Signs Perimenopause Is Ending

The human body undergoes life changes attributed to factors like age and hormones. For most people assigned female at birth, these transitional phases include puberty (reproductive years), menopausal transition, and postmenopause.

Menopause is a natural biological process that occurs when people who menstruate stop making the reproductive hormones their body needs to ovulate and menstruate each month. Perimenopause is the few years leading up to menopause.

Perimenopause often starts with changes in the duration of time between periods and ends a year after the last period. It typically lasts about 4–8 years. It typically occurs around your mid-40s or 50s but may occur earlier—for example, if you smoke, have a history of early menopause, underwent cancer treatments, or had a medical intervention, such as surgery to remove both ovaries.

Perimenopause causes notable changes similar to menopause, such as vaginal dryness, hot flashes, and mood swings.

Increased Time Between Periods

A variation in menstrual cycle lengths often occurs in early perimenopause, with some people noting differences of about seven days. 

In later perimenopause, the menstrual cycle becomes highly irregular. Many people experience periods up to 60 days apart or more. This increased time between periods is one of the prominent signs that perimenopause is ending.

Changes in Hot Flashes

You will most likely experience increased severity of vasomotor symptoms like hot flashes as you enter the late stage of perimenopause. These are symptoms linked to changes in blood vessels that supply blood as a result of contraction or relaxation of the smooth muscles that line the walls of the vessels.

Hot flashes occur due to a drop in estrogen (or other hormone) levels. This disrupts the hypothalamus—the body's natural thermostat and thermoregulatory center in the brain—causing it to think the body is hotter than it actually is. The hypothalamus responds by widening blood vessels near the skin's surface and activating sweat glands to cool the body. 

About 85% of people experience hot flashes as they reach menopause. Other symptoms typically associated with hot flashes toward the end of perimenopause include feeling hot, chills, sweating (or night sweats), and flushing (skin reddening), which can last about 1–5 minutes.

Mood Changes

Mood changes are common as you enter perimenopause. They tend to increase throughout this transitional phase, with the largest increase in severity occurring toward the end.

The constant mood changes can be distressing and negatively affect well-being. They may include:

• Tension or anxiety
• Irritability
• Depression
• Anger

Mood changes are also linked to a decline in estrogen. Estrogen receptors are found in some areas of the brain that regulate mood and cognition. An increase in vasomotor symptoms, as well as changing social or personal life factors, may also play a role in the mood changes that occur during this perimenopause.

Sleep Disturbances

If you have been having occasional changes in your sleep pattern, it may worsen as you transition into menopause. You’ll tend to experience poor-quality sleep and insomnia (difficulty falling or staying asleep), which may be caused by estrogen withdrawal, mood swings, and even aging. Experiencing hot flashes at night can also affect your ability to fall or stay asleep.

Differences in Sexual Function

Because estrogen plays a vital role in sexual function, its decline as you near menopause can significantly affect your sexual life. You may experience reduced sexual desire and painful sexual intercourse, which can be linked to vaginal dryness and irritation.

Migraines

Some people experience migraines during their perimenopause years, which may worsen in severity and intensity toward the end of this phase. 

Migraines are a form of headache that causes pulsating or throbbing pain accompanied by light and sound sensitivity. They can be triggered by hormone fluctuations during the perimenopause stage.

After menopause occurs, hormone levels tend to stabilize, causing migraine attacks to stop or decrease in some people.

Stages of Menopause

In a 2011 Stages of Reproductive Aging Workshop (STRAW), scientists established the STRAW + 10 staging system. This system divides the female reproductive cycle into ten stages and three general categories.

Reproductive Stage (Stages -5, -4, -3b and -3a)

This stage, also called premenopause, includes the reproductive years, where the menstrual cycle is typically regular with no symptoms of menopause. However, changes in hormonal levels may be observed toward the later phases of this stage (-3a and -3b).

