When women hit their late thirties or early forties, many begin the process of perimenopause, a highly variable period of time when the reproductive cycle begins to shorten, eventually starts to skip (usually around age forty-seven), and then finally comes to a halt with menopause (average age fifty-one). The term perimenopause is more of a description than it is a true developmental state. It is a time of transition from full fertility into menopause.
The average age of perimenopause onset is within a broad range, between thirty-nine and fifty-one (but it can start anywhere after age 25, the peak age of fertility) and is highly unpredictable with respect to any individual woman. How and when perimenopause appears is an inexact process; its symptoms vary month-to-month and even day-to-day. Often the earliest sign is the shortening of the monthly cycle. You still will have your period, but you may notice that it comes sooner, is heavier and/or shorter. You may skip some months. You may also notice physical changes reflecting changing ratios of hormones.
These changes are the result of the aging and declining number of remaining follicles, or eggs, in the ovary. The ovaries are somewhat like an hourglass of sand, with the follicles (eggs) being represented as the grains of sand. The hourglass is turned over even before we are born, and the follicles begin to slip away. As we age, the “sand” begins to run out and the volume left behind is less, affecting the end mix of the hormones generated by the remaining follicles. Thus, the lessening of hormonal power becomes more evident. Usually this takes place in the early to mid-forties, but even earlier for some women.
When the remaining eggs’ cells can no longer generate the response the brain demands for fertility, the hormones generated by the follicles begin to change in duration of maximum peak and in the ratio of one hormone to another. This is what kicks in the symptoms of perimenopause. Some of the symptoms include:
- Shorter cycles (shorter and earlier periods)
- Bleeding amounts changing: heavier or lighter
- Night sweats, especially before periods
- Decreasing vaginal lubrication
- Worsening PMS (more abrupt)
- Insomnia, worse premenstrually
- Adult acne
- Increasing facial hair
- Thinning head hair
- Symptoms of anxiety: racing thoughts, air hunger, feelings of unexplained worry
- Palpitations
Handling some or all of these changes at once can be an incredible challenge when many in their forties are already dealing with parenting demands, spousal needs, aging parents, and professional expectations. What is absolutely clear is that no two women have the same way of experiencing perimenopause or its symptoms. Many women experience hot flashes, sleep disturbances, lessening of libido (sex drive), and vaginal dryness (usually associated with menopause), while some women experience no symptoms at all. Others may experience a short period of hot flashes, but as soon as they hit menopause (the actual cessation of menses), their hormones complete the transition and the symptoms stop.
The duration of symptoms also varies from woman to woman. Occasionally, symptoms that begin in perimenopause, such as hot flashes, may persist into the postmenopausal years indefinitely. Sometimes women suffer typical PMS associated with one cycle day, only to have hot flashes and insomnia the next month. Such is the roller coaster for many in perimenopause.
During perimenopause, estrogen levels may remain normal in your blood and saliva (or even slightly higher than average, in response to the brain’s signal for more) and the peak of estrogen that generally occurs right before ovulation (the midcycle) may remain, but the duration of the estrogen-dominant days is lessened by the aging follicle(s). This can be confusing to patients who are told that their hormone levels are normal when they feel so hormonally different. As the ovary ages, blood levels of estrogen may not reflect the health of your follicles until they (the eggs themselves) have nearly disappeared.
Much has been theorized about the various causes of “ovarian decline”; however, the truth is that it is not a disease, but a natural occurrence. As human women, we are programmed to stop reproducing long before our expected time of death, so that we can be around for an extended time to raise our youngest child. For some, ovarian decline begins somewhat early, but it happens eventually for all women. Again, the ovary is programmed to spend its follicles (beginning before birth), but ovarian decline is not often obvious until about age forty-three, when a woman may develop clear symptoms (such as those listed earlier).
Some physical consequences follow the change from regular ovulation to a sporadic pattern. Ovulation must occur to generate progesterone. In your mid- to late-forties, ovulation is interrupted more easily and time may stretch between ovulation occurrences, causing skipped periods. If significant amounts of estrogen in your body tissues are present, the absence of bleeding can lead to what is known as an unopposed estrogen effect. Without progesterone and the coordinated sloughing of the menstrual uterine lining, the lining can build up, resulting in very heavy, unpredictable vaginal bleeding and even increase the risk of uterine (endometrial) cancer. Endometrial cancer is very rare before menopause, but abnormal bleeding is common in many forty-something women. Often, using cyclic hormones or even the low-dose birth control pill can help these problems. If you are experiencing abnormal bleeding, you may need an ultrasound to check for other causes of bleeding and, possibly, a biopsy of the uterine lining to rule out pre-cancer or cancer, although rare.
