Perimenopause and menopause
What to expect, often starting in the early 40s. Hot flashes, sleep, mood and brain fog, and what to know about hormone therapy before talking to a doctor.
- 1What's happening, and whenMenopause is when periods stop for good, confirmed after 12 months without one, at 51 on average. The years before, called perimenopause, can start in the 40s with changing cycles and symptoms that often last 7 to 9 years.
- 2Hot flashes, sleep, mood and brain fogHot flashes affect about 80% of people going through menopause. Sleep problems, mood changes, trouble with memory and concentration, joint pain and vaginal dryness are common too. Most can be treated.
- 3Hormone therapyHormone therapy is the most effective treatment for hot flashes and also protects bones. For healthy people under 60 or within 10 years of menopause, its benefits outweigh its risks. People with a uterus also need a progestogen.
- 4Options without hormonesFor people who can't or don't want to take hormones, some antidepressants, gabapentin and two newer medicines that act on the brain's temperature control can ease hot flashes. Herbal supplements aren't regulated and mostly unproven.
- 5Early menopauseMenopause before 45 is early. Losing ovarian function before 40 is called premature ovarian insufficiency (POI), and it's more common than once thought, about 3.5%. Hormone therapy is recommended until the usual age of menopause, to protect bones, heart and brain.
- 6For loved onesPerimenopause can last years and bring hot flashes, poor sleep, mood changes and brain fog. Take it seriously, make room for symptoms, and support her in getting treatment, which works.
- QuizA short quiz on this section. Try again for new questions.
Where can I learn more?
- ACOG: The menopause years
- NHS: Menopause
- NHS: Menopause symptoms
- NHS: Early menopause
- Cleveland Clinic: Testosterone
- FDA: FDA approves novel drug to treat moderate to severe hot flashes caused by menopause (2023)
- The 2022 hormone therapy position statement of The North American Menopause Society, Menopause 2022
- FDA: Hormone replacement therapies can help women with bothersome menopausal symptoms (updated 2026)
- FDA: Drug trials snapshots, Lynkuet (elinzanetant)
- ESHRE, ASRM, CRE-WHiRL and IMS: Evidence-based guideline on premature ovarian insufficiency (2024)