Are you going through perimenopause? Here’s what a doctor says you should watch for.

By middle age, half of all women will experience menopause, but the symptoms can begin years earlier during perimenopause.

During perimenopause, many women notice symptoms like irregular periods, fatigue, trouble sleeping, hot flashes, and weight gain.

In the past, many women dealt with menopausal symptoms in silence, but now more are opening up in conversations with friends and joining online support communities. They're seeking clarity on what perimenopause really is, when it starts, and the typical symptoms. Should they check their hormone levels? How can they handle weight gain during perimenopause? What if they're struggling with sleep? What are the best sources for accurate information — and which ones should be avoided?

To help answer these questions, I consulted Dr. Leana Wen, a wellness expert with Dinogo. Dr. Wen is an emergency physician, an adjunct professor at George Washington University, and former health commissioner of Baltimore.

Dinogo: What is perimenopause?

Dr. Leana Wen: Menopause marks the point in a woman’s life when she no longer has menstrual cycles. It’s officially defined as having gone 12 consecutive months without a period.

For most women, periods don’t stop abruptly. However, in cases where menopause is triggered by surgery or certain medical treatments that halt ovarian function, it may happen suddenly. Otherwise, women experience a transitional phase lasting anywhere from four to eight years, during which reproductive hormones fluctuate. This phase is known as perimenopause.

Dinogo: When does this typically begin?

Wen: The majority of women experience menopause in their 40s or 50s, with the average age being 52, according to the US Department of Health and Human Services’ Office on Women’s Health.

Perimenopause refers to the years leading up to menopause, with most women beginning this phase in their 40s.

Dinogo: What are the common signs of perimenopause?

Wen: Irregular periods are a key indicator of perimenopause. Cycle lengths can become longer or shorter, and the frequency may change. Women may notice heavier or lighter periods, or even skipped cycles, with the gap between them growing longer, especially as they approach menopause.

Hot flashes are another frequent symptom of perimenopause. Night sweats can disrupt sleep, leading to daytime fatigue and brain fog. Mood swings may also occur due to hormone fluctuations and sleep deprivation.

As estrogen levels decline, some women experience vaginal dryness, which can cause discomfort during intercourse. This condition may also raise the risk of urinary tract infections and incontinence. Other possible symptoms include dry skin, thinning hair, and weight gain.

Dinogo: Should women have their hormone levels tested to determine if they are in perimenopause?

Wen: In general, this isn't necessary. Menopause is diagnosed clinically when a woman has gone without a period for 12 consecutive months. There's no specific test required to diagnose either menopause or perimenopause.

Additionally, hormone testing may not provide clear answers. Hormone levels fluctuate significantly during perimenopause, so a test done on one day might show different results from one taken the next day.

There are certain situations where testing may be helpful. For instance, a woman who has had a hysterectomy but kept her ovaries won’t have periods. Similarly, women on hormonal birth control like the pill may not notice changes in their cycles, as these hormones can mask other symptoms. In such cases, they may want to know if they’re approaching menopause. Women under 40 who’ve stopped having periods may also consider testing for premature ovarian failure, also known as primary ovarian insufficiency.

Other types of tests may be necessary as well. Just because a woman is at an age when perimenopause could occur doesn’t mean that all her symptoms are related to hormonal changes. It's important to rule out other potential health conditions.

Dinogo: Does weight gain occur with perimenopause?

Wen: Yes, weight gain is a common experience. Part of it is due to aging, as metabolism slows down and muscle mass decreases. Additionally, hormonal changes during perimenopause can cause fat to redistribute around the abdomen. Lifestyle factors, such as stress, work pressures, caregiving duties, and fatigue, may also lead to reduced physical activity and less focus on healthy eating.

Managing weight during perimenopause starts with a diet rich in whole foods like fruits, vegetables, nuts, lean meats, fish, and whole grains. Reducing intake of ultraprocessed foods, which are linked to obesity, diabetes, heart disease, cancer, and other health issues, is crucial. Smoking cessation and monitoring alcohol consumption are also important, as both can contribute to extra calories and weight gain.

Regular exercise is essential, especially for those with desk-based jobs. It's important to find ways to include short bursts of activity throughout the day. The most effective workout routines include both aerobic exercises and strength training with weights. Prioritizing good sleep is also crucial, as consistent poor sleep is linked to weight gain.

Dinogo: Speaking of sleep, what can perimenopausal women do if they're struggling to sleep?

Wen: Understanding the root causes of sleep disturbances is key. Is it night sweats, or are you experiencing hot flashes during the day as well? If so, treatments can help. If stress, depression, or anxiety are involved, those mental health concerns need to be addressed too. Starting with good sleep hygiene is always beneficial — establishing a regular sleep schedule, avoiding naps and alcohol, and refraining from screen time in bed are all helpful strategies.

Dinogo: Is hormone therapy recommended for women in perimenopause?

Wen: It's important to distinguish between systemic hormone therapy, which affects the entire body, and localized treatments that target specific areas of the body with hormones.

For some women, systemic hormone therapy can be beneficial. Women dealing with severe hot flashes, for example, may find relief through treatments like pills, patches, or sprays. It's important to consult with a primary care provider to discuss symptoms and determine whether this treatment is suitable.

Dinogo: Can targeted hormone therapy help with other symptoms, such as vaginal dryness?

Wen: Yes, there are various treatments, including vaginal tablets, creams, and rings, that can deliver estrogen directly to the vaginal tissues. These can help alleviate dryness, discomfort during intercourse, and some urinary issues.

Dinogo: Where can people find reliable information about perimenopause and menopause? Are there sources to avoid?

Wen: If you have a trusted primary care provider experienced in menopause management, they are a great resource. I highly recommend The Menopause Society as a reliable source of information.

Many companies offer products for menopause and perimenopause, some of which provide helpful information. However, it's important to exercise caution, as these companies often have commercial goals that may not always align with the best interests of individual patients.

To cope with the anxiety and stress some women feel, connecting with friends — both in person and online — who are experiencing the same transition can be helpful. These groups can also be a valuable source of shared knowledge, but it’s crucial to ensure the information comes from trustworthy, reputable sources.