Perimenopause: symptoms, age, how long it lasts and natural remedies
By the Mush n Go editorial team - 11 October 2026
By the Mush n Go editorial teamUpdated on 10 November 202618 min read
Perimenopause
Perimenopause is the transition phase before menopause, when your cycles start to become irregular. It begins on average around 47 and usually lasts 2 to 4 years, until menopause is confirmed after twelve months without a period. Irregular cycles, hot flushes, broken nights and brain fog are its typical signs.
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What is perimenopause? The years leading up to your last period.
Menopause doesn't happen overnight. With age, the ovaries' reserve of follicles runs out and ovulation becomes irregular. For several years, hormones don't fall in a straight line: they fluctuate, with highs and lows that are sometimes sharper than before. This transition is what doctors call perimenopause, and what is often called premenopause in everyday life.
The first change usually concerns progesterone, the hormone produced after ovulation. According to the Assurance Maladie (French national health insurance), the early symptoms, around 47, are due to a lack of progesterone, while oestrogen production is still preserved. Oestrogen then falls, more and more markedly, until periods stop. As these two hormones act on body temperature, sleep, mood, skin, bones and the brain, the symptoms are very varied.
Perimenopause is not an illness. It is a normal stage, which some women go through almost without noticing, and which disrupts daily life for others for several years. Either way, knowing what is happening helps: it stops you blaming your sleepless nights or your forgetfulness on stress alone.
Premenopause or perimenopause?
Premenopause, perimenopause, menopause: what sets them apart.
The first two words are often used interchangeably, including by the Assurance Maladie, which writes “perimenopause (or premenopause)”. The most precise medical term is perimenopause: the Greek prefix peri means “around”. Strictly speaking, premenopause refers to the whole reproductive life before menopause; in everyday use, it mainly refers to the start of the transition, when cycles begin to shift.
| Stage | What happens | Periods |
|---|---|---|
| Premenopause | In everyday use, the start of the transition | Still regular, or nearly |
| Perimenopause | Fluctuating hormones, first symptoms | Irregular, heavier or lighter |
| Menopause | Permanent end of ovarian function | Absent for 12 consecutive months |
| Postmenopause | All the years that follow | Absent |
In practice, as long as you have periods, even infrequent ones, you are not menopausal. Menopause can only be confirmed after the event: it is the date of your last period, confirmed by twelve months without bleeding, with no other cause. In France, it occurs at 51 on average.
Age
At what age does perimenopause start, and at what age does menopause arrive?
According to the Assurance Maladie, perimenopause symptoms most often appear around 47. The transition can start earlier, though: some women see their cycles change from their early forties. Menopause itself occurs naturally between 45 and 55, at 51 on average.
Before 40
Periods stopping is not normal perimenopause: this is called premature ovarian insufficiency. Medical advice is essential.
From 40 to 45
Menopause at this age is called early menopause. It is also the age when cycles start to change in some women.
Around 47
The average age at which perimenopause symptoms appear.
From 45 to 55
Natural menopause, at 51 on average. After 55, it is called late menopause.
The age of menopause cannot be predicted for an individual woman. Heredity plays a part: the age at which your mother reached menopause gives you a guide. Smoking is associated with earlier menopause. Ovarian surgery, chemotherapy or radiotherapy can also cause menopause, called iatrogenic menopause, at any age.
Duration
How long does perimenopause last? Often 4 years, sometimes 10.
The Assurance Maladie gives a duration of 2 to 4 years, more often 4, sometimes longer. The differences are wide: a few months for some women, nearly ten years for others. Doctors divide the transition into stages, described by an international group of experts, the 2012 STRAW+10 consensus.
Early transition
Cycle length varies: a difference of at least 7 days between two successive cycles, which keeps recurring.
Late transition
Intervals of 60 days or more without a period, and hot flushes more likely. It generally lasts 1 to 3 years.
Menopause
The last period, confirmed after 12 months without bleeding. Some symptoms carry on afterwards.
Don't confuse the length of the transition with the length of the symptoms. In the large American SWAN cohort, frequent hot flushes lasted a median of 7.4 years, including 4.5 years after the last period. They lasted longer in women in whom they had started early, before periods stopped. Genitourinary symptoms, for their part, can become long-lasting.
Symptoms
The 35 symptoms of perimenopause, group by group.