Menopausal Transition Stage (Stages -2 and -1)

This includes early and late perimenopause. At this stage, the body is transitioning into menopause. While menstruation still occurs, differences in cycle length typically occur—about seven days of variability for early perimenopause and up to 60 days with no period for late perimenopause.

This stage is also characterized by a decline in estrogen levels and the occurrence of different menopause-related symptoms.

Postmenopause stage (stages +1a, +1b, +1c, and stage +2)

This stage follows the menopausal transition and occurs after your last period. It continues up to one year after your period (which is called menopause or early postmenopause). It is characterized by high follicle-stimulating hormone (FSH) levels, low estradiol (estrogen) levels, and vasomotor symptoms.

The late postmenopause stage occurs about 3-6 years later and continues to the end of life. It is characterized by increased:

• Symptoms of urogenital atrophy, such as thinning, dryness, and irritation of the vaginal walls
• Loss of labial and vulvar fullness
• Painful sex
• Recurrent urinary tract infections (UTIs)

How Do I Know I'm In Menopause?

Because perimenopause symptoms vary from person to person, it can be difficult to tell when you are nearing the end of this transitional phase. However, one of the sure signs that you have entered menopause is the lack of a period if you had one before. If you are in your 40s or 50s and haven’t had a period for up to 12 months, you most likely have entered the menopause phase. 

Menopause also commonly causes symptoms like:

• Night sweats
• Hot flashes
• Migraines
• Palpitations
• Vaginal dryness
• Mood swings and irritability
• Sleep disturbances

Not everyone who presents with these symptoms has entered menopause. To help rule out other possible causes, your healthcare provider may order tests like:

• Follicle-stimulating hormone (FSH) test: This checks for elevated FSH levels. A level consistently higher than 30 milli-international units per milliliter (mIU/mL) and the absence of a period for more than a year indicates menopause. 
• Estradiol tests: This checks for the level of estrogen (also called estradiol), which is often reduced during menopause.
• Thyroid-stimulating hormone (TSH) test: This may be carried out to rule out hypothyroidism (underactive thyroid), which can cause symptoms similar to those of menopause.
• Anti-Müllerian hormone (AMH): AMH levels typically decrease when egg supply reduces as people approach menopause. While it can be helpful to check for early or premature menopause (menopause before age 40), it may not be as useful in determining when you’ll reach menopause.

The use of these hormone tests as menopause indicators is still controversial. Organizations like the North American Menopause Society report that they may sometimes be misleading because hormone levels fluctuate from day to day. 

Other factors, like surgical removal of the ovaries or uterus, can trigger menopause. For example, if you have an oophorectomy (removal of one or both ovaries) or a hysterectomy (removal of the uterus), you’ll likely experience menopause symptoms right away.

When To See a Healthcare Provider

Menstrual cycle changes or abnormalities can occur at any age, e.g., amenorrhea, which is the absence of a menstrual period for at least three months. Other common menstrual irregularities include heavy menstrual periods (menorrhagia), extremely painful periods, and bleeding between periods (spotting). It’s necessary to see a healthcare provider for such issues.

If you are in your mid-40s or 50s, you’ll likely experience symptoms that suggest you are transitioning to menopause. These symptoms may come earlier for some people and later for others. They will also differ in severity. Consider seeing your healthcare provider if you experience:

• Irregular menstrual cycle
• Sleep problems
• Constant mood changes
• Hot flashes and night sweats
• Vaginal dryness
• Changes in weight and body shape
• Low-sex drive
• Recurrent urinary tract infection

A Quick Review

Perimenopause is not an abnormality: It's a phase of life. It comes with gradual changes and symptoms that can be distressing for some people. The severity of some symptoms, e.g., vasomotor symptoms, could increase toward the end of the stage (as you near menopause), and you will most likely experience an increased duration of time between each period.

Speaking with your healthcare provider about these symptoms and the challenges you experience can help prepare you for current and future phases. They can suggest treatment and management strategies to help you move through perimenopause with less discomfort.