine, and/or menopause hormone therapy.

Your gynecologist or a menopause specialist can work with you on a personalized care plan that’s right for you. Your Progyny Care Advocate is also here to help you make lifestyle changes, find answers, and lend the support you need over time.

Explore related: 

• How will my period change during perimenopause? 

Disclaimer: The information provided by Progyny is for educational purposes only and is not medical advice. Always consult a qualified healthcare provider for medical guidance.