No woman has them all. Some notice only one or two, others have a dozen. Here are the 35 symptoms of perimenopause, or premenopause, most often described by the Assurance Maladie and the UK's NHS, in six groups. Hot flushes, the best known, affect seven women in ten around menopause.
The cycle (8)
Irregular cycles · shorter cycles · longer cycles · heavier periods · longer periods · bleeding between periods · worse premenstrual syndrome · tender or painful breasts.
Heat (3)
Hot flushes · night sweats · palpitations.
Sleep and energy (5)
Difficulty falling asleep · night-time waking · unrefreshing sleep · persistent fatigue · restless legs.
Head and mood (7)
Irritability · mood swings · anxiety · low mood · brain fog · memory lapses · words that slip away.
Body (8)
Weight gain · a rounder belly · joint pain · headaches and migraines · dry skin · thinning hair · dizziness · bloating.
Intimacy (4)
Vaginal dryness · lower libido · urinary urgency or leaks · more frequent urinary infections.
Three of these groups are linked. Night sweats and hormonal fluctuations break up your nights; broken nights feed the next day's fatigue, irritability and brain fog. That is why sleep is often the first thing to work on. We cover these symptoms in dedicated guides: menopause insomnia, menopause fatigue and menopause brain fog. If you wake at the same time every night, also read why you wake up at 4am.
These symptoms are not specific. Intense fatigue, palpitations or weight gain can also come from the thyroid, anaemia or depression: one more reason to talk to your doctor.
Cycles and periods
Periods in perimenopause: what is common, what should alert you.
The cycle is often the first thing to change. At first, falling progesterone tends to shorten cycles, to the point where periods sometimes seem to come back every fortnight. Later, when ovulation becomes rarer, cycles lengthen and months without periods appear. The length of periods in premenopause also varies: longer and heavier than before, sometimes with clots, or on the contrary lighter.
| What you notice | Common in perimenopause? | What to do |
|---|---|---|
| Shorter or longer cycles | Yes, it's the typical sign | Note the dates in a diary or an app |
| Longer, heavier periods | Yes, especially at the start | Mention it if they last more than 7 days or wear you out |
| Clots | Possible if periods are heavy | See a doctor if they are large or frequent: risk of anaemia |
| Brown discharge, spotting | Possible | Tell your doctor, especially if it keeps happening |
| Periods every 15 days | Needs checking | See a doctor: a fibroid or a polyp can also be the cause |
| Bleeding after sex | No | See a doctor |
| Bleeding after 12 months without a period | No | See a doctor without delay |
Pregnancy is still possible as long as menopause has not been confirmed. The Assurance Maladie recommends continuing contraception until then, and advises against natural methods, which are unreliable when cycles are irregular. A late period can therefore also warrant a pregnancy test.
How can you tell?
How do you know if you're in perimenopause? Your cycle tells you more than a blood test.
The first signs of perimenopause are often subtle, and easily blamed on stress or tiredness. Here are the ones that come up most, especially after 40:
- Your cycles are changing: shorter, longer, less predictable than before.
- Your premenstrual syndrome is stronger: tender breasts, irritability, restless nights before your period.
- You wake at night for no reason, often in the early hours, sometimes sweating.
- You have your first hot flushes, even brief ones.
- You search for words or forget what you were about to do more often.
- Your mood is more changeable, your patience shorter.
The diagnosis is clinical: it is based on your age, how your cycles are changing and your symptoms. The Assurance Maladie is clear: no test is needed in a typical situation, and hormone tests are usually pointless. The UK's NICE guidelines say the same after 45, as does a review published in 2025 in the Canadian Medical Association Journal. The reason is simple: in perimenopause, hormones fluctuate. An FSH or oestradiol test can be normal one month and high the next. The urine tests sold in pharmacies, which measure FSH, have the same limitation.
A three-month diary
Note the date and length of your periods, your nights, your hot flushes and your mood. It's the best basis for a conversation with your doctor.
The prevention check-up
In France, between 45 and 50, the Assurance Maladie prevention check-up lets you discuss these symptoms with a doctor, a midwife, a nurse or a pharmacist.
Ruling out other causes
If the symptoms suggest it, your doctor may prescribe a blood test for your thyroid or iron. It isn't a perimenopause test, it's a way of sorting causes.
What the studies say
Perimenopause: four studies worth knowing.
