What Is Perimenopause? OB/GYNs Weigh in on What to Expect

And what it means for your fertility.

woman in her 40s


Chances are you've heard a little something about menopause. Hot flashes, difficulty sleeping, night sweats, irritability and vaginal dryness top the list of symptoms, and eventually there's a silver lining to it all: Your period stops.

While it's great we're talking about menopause at all (historically people going through it have little to reference), there's an often overlooked life stage that comes before menopause. It's called perimenopause. Typically perimenopause occurs sometime in your 40s and comes with its own batch of unique, often annoying symptoms. But what is perimenopause, exactly, and what does it mean for your fertility? We asked the experts—here's everything you need to know.

What is Perimenopause?

By definition, menopause is when a woman goes one year without a period without any other explanation. While every person is different, the average age of menopause in the U.S. is 51.3. Then there's perimenopause, the time frame before menopause which can go on for several years. "Perimenopause can be marked by erratic periods—irregular, some heavier, some lighter—and menopausal symptoms like hot flashes, night sweats, insomnia, and vaginal dryness, to name a few," says Mary Jane Minkin, an OB/GYN and clinical professor at Yale School of Medicine. "And you can have these symptoms without even skipping one period. It's a time of significant hormonal fluctuation."

Meet the Expert

Mary Jane Minkin, MD, is clinical professor in the Department of Obstetrics, Gynecology, and Reproductive Sciences at the Yale University School of Medicine, and has been in private practice in New Haven (CT) for more than 40 years. Dr. Minkin is board-certified in obstetrics and gynecology, and she practices at Yale-New Haven Hospital. 

When your period stops for good, which will likely happen sometime in your early 50s, you're likely no longer able to conceive. But what about during perimenopause, when you're still getting a period but it's not regular? "In perimenopause, there will be a decrease in estrogen and, therefore, affect the ovulation cycle and the quality of the follicles released from the ovaries," says Dr. Jessica Shephard MD, OBGYN and partner with Happy V. "This ultimately decreases the ability to spontaneously conceive."

While it might be more difficult to conceive during perimenopause, Minkin notes it's not impossible. "We tell our patients to use contraception until they're fully menopausal, presuming they don't want to get pregnant," she says. "I personally have delivered babies to three women aged 47 who were not trying to get pregnant! But if you think you may be perimenopausal and do want to get pregnant, you should be in touch with your gynecologist as soon as you can to maximize your chances."

How to Make Perimenopause More Bearable

Whether you have mild symptoms or severe symptoms, you don't have to suffer through the night sweats and hot flashes until your period eventually stops for good. Actually, there's a lot you can do to manage your symptoms. "Consider bioidentical hormones for stabilization of hormones," suggests Shephard. And if hormones aren't your thing, try making a few positive lifestyle tweaks. "Increasing exercise for heart health also helps minimize symptoms," he adds. "It's also important to give the body the nutrients it needs. I recommend my patients incorporate more omega-3 fatty acids from fish to decrease inflammation in the body and limit saturated fats, dairy, sugar, and alcohol."

The Product That Can Help

If vaginal dryness is an issue, there's a lot you can do about that, too. "You can go to your pharmacy and pick up some Replens vaginal moisturizer, and its companion product for external dryness around the vulva," says Minkin. "If you need a lubricant, Replens Silky Smooth is quite good."

What about hot flashes and night sweats that make your whole body feel like a furnace? "Remifemin, which is a German black cohosh product, is also available at pharmacies," Minkin says. "Relizen, a Swedish pollen extract, is available online."

If you have any concerns about perimenopause—or simply want extra tips fo managing symptoms—be sure to chat with your OB/GYN, who can help cater to your specific needs and issues.

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