Perimenopause: symptoms, age, duration, and solutions

Are you sleeping less well, feeling more anxious for no clear reason, and finding your periods are a bit unpredictable... and you're blaming it all on stress? It might be the start of perimenopause. The word can be intimidating, yet it describes a stage that all women go through.

Flamme Servera discovered it almost by accident. A former investment fund manager, she attended a conference on women's health at 29 and heard the word for the first time. She realized that symptoms can start as early as 35, that the topic is booming in the United States, and that no one around her knew about it. She has since founded Ginama, a brand of supplements designed for this period, and co-produced the series with Reflet Génération Péri, with pharmacist Carole Minker. In her episode, she has a simple message: "You are in perimenopause, but you are not past your prime."

What is perimenopause?

Perimenopause is a hormonal transition. For several years before menopause, the production of hormones by the ovaries becomes irregular. Flamme describes it as a "rollercoaster": estrogen and progesterone do not decrease steadily; they fluctuate, rising, falling, and rising again. It is these variations that cause most of the symptoms.

It is important to distinguish between three terms:

• Perimenopause : the transition period, characterized by changing cycles and symptoms.
• Menopause : the point at which periods have stopped for at least 12 months. It is an event, not a period of time.
• Post-menopause : everything that comes after.

In France, the average age of menopause is 51. Perimenopause therefore begins several years earlier.

Perimenopause is not a disease. It is a physiological stage, just like puberty. But "physiological" does not mean you have to just put up with it: symptoms can be managed.

At what age does perimenopause begin?

Most often between 40 and 45 years old, but the first signs can appear as early as 35. This is what surprised Flamme the most: "I thought, actually, I could potentially have this very soon. And I don't even know what it is."

The age varies from woman to woman and depends in particular on family history, smoking, or certain medical treatments. We explain everything in our article at what age does perimenopause start. And if your periods stop before age 40, we are talking about something else: early menopause, which requires a medical consultation.

How long does perimenopause last?

There is no single duration. An average of 2 to 4 yearsis often cited, but it can be shorter or last for nearly ten years for some women. It officially ends one year after your final period.

Symptoms, however, do not always stop exactly at menopause. Hot flashes, for example, can last for several years: we discuss this in our article on the duration of hot flashes.

Perimenopause symptoms

This is where things get complicated: there are manyof them, and they vary greatly from one woman to another. Flamme observed this through the hundreds of questionnaires she had people fill out in Facebook groups before launching Ginama.

The first signs, often misidentified

According to Flamme, the symptoms that appear first are often:

• anxiety, sometimes new and unexplained;
• sleep disturbances : difficulty falling asleep, waking up during the night;
• fatigue.

The trap is the timing of when they occur. "It happens at a point in your life where you are potentially a mother, you might be in a position with more responsibilities. So you don't immediately attribute it to hormonal changes, but rather to stress."

The most common symptoms

• irregular, heavier, or more frequent periods;
• hot flashes and night sweats;
• brain fog, concentration or memory issues;
• irritability, mood swings;
• low libido;
• vulvovaginal dryness;
• recurrent cystitis and vaginal flora imbalances;
• weight gain, especially around the midsection;
• joint pain;
• hair loss.

The more surprising symptoms

Flamme also mentions less well-known symptoms that frequently come up: itchy ears, dry eyes, dry mouth. All mucous membranes can become dry.

For the full list, read our article on the 35 symptoms of perimenopause.

Hot flashes aren't always the number one symptom

This is one of the most surprising takeaways from the episode. When we talk about perimenopause, everyone thinks of hot flashes. But in the responses Flamme received, the most common themes were libido, recurring cystitis, and vulvovaginal dryness. These are more intimate topics, making them harder to discuss, even with a doctor or pharmacist.

Why perimenopause is still such a taboo

A scary word

"The term 'perimenopause' is just awful. You've got 'perished' and 'menopause' in the same word," Flamme jokes. When she brings it up with her friends, the reaction is immediate: that doesn't apply to us, you're stressing us out. When she talks to her mother about it: "What are you even talking about?"

The idea that you can no longer have children

This is the biggest taboo, according to her. In the collective imagination, perimenopause rhymes with "expiration date." Many women replied to Ginama's videos saying, "This doesn't concern me, I just had a baby." However, you can absolutely get pregnant during perimenopause. Fertility decreases, but ovulation continues irregularly. If you do not wish to get pregnant, contraception remains necessary until menopause is confirmed: talk to your gynecologist or midwife about it.