Perimenopause was little studied for a long time. These four studies have changed the way doctors describe it and support women through it. Full references are at the bottom of the page.
Harlow et al., 2012 · STRAW+10 consensus
An international group of experts defined the stages of reproductive ageing: early transition when cycle length varies by at least 7 days, late transition when periods are missing for 60 days or more. Limitation: the markers are less usable with hormonal contraception, after a hysterectomy or with polycystic ovaries.
Avis et al., 2015 · United States
1,449 women from the SWAN cohort. Frequent hot flushes lasted a median of 7.4 years, and 4.5 years after the last period. Those who had them early, before periods stopped, kept them the longest. Limitation: self-reported symptoms, in an American population.
Greendale et al., 2009 · United States
2,362 women from SWAN took memory and speed tests, repeated over the years. During perimenopause, they no longer improved from one session to the next as you would expect with practice; this effect disappeared after menopause. Limitation: small differences, measured by tests.
Ayers et al., 2012 · United Kingdom
140 women bothered by their hot flushes, in the MENOS 2 trial. Cognitive behavioural therapy, in a group or alone with a booklet, reduced the bother caused by hot flushes and night sweats compared with no intervention. Limitation: the trial primarily measured perceived bother.
The takeaway: perimenopause is a measurable stage, longer than people think, whose brain fog is usually temporary, and whose experience can improve without medication.
Lifestyle
The habits that really help, from perimenopause onwards.
The Assurance Maladie sums it up like this: from premenopause onwards, adopting healthy habits is essential to live better through menopause. These aren't tricks, but levers that act both on today's symptoms and on the health of your bones and heart tomorrow.
| The lever | What it changes | In practice |
|---|---|---|
| Physical activity | Eases symptoms, protects muscles and bones | 150 minutes of moderate activity per week and 2 strength sessions (WHO) |
| Regular sleep | Less fatigue and irritability | Fixed wake-up time, cool bedroom, screens away an hour before bed |
| Less alcohol | Fewer hot flushes, better nights | Alcohol-free days, nothing in the evening |
| Stopping smoking | Smokers have more hot flushes | Get help (in France: Tabac info service, 39 89) |
| Calcium and protein | Protect bones and muscle mass | Dairy or calcium-rich mineral water, protein at every meal |
| Hot flushes | Identify your triggers | Two-week diary, layered clothing, cool drinks |
| Stress management | More stable mood, calmer nights | Slow breathing, yoga, sophrology |
Perimenopause and weight gain. Weight gain, and especially fat shifting towards the belly, is among the hardest symptoms to live with. It is down to hormones, age-related muscle loss, shorter nights and activity that often drops. If you are overweight, the Assurance Maladie recommends a moderate reduction in intake, a diet with enough protein and regular physical activity, to lose fat mass without losing muscle. Very restrictive diets, by contrast, also melt away muscle.
Perimenopause and fatigue. Perimenopause fatigue most often comes from broken nights, sometimes from heavy periods that drain your iron stores. Morning daylight, a daily walk and regular hours help; if it persists, a blood test sorts out the causes. Our guide persistent fatigue: what to do sets out the causes to rule out. Chronic stress also keeps it going: we explain how it works in cortisol, the stress hormone.
With your doctor
The medical options to discuss with your doctor.
When symptoms affect your sleep, your work or your relationship, you don't have to put up with them. Your GP, your gynaecologist or your midwife can offer several options, depending on your age, your symptoms and your medical history. Here are the main families, without going into the detail of prescriptions, which belongs in the consultation.
During perimenopause
A progestogen or a low-dose oral contraceptive can relieve some symptoms, if there is no contraindication.
Hormone therapy (HRT)
It combines an oestrogen and a progestogen. In 2025, France's HAS (national health authority) confirmed its place for moderate to severe symptoms, with a review at least once a year.
Non-hormonal treatments
Non-hormonal medicines exist for hot flushes. Hypnosis and cognitive behavioural therapy also appear to be effective.
Local treatments and support
Moisturisers, lubricants or local oestrogen for intimate dryness; psychological support, reimbursed in France through the Mon soutien psy scheme, for anxiety and mood.
You sometimes hear about “natural” or “bioidentical” menopause hormone therapy, because the oestradiol and progesterone used in France are identical to the body's own hormones. They are nonetheless medicines, prescribed and monitored as such: nothing to do with plants or food supplements.