The ebb and flow of emotions at this time can also be a source of frustration. Some women in perimenopause feel so depressed the week before their period that they are literally stymied in their lives. Other women experience frustration with low libidos. Still others are actually experience an increase in libido due to the lessening of estrogen’s presence, which can free up more testosterone (estrogen’s effect can suppress testosterone); these women may also experience unpleasant symptoms of testosterone dominance such as adult acne, negative cholesterol changes, scalp hair thinning, and facial hair.
Most women need an individualized approach to their perimenopause. There is no one-size-fits-all, and a careful analysis of physical and emotional issues must be carried out to answer questions and deal with problems.
Your metabolism also changes in perimenopause, and you will become more likely to store fat after eating processed carbohydrates (sugar, starch, etc). Exercise is of utmost importance at this time: at least 150 minutes a week, (22 minutes a day). Exercise will help even out dramatic hormone fluctuations and elevate your mood (besides the fact that it is good for your heart, brain, and sex-life).
Omega 3 fatty acids (fish oils) are also helpful as they stabilize mood and metabolism and are good for the heart, brain, and sex-life. Taking a multivitamin daily is of prime importance to make certain your body has the tools to keep its chemistry optimal. For those who have trouble swallowing or who have stomach upset with a multivitamin, chewables work just as well. Calcium is important as perimenopause marks the time of a loss in bone density due to declining estrogen. Calcium has been shown to help stabilize mood swings with PMS as well. Vitamin D is also important in perimenopause as in other stages. Studies show that most women do not get sufficient Vitamin D, which is imperative for bone health but also for cancer protection. Many health experts feel the current US RDA (recommended daily allowance) of 400 IU is set too low.
- Multivitamin (preferably women’s formula)
- Calcium, from your diet or supplements: 1000 to 1200mg a day in divided doses (no more than 500-600 mg at once)
- Vitamin D: 1000 IU a day
- Omega-3 fatty acids (fish oils): 1000mg a day
- Phytoestrogens: 50-70 mg of isoflavones a day to reduce night sweats and stabilize declining estrogen levels
If you are still feeling concerned about your symptoms, and you are seeing no change with the above mentioned over-the-counter solutions, consult with your health care provider to discuss your specific issues.
What People Are Saying
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Lindsey Kaelin26 October 2026Trustindex verifies that the original source of the review is Google.
Truly one of the best women’s health visits I have ever had! Emily Fountain is so incredible and listened to all of my concerns and offered so many options to me that have NEVER been offered to me by any other healthcare provider before. I felt truly cared for. The staff is amazing and kind and QUICK! And the office is beautifully decorated and clean. I will never go anywhere else ever again!Posted on Google
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Charisa McMahon21 July 2026I highly recommend Audrey Fenwick. She truly takes the time to listen and never makes me feel rushed during my appointments. I always feel like my concerns are heard and taken seriously. What I appreciate most is that she’s willing to explore different treatment options rather than taking a one-size-fits-all approach. She works with me until we find a plan that we’re both comfortable with, and I always leave feeling confident that I’ve received thoughtful, personalized care. It’s refreshing to have a healthcare provider who is knowledgeable, compassionate, and genuinely invested in helping her patients feel their best.Posted on Google
Amy Curry26 June 2026Dr. Shannon was a great provider during my last pregnancy with twins! She answered every question I had, kept me in the loop on all the clinical decisions and options I had available, and made me feel safe and heard during all of my interactions with her and her staff. All of the staff at Women’s first always took great care of me and my babies no matter what concern I had at the time.Posted on Google
Rhonda Eichenberger20 June 2026They are always all so nice and welcoming. I just love Brook McAfee, APRN, she is awesome!Posted on Google
Robin12 June 2026Dr Grider is the best Doctor. Very thorough, kind and personable!Posted on Google
Cathy Carter4 June 2026I cannot tell you how pleased I am with the services provided by Dr. Anne L. Oliphant and the staff at Women First of Louisville. Dr. Oliphant and staff exhibit outstanding professionalism, punctuality and courtesy. I highly recommend Dr. Oliphant based on the fact that she is an exceptionally skilled and compassionate physician who truly takes the time to listen to her patients. Throughout my appointments, she and the staff made me feel completely at ease. She thoroughly explained my diagnosis and patiently answered all my questions without ever making me feel rushed. I had to do bloodwork during my last appointment. The clinicians and staff were especially friendly and professional as well. Dr. Oliphant’s, and the staff’s, empathetic bedside manner and clear communication elicit standout medical providers in the specialized field of menopause medicine. I believe that Dr. Oliphant has really listened to my concerns and has taken the time to support my health journey. I highly recommend her and the staff to anyone seeking personalized and highly effective care.Posted on Google
Nancy Nance3 June 2026I have been a patient here for over 25 years. The best of care for any need I have had ! Simply the best !
