Normal Menstrual Cycle

Reference Perimenopause Opens New Window, which means "around menopause," refers to the 2 to 8 years of changing hormone levels and related symptoms that lead up to Reference menopause Opens New Window. The most common sign of perimenopause is longer, often irregular menstrual cycles that are caused by hormonal ups and downs.

Most women start perimenopause between ages 39 and 51.^{Reference 5} Some women begin to notice menstrual changes and Reference premenstrual syndrome (PMS) Opens New Window symptoms in their late 30s when hormones begin to fluctuate and fertility naturally declines. Other women don't notice perimenopausal changes until their late 40s.

Perimenopause is a time of unpredictability. Menstrual and hormone-related symptoms are different for every woman. Some notice few or no changes. And others have severe symptoms that disrupt their sleep and daily lives. As during the teen years, irregular cycles can lead to Reference heavy menstrual bleeding Opens New Window. Other common symptoms include mild to severe Reference hot flashes Opens New Window, Reference insomnia Opens New Window, cloudy thinking, headaches, heart palpitations, mood swings, irritability, depression, and anxiety. Some of these symptoms can also be related to aging and other life changes. See your doctor to discuss your symptoms, whether you want symptom treatment, and which therapies you can consider.

See a doctor for menstrual bleeding that lasts longer than 7 days or for cycles that are shorter than 21 days or longer than 35 days. For more information, see the topics Reference Dysfunctional Uterine Bleeding and Reference Menopause and Perimenopause.

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