Natural treatment
Menopause and perimenopause: natural remedies, what we really know.
No natural treatment for menopause has proven itself the way hormone therapy has, and none delays menopause. The Assurance Maladie asks you to talk to a health professional before any herbal medicine, homeopathy or food supplement. Some plants have a traditional use, others have been tested, with mixed results.
| Plant | Traditional or studied use | Precaution |
|---|---|---|
| Common sage | Traditional use against sweating | Not long term at high doses, nor in case of epilepsy |
| Black cohosh | Studied for hot flushes, mixed results | Rare cases of liver damage reported |
| Soya, red clover | Rich in isoflavones (phytoestrogens) | Not recommended by the HAS, advised against after breast cancer |
| Hops | Traditional use for sleep | Also contains phytoestrogens |
| Valerian | Traditional evening plant | Can increase drowsiness |
| Ashwagandha | Ayurvedic plant, studied for stress | Not recommended in case of thyroid problems or pregnancy |
| Saffron | Studied for mood | Stick to the doses |
Natural doesn't mean harmless: these plants can interact with medicines, including anticoagulants, antidepressants and hormone treatments.
Comparing specialist menopause supplements? We have analysed their formulations in our menopause supplement comparison, and in detail in our reviews of Manhaé, Sérélys, Jolly Mama and Nala pour elle.
Our answer
Nights, mood and head: where we can help.
Let's be clear: Mush n Go has no product for hot flushes, and none of our supplements acts on hormones or on the cycle. What we offer concerns three problems that weigh heavily on daily life in perimenopause: nights, daytime mood and brain fog.
Nights
Sleep+: reishi, valerian, magnesium bisglycinate (300 mg, i.e. 60 mg of magnesium) and 1.9 mg of melatonin, which contributes to the reduction of time taken to fall asleep.
Days
Anti-Stress: ashwagandha, reishi, holy basil, schisandra and vitamin B6, which contributes to normal psychological function and to the reduction of tiredness and fatigue.
Head
Focus combines Lion's Mane, saffron, bacopa, ginkgo and maritime pine, with niacin, which contributes to the reduction of tiredness and fatigue. Brainstoorm, our mushroom coffee, provides only 20 mg of caffeine per cup.
These formulas fit into a day, they don't replace it. Here is a typical day, to adapt:
In the morning
Fixed wake-up time, ten minutes of daylight, protein at breakfast. Anti-Stress at this point, if it's part of your routine.
Before noon
Your coffee of the day, or a Brainstoorm with 20 mg of caffeine, so as not to spoil the following night.
In the afternoon
Thirty minutes of walking or a strength session. Focus during busy weeks.
In the evening
Light dinner, no alcohol, cool bedroom, screens away. Sleep+ thirty minutes before bed.
To cover morning, daytime and evening in a single order, our Perimenopause Pack brings together Brainstoorm, Anti-Stress and Sleep+.
These are food supplements: they replace neither treatment, nor medical advice, nor a varied diet. Sleep+ is not recommended during pregnancy and breastfeeding; ask for advice before taking Focus if you take an anticoagulant or an antidepressant, and before Anti-Stress in case of thyroid problems. Our products come with a 60-day guarantee, even on opened boxes. To go further: ashwagandha for women and our 7-day plan against brain fog.
The Perimenopause Pack
Brainstoorm in the morning, Anti-Stress during the day, Sleep+ in the evening: all three products together in a 30-day ritual, cheaper than buying them separately, as a one-off purchase or a subscription.
Discover the Perimenopause Pack →When to see a doctor
When should you see a doctor without waiting?
Perimenopause is also the right time to take stock of your health: blood pressure, cholesterol, bones, gynaecological and breast cancer screening. Some situations, however, call for a prompt appointment.
See your doctor, your gynaecologist or your midwife if:
- your periods stop before 40;
- your periods are so heavy that they wear you out, or come with large clots;
- you bleed between periods, after sex, or after twelve months without a period;
- you have palpitations, breathlessness or chest pain;
- your symptoms disrupt your sleep, your work or your relationship;
- you feel lasting sadness, overwhelming anxiety or dark thoughts;
- you want to take a supplement while you are on medication.
