Perimenopause: Symptoms, Age and How Long It Lasts

What is perimenopause?

Perimenopause is the stage leading up to your final period, plus the 12 months after it. Menopause itself is a single point in time: the final menstrual period, confirmed once you have gone a full year without one.¹

During perimenopause the ovaries release eggs less predictably. Oestrogen doesn’t fall in a straight line. It swings, sometimes higher than before and sometimes very low, while progesterone tends to drop. Those swings, more than low hormone levels alone, drive many of the symptoms.²

What age does perimenopause start?

For most women it starts in the mid-40s, though it can begin in the late 30s. The average age of menopause in Australia is 51, and most women reach it between 45 and 55.^9,10

Researchers describe two phases. In the early phase, cycle length starts to vary by a week or more. In the late phase, gaps of 60 days or longer appear between periods.¹

How long does perimenopause last?

On average, four to six years, though it can be shorter or longer.¹⁰

Symptoms don’t always stop at the final period. In a large study that followed women through the transition, frequent hot flushes and night sweats lasted more than seven years for over half of the women who had them, and tended to last longest in those whose flushes began while they were still having periods.³

Perimenopause symptoms

Symptoms vary a lot. Some women barely notice the transition and others find it disrupts work, sleep and relationships.

• Period changes. Cycles that are shorter, longer or unpredictable, and bleeding that is lighter or much heavier than usual
• Hot flushes and night sweats. See hot flushes and night sweats
• Sleep problems. Trouble falling asleep or waking through the night. Sleep complaints rise as women move through the transition, even allowing for age⁴
• Mood changes. Irritability, anxiety and low mood. Women with no history of depression are more likely to develop it once they enter the transition than women of the same age who haven’t yet⁵
• Brain fog. Trouble concentrating or finding words
• Body changes. Vaginal dryness, lower libido, sore joints, headaches, breast tenderness and bladder changes

You may have seen lists of “34 symptoms of perimenopause”. There is no official list of 34. The number comes from popular articles, not a medical guideline, and many symptoms on those lists have other common causes that are worth checking.

How is perimenopause diagnosed?

If you are over 45, perimenopause is diagnosed from your symptoms and the changes in your periods. Blood tests aren’t usually needed, because hormone levels can be normal one week and menopausal the next.⁸

Testing is more useful if you are under 45, and especially under 40, when early or premature menopause needs to be confirmed and other causes ruled out.⁸

Since July 2025, Medicare has covered a menopause and perimenopause health assessment with your GP, available once every 12 months.¹²

Can you get pregnant during perimenopause?

Yes. Ovulation becomes irregular, not absent, and pregnancy is still possible until menopause is confirmed. Keep using contraception through perimenopause if you don’t want to become pregnant, and ask your doctor when it is safe to stop.⁹

What helps

• Looking after the basics. Regular exercise, a steady sleep routine, less alcohol and not smoking help with sleep, mood, bones and heart health
• Menopausal hormone therapy. For hot flushes and night sweats, this is the most effective treatment. For most healthy women under 60, or within ten years of their final period, expert bodies consider the benefits outweigh the risks. It isn’t suitable for everyone, so the decision is made with your doctor^6,7
• Non-hormonal options. Some prescription medicines reduce hot flushes for women who can’t or don’t want to use hormones⁷
• Cognitive behavioural therapy (CBT). In a randomised trial, group and self-help CBT both made hot flushes and night sweats less of a problem, and improved mood and quality of life¹¹
• Help with bleeding. Heavy or erratic periods can be treated, often with hormonal options that also provide contraception

Many women go without help. In an Australian community study, most women with moderate to severe symptoms were not using any effective treatment.¹³

When to see a doctor

• Periods that are very heavy, last longer than a week, or come less than three weeks apart
• Bleeding between periods, after sex, or any bleeding after menopause
• Symptoms that are affecting your sleep, work or relationships
• Symptoms before age 45
• Low mood that isn’t lifting

If you are having thoughts of harming yourself, call Lifeline on 13 11 14, or 000 in an emergency.

References

1. Harlow SD, Gass M, Hall JE, et al. Executive summary of the Stages of Reproductive Aging Workshop + 10: addressing the unfinished agenda of staging reproductive aging. J Clin Endocrinol Metab. 2012;97(4):1159-68.
2. Davis SR, Pinkerton J, Santoro N, et al. Menopause-Biology, consequences, supportive care, and therapeutic options. Cell. 2023;186(19):4038-4058.
3. Avis NE, Crawford SL, Greendale G, et al. Duration of menopausal vasomotor symptoms over the menopause transition. JAMA Intern Med. 2015;175(4):531-9.
4. Kravitz HM, Zhao X, Bromberger JT, et al. Sleep disturbance during the menopausal transition in a multi-ethnic community sample of women. Sleep. 2008;31(7):979-90.
5. Cohen LS, Soares CN, Vitonis AF, et al. Risk for new onset of depression during the menopausal transition: the Harvard study of moods and cycles. Arch Gen Psychiatry. 2006;63(4):385-90.
6. “The 2022 Hormone Therapy Position Statement of The North American Menopause Society” Advisory Panel. The 2022 hormone therapy position statement of The North American Menopause Society. Menopause. 2022;29(7):767-794.
7. New Collective Author. The 2023 nonhormone therapy position statement of The North American Menopause Society. Menopause. 2023;30(6):573-590.
8. National Institute for Health and Care Excellence (UK). Menopause: identification and management (NG23).
9. healthdirect. Perimenopause.
10. Jean Hailes for Women’s Health. Menopause.
11. Ayers B, Smith M, Hellier J, et al. Effectiveness of group and self-help cognitive behavior therapy in reducing problematic menopausal hot flushes and night sweats (MENOS 2): a randomized controlled trial. Menopause. 2012;19(7):749-59.
12. Australian Government, MBS Online. Item 695: Menopause and perimenopause health assessment.
13. Worsley R, Bell RJ, Gartoulla P, et al. Low use of effective and safe therapies for moderate to severe menopausal symptoms: a cross-sectional community study of Australian women. Menopause. 2016;23(1):11-7.