How Long Does Perimenopause Last? Spoiler Alert: It’s Not Short

Just when you think you’ve gotten a handle on those pesky perimenopause symptoms, your body chortles, “Not so fast!”

Thought you had licked those early-onset symptoms like sleep issues, anxiety, mood swings, weight gain, and irregular periods, didn’t you? Only for a whole new slew of annoyances like hot flashes, night sweats, and vaginal dryness to suddenly show up a few years into perimenopause?

Well, we’ve got some news for you: perimenopause is a marathon, not a sprint. Symptoms “typically begin five to 10 years before menopause,” says board-certified OB-GYN Caledonia Buckheit, M.D.

But the years leading up to menopause don’t have to be a slog, even though they can feel like one. The more you know what to expect from perimenopause — and how long it can last — the less interminable this season of your life will seem. Read on for our expert insights on why perimenopause seems to take forever, and how Alloy Health can provide the support system you need.

Perimenopause 101

It all goes back to your ovaries and egg reserve: perimenopause begins because you’re getting older, and as you get older, your egg reserve declines. And as your egg reserve declines, “your body has to work harder and harder to produce ovulation each month,” explains Dr. Buckheit. “This creates bigger hormonal peaks and valleys, which can lead to a variety of symptoms.” Eventually, she continues, “these changes begin to alter your menstrual cycle.”

Stages of perimenopause

One of the reasons why it feels like perimenopause lasts a long time is that it occurs in stages.

First stage: “[It’s] characterized by compensated ovarian failure — basically, you are running out of eggs, but your brain and ovary work in overdrive to produce ovulation each month,” says Dr. Buckheit. “In this stage, periods are still regular, but symptoms can be wide ranging (from mood changes and sleep disturbances, to hot flashes and heavier periods).”

Second stage: Dr. Buckheit notes that this is “the first clear sign of perimenopause for many.” That’s because once your egg reserve falls further, you’ll start to notice changes in your menstrual cycle.

To clarify, “early perimenopause is characterized by variable cycle length and a couple of missed periods per year,” says Dr. Buckheit. “In late perimenopause, cycles space out further and three or more periods are missed per year.”

Also, since perimenopause symptoms can come and go, it can sometimes feel like you’re on a roller coaster (remember what Dr. Buckheit said about “peaks and valleys”?). This happens “because a lot of perimenopause symptoms occur due to changes and periods of anovulation,” explains Dr. Buckheit. “If ovulation ‘recovers’ for a period of time, symptoms could abate for those cycles.”

But in general, she does say that as perimenopause progresses, “symptoms will become more persistent and severe.”

Once you have gone 12 months without a menstrual cycle, you are officially in menopause, and perimenopause is over.

Why does perimenopause last so long?

Keep in mind that perimenopause timelines vary from individual to individual. This is in terms of “how long it lasts and how many symptoms occur,” says Dr. Buckheit. “For some, it feels like it lasts forever, and for others, it can be quick and relatively symptom-free. These differences likely have to do with individual differences in genetics, lifestyle, and ovarian function.”

But, for those who do feel perimenopause is never-ending, it’s because, as previously mentioned, symptoms can typically begin up to a decade before menopause. And, because symptoms can be at their worst in the lead-up to menopause: “symptoms related to menopause are generally most severe in the three to five years right around menopause (before and after),” says Dr. Buckheit. “One large study found the mean age at onset of perimenopause to range from 45.5 to 47.5 years, and the mean duration to be 3.8 to 6.25 years.”

So if you’re looking for an average age for when perimenopause “peaks,” Dr. Buckheit says it’s around your late 40s (with the average age of menopause being 52).

One of the most common and reliable signs that you’re nearing the end of perimenopause is an increased time between your periods. This can be around 60 or more days before your periods stop permanently.

Taking control of perimenopause

Now that you’ve learned why perimenopause feels never-ending, here are some actionable steps that can help you manage your symptoms. First and foremost, “focus on overall health and wellbeing in your life,” advises Dr. Buckheit. This includes prioritizing sleep, hydration, a healthy and varied diet, and regular exercise.

But if you have additional questions and are considering a personalized perimenopause treatment plan, Alloy Health can help. Alloy offers several different types of Menopausal Hormone Therapy (MHT), considered the most effective at managing perimenopausal symptoms, as well as non-hormonal options.

With Alloy, you also have the option of talking to a board-certified, perimenopause-expert physician who can help you determine which type of treatment is right for your symptoms.

All your perimenopause questions answered. Consult an expert physician at MyAlloy.com with code RESCRIPTED20.

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Sarene Leeds holds an M.S. in Professional Writing from NYU, and is a seasoned journalist dedicated to reporting on women's health, parenting, mental health, TV, and pop culture. Her work has appeared in HuffPost, Rolling Stone, The Wall Street Journal, Vulture, SheKnows, and numerous other outlets. Subscribe to her Substack, the Critical Communicator, and follow her on Instagram, BlueSky, or Threads.