If you have suicidal thoughts, call 116 123, the Samaritans helpline in the UK and Ireland, free and available 24 hours a day. If you have chest pain, call 112.
Your questions
Perimenopause: your questions.
At what age does perimenopause start?
Perimenopause most often starts in the second half of your forties: according to the Assurance Maladie, its symptoms appear on average around 47. In some women, cycles change from 40. Periods stopping before 40 is not normal perimenopause and warrants medical advice.
How long does perimenopause last?
Most often 2 to 4 years, more often 4, according to the Assurance Maladie, but it can last anything from a few months to about ten years. It ends with menopause, confirmed after twelve months without a period. Some symptoms, such as hot flushes, can continue for a few years afterwards.
What are the first signs of perimenopause?
Most often, cycles that change length, stronger premenstrual syndrome with tender breasts, and sleep that gets worse. Then come the first hot flushes and night sweats, irritability and difficulty concentrating.
How do I know if I'm in perimenopause?
The diagnosis is based on age, how your cycles are changing and your symptoms. Hormone tests are usually pointless, because hormones fluctuate in perimenopause. The most useful thing is to note your cycles and symptoms for three months, then talk to your doctor or midwife.
What is the difference between premenopause and perimenopause?
In everyday life, both words refer to the same transition before menopause. The most precise medical term is perimenopause. Strictly speaking, premenopause refers to the whole reproductive life before menopause, and in everyday use, the very start of the transition.
Does perimenopause make you gain weight?
It contributes: hormonal changes encourage fat storage around the belly, muscle mass decreases with age and shorter nights play a part too. Protein at every meal, a moderate reduction in intake if you are overweight and regular physical activity, including strength training, are the recommended levers.
Why am I so tired in perimenopause?
Most often because of nights broken by waking and night sweats, sometimes because of heavy periods that lower your iron stores. The stress of this period adds to it. If fatigue persists despite better nights, a blood test can rule out anaemia or a thyroid problem.
Can you get pregnant during perimenopause?
Yes. Fertility falls, but pregnancy is still possible as long as menopause has not been confirmed. The Assurance Maladie recommends continuing contraception until then, and advises against natural methods, which are unreliable when cycles are irregular.
How long do periods last in premenopause?
It varies: periods can last longer and be heavier than before, especially at the start of the transition, or on the contrary become lighter and further apart. Periods lasting more than seven days, very heavy ones or ones with large clots should be reported to your doctor.
Is there a natural treatment for perimenopause?
No natural treatment has proven itself the way hormone therapy has. Lifestyle really helps: physical activity, regular sleep, less alcohol, stopping smoking, managing stress. Some plants have a traditional use; ask your doctor's advice before taking them, especially if you are on medication.
Sources
- Assurance Maladie (ameli.fr). Périménopause (préménopause) : symptômes et contraception. Updated on 9 April 2026.
- Assurance Maladie (ameli.fr). Ménopause : définition, symptômes et diagnostic. Updated on 20 February 2026.
- Assurance Maladie (ameli.fr). Périménopause et ménopause : mode de vie et traitement. Updated on 9 April 2026.
- CNGOF and GEMVi (2021). Les femmes ménopausées : recommandations pour la pratique clinique. Gynécologie Obstétrique Fertilité & Sénologie, 49(5).
- National Institute for Health and Care Excellence (2015, updated in 2024). Menopause: identification and management (NG23).
- Lega I. C., Jacobson M. (2025). Perimenopause. CMAJ, 197(2), E52-E53.
- Harlow S. D. et al. (2012). Executive summary of the Stages of Reproductive Aging Workshop + 10: addressing the unfinished agenda of staging reproductive aging. Menopause, 19(4), 387-395.
- Avis N. E. et al. (2015). Duration of menopausal vasomotor symptoms over the menopause transition. JAMA Internal Medicine, 175(4), 531-539.
- Greendale G. A. et al. (2009). Effects of the menopause transition and hormone use on cognitive performance in midlife women. Neurology, 72(21), 1850-1857.
- Ayers B. et al. (2012). 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, 19(7), 749-759.
- World Health Organization (2020). WHO guidelines on physical activity and sedentary behaviour.
- NHS (United Kingdom). Perimenopause: symptoms.
Keep reading
Further reading.
Perimenopause affects sleep, energy and concentration. Here are our most useful guides to keep going, or our guide to mushrooms.
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