Women who feel alone

To the final question in her surveys, "Is there anything else you'd like to add?", the responses moved Flamme deeply: thank you for taking an interest in this period, we feel so alone. Many also shared that they had been told by their gynecologist that they were "too young" to be in perimenopause. For Flamme, it's a bit like PCOS or endometriosis a few years ago: a subject no one talked about, even though it affects every single woman.

How do you know if you're in perimenopause?

There is no single, reliable test. The diagnosis is based primarily on your age, your cycles, and your symptomsBecause hormones fluctuate significantly, a blood test at any given moment might appear normal even when you are clearly in transition.

To help you discuss this with your doctor:

• track your cycles for a few months (dates, duration, flow);
• note your symptoms and their intensity;
• report your personal and family medical history.

A check-up can also help rule out other causes, such as thyroid issues, which can cause similar symptoms.

Consult a doctor without delay if you experience very heavy bleeding, bleeding between periods or after intercourse, or if bleeding returns after several months without a period.

What are the solutions during perimenopause?

The good news: "It's not inevitable; there are plenty of solutions," insists Flamme. And what works for one woman won't necessarily work for another.

Lifestyle: the foundation

This is what Flamme calls the "basics." Perimenopause is also the perfect time to establish habits that will make menopause easier: regular physical activity including strength training, a protein-rich diet, and protected sleep. This is exactly what gynecologist Odile Bagot recommended in our series, Osée, ménopausée.

Hormone therapy

This should be discussed with your gynecologist or doctor. During perimenopause, medical opinions vary: some offer it, while others prefer to wait until menopause, partly because hormone levels fluctuate wildly, making it harder to find the right dosage. Both approaches are valid, and it is up to you to determine your own path with your doctor.

Local solutions for intimate health

For vulvovaginal dryness, caused by the drop in estrogen that dries out mucous membranes, several options exist: hormone-free moisturizing gels (for example, those based on hyaluronic acid and aloe vera), local hormone treatments prescribed by your doctor, or even laser therapy in some cases. Flamme says it herself: she had to overcome her own taboos to talk about intimate dryness. Talking about it is the first step toward finding solutions.

Dietary supplements

They can help some women, provided they are chosen carefully. With or without phytohormones, when to take them, and for how long: we break it all down in our article dietary supplements and perimenopause. If you are interested in plants, also read our article on phytoestrogens : they are not suitable for everyone.

Complementary approaches

Yoga, breathing exercises, heart coherence, and stress management: anything that calms the nervous system can help, especially with hot flashes.

Discover the episode with Flamme Servera

The Generation Peri series consists of eight episodes to help you understand perimenopause: what happens in your brain, fertility, phytoestrogens, hot flashes, nutrition, and exercise. Featuring pharmacist and author Carole Minker, and an episode with Flamme Servera, founder of Ginama, a partner of the series. You can also find all our content on perimenopause and menopause.

Discover the Generation Peri series

Key takeaways

• Perimenopause is a hormonal transition that affects all women, often between the ages of 40 and 45, and sometimes as early as 35.
• It ends at menopause, one year after your final period, which occurs on average around age 51.
• The first signs are often anxiety, sleep disturbances, and fatigue, which are easy to mistake for stress.
• You can still get pregnant during perimenopause.
• Lifestyle changes, hormone therapy, local treatments, and supplements: there are many solutions to explore with your doctor.

FAQ

At what age does perimenopause begin?

Most often between 40 and 45, but the first signs can appear as early as 35.

How long does perimenopause last?

On average 2 to 4 years, but it varies significantly: it can last longer for some women.

Can you get pregnant during perimenopause?

Yes. Fertility decreases, but ovulation continues irregularly. Contraception is still necessary if you do not wish to become pregnant.

What are the first symptoms of perimenopause?

Often anxiety, sleep disturbances, fatigue, and changes in your periods. Hot flashes may occur later on.

Can a blood test diagnose perimenopause?

Not always: hormones fluctuate significantly. Diagnosis is primarily based on age, cycles, and symptoms. A blood test can help rule out other causes.

The information in this article is for informational purposes only and does not replace professional medical advice. Flamme Servera is the founder of the brand Ginama, a partner of the Génération Péri series; she is not a healthcare professional. If you have any symptoms that worry you, or before starting any treatment or supplement, talk to your doctor, gynecologist, or midwife.