Understanding Perimenopause

This article is sponsored by UnityPoint Health — Des Moines.
© Marija Babic photo by Canva

Gwyneth Paltrow once said, “I think menopause gets a really bad rap and needs a bit of rebranding. I don’t think we have in our society a great example of an aspirational menopausal woman.”  

What is Menopause?

What most women know about menopause is unpleasant. Menopause is the stopping of a woman’s natural menstrual bleeding for twelve months without another cause (like overexercise, pregnancy, and breastfeeding). It occurs for the average woman at approximately 51 ½ years old (45-55 is normal) and is complete or near complete ovarian follicular depletion. In other words, the ovaries no longer make or release eggs.

What is Perimenopause?

The years of a woman’s life just before menopause is called perimenopause. It is characterized by irregular menstrual periods, changes to the endocrine system, and symptoms ranging from mood changes to hot flashes. Perimenopause is also called “transition” because this is the time a woman is transitioning from having a menstrual cycle to not having a menstrual cycle. Transition typically lasts four years but can be shorter or longer depending on the woman.  

Stages of Transition

Transition happens in two stages that can be confusing and frustrating. Women often want answers – a definitive label – for their symptoms. Unfortunately, hormone tests are unpredictable and may give unclear results.  

  1. Early Transition – For most women during early transition, their menstrual cycle shortens to less than 25 days but may increase to more than 35 days.
  2. Late Transition – Most commonly during this stage, women’s cycles gradually decrease in flow. However, it is not uncommon for some women to experience heavy or prolonged menstrual bleeding or even skip a month or more. Late transition typically lasts for one to three years.  


The most common symptom during transition is hot flashes, which occur in approximately 80 percent of women. Other common symptoms include anxiety, sleep disturbance, brain fog, vaginal dryness (causing pain with sex or increased vaginal infections), joint pain, breast pain, weight gain/loss of lean muscle, menstrual migraines, and depression. In fact, depression risk is increased two-fold during transition. In addition, women experience a decrease in bone density, cardiovascular health, and balance.


So, what can you do to make this unpleasant and frustrating time more bearable? 

  • Keep a menstrual calendar with a detailed journal of symptoms and bring it to your health checks. Talk to your provider about any symptoms that bother you, as they can recommend options that can decrease your discomfort.
  • To combat hot flashes, dress in layers, keep your home at a comfortable temperature, and avoid hot drinks. If your hot flashes occur seven or more times per day and/or impact your sleep, mood, energy, concentration, work, or sex life, talk with your provider.
  • Continue regular exercise to maintain bone health. If you smoke, ask your provider for help to quit. Avoid caffeine, limit alcohol, and get up at the same time every day. 
  • If you are experiencing vaginal dryness, it is safe to utilize vaginal moisturizers a few times a week and lubrication with sex.
  • Discuss your contraception with your provider. In most cases, it is safe to continue contraception to the age of 50-51. Contraception can even decrease or prevent symptoms such as hot flashes and irregular periods during transition. 

Finally, reframe the way you think about perimenopause. As Oprah Winfrey states, “I’ve discovered that this is your moment to reinvent yourself after years of focusing on the needs of everyone else.”

Do you have questions about perimenopause? Contact Midwife Services of UnityPoint Health – Des Moines for all your women’s healthcare needs.

Khara Keegan, ARNP, BSN, CNM, MSN, is a Certified Nