Straight answers
Perimenopause: symptoms, age and what can be done
Perimenopause is the natural stage when your body starts the transition towards menopause. It isn't an illness and it isn't the end of anything: it's a hormonal shift, a very common one, with a name of its own and — this is the important bit — plenty you can do about it. Here's what it is, when it arrives, what it can throw at you and what actually helps. No drama.
In short
- It's a normal stage, not an illness.
- For most women it starts from 45, though it can begin earlier, and it typically lasts 4 to 8 years.
- The classic sign: your periods start to go irregular.
- Symptoms vary hugely from one woman to the next, and plenty of them are mild.
- Almost all of them can be eased. You don't have to put up with it.
What exactly is perimenopause?
"Peri" means "around". Perimenopause is the time before menopause, when the ovaries produce oestrogen more and more erratically. That's where the ups and downs come from: hormones rise and fall with no fixed pattern, and your body notices.
It counts as menopause once you've gone twelve months without a period. Everything before that — swings and all — is perimenopause. And what comes afterwards is postmenopause. Put another way: menopause is the finish line; perimenopause is the road, and that's where nearly all the symptoms happen.
When does it start, and how long does it last?
The average age of menopause is 51, and it usually happens between 45 and 55, according to the NHS. Perimenopause starts a few years earlier: for most women from 45, according to the US National Institutes of Health, though it can start earlier. The European Society of Endocrinology guideline recommends considering it from 40 to 45 if periods become irregular or hot flushes appear. It usually lasts 4 to 8 years.
That matters more than it might seem: knowing this window exists helps you recognise what's happening and put a name to it, instead of assuming something is wrong.
The most common symptoms
No two perimenopauses are alike. Some women barely notice a thing; others go through a much rougher patch. These are the most common ones, with the numbers to go with them, so you can see you're not the exception:
- Changes to your periods. Shorter or longer cycles, heavier or lighter bleeding. It's the classic sign, and nearly always the first one you'll spot.
- Hot flushes and night sweats. The headline symptom. Up to 8 in 10 women get them at some point in the transition.
- Sleep that just won't come. Waking at 4 a.m., struggling to drop off. Between a third and two thirds of women notice it, depending on the study — from 37% in SWAN to 2 in 3 in the Spanish DOMMA study.
- Tiredness that sleep doesn't fix. One of the most common symptoms of this stage — and one of the least talked about. We cover it in extreme fatigue and perimenopause.
- Mood and anxiety. Irritability, low patches, more anxiety. The hormonal swings make everything land harder — it isn't "just you".
- Brain fog. Losing words, losing your thread, struggling to concentrate. It's documented right across the transition and, for most women, it stays mild: only 11 to 13% reach clinically significant impairment. It usually passes — we explain it in brain fog and perimenopause.
- Joint pain. Stiffer or achier joints — more common than almost anyone expects: between half and seven in ten women, from 51.7% in a Spanish survey of 1,750 women to 71% in a meta-analysis of 14 studies.
- Genitourinary symptoms. Dryness, discomfort or recurrent UTIs. We go into this properly in vaginal dryness and perimenopause.
- And some that catch you off guard. Like frozen shoulder, which almost nobody connects to hormones.
A long list doesn't mean you'll get the lot. Most women notice only a handful, and plenty of those are perfectly manageable.
The important part: you don't have to put up with it
Here's the good news, the bit almost nobody tells you. First, getting a diagnosis is simple: it comes down to your symptoms, the changes to your periods and, above all, your own experience. So tell your doctor the details, even the ones that seem beside the point.
And second: there are things that help. Good habits, for a start — sleep, movement, eating well and keeping stress in check won't fix everything, but they make a difference.
Beyond that, there are effective treatments backed by clinical guidelines. Which of them is right for you is a personal decision, so the best thing you can do is talk it through with a professional who knows this stage well. There are more — and better — options now than there have ever been.
If you already use HRT in Spain and can't find it at the pharmacy, here's what's going on with the shortage and what to do.
This is exactly what Maia is for. The hard part is rarely one symptom on its own: it's that the brain fog, the 4 a.m. wake-ups, a mood that's hit the floor and the dryness all look like unrelated glitches. Maia connects the dots so you can see the whole picture and finally understand what's going on.
Join the waitlistFrequently asked questions
At what age does perimenopause start?
For most women it starts from the age of 45, though it can begin earlier: the European Society of Endocrinology recommends considering it from 40 to 45 if periods become irregular or hot flushes appear. It typically lasts 4 to 8 years. Menopause itself — your last period — comes at 51 on average.
How do I know if I'm in perimenopause?
Mainly from two things: changes to your periods (more irregular cycles) and new symptoms such as hot flushes, insomnia or mood changes. From the age of 45 you generally don't need a hormone test to confirm it, because hormones fluctuate so much that a one-off blood test tells you little. If you're unsure, talk it through with your doctor.
How long do perimenopause symptoms last?
It varies enormously from one woman to another. Hot flushes, for example, last around 7 years on average according to the SWAN study, but you don't have to wait them out: there are effective treatments to ease them.
Is there any treatment for perimenopause?
Yes, and that's the part almost nobody tells you. There are effective treatments backed by clinical guidelines, both hormonal and non-hormonal. Which one suits you depends on your case, so it's a conversation to have with a professional.
Maia isn't a medical service and doesn't replace your healthcare professional. This guide is for information only; to decide about treatment, talk to your doctor.
Sources: NHS, "Menopause and perimenopause"; NICE guideline NG23 (2024 update); on age of onset, National Institute on Aging (NIH), "What is menopause?" and Lumsden MA et al., "European Society of Endocrinology clinical practice guideline for evaluation and management of menopause and the perimenopause", European Journal of Endocrinology 193(4):G49-G81 (2025); on sleep, "Sleep Disturbance and Perimenopause: A Narrative Review" (2025), drawing on the Study of Women's Health Across the Nation (SWAN), and the DOMMA study, "Radiografía de la Menopausia en España"; on brain fog, Maki PM and Jaff NG, "Brain fog in menopause", Climacteric (2022), an International Menopause Society white paper; on joint pain, Lu et al., "Musculoskeletal Pain during the Menopausal Transition", Neural Plasticity (2020), and the AEEM-FEEM survey of 1,750 women (2024); The Menopause Society; and on how long hot flushes last, Avis et al., SWAN study, JAMA Internal Medicine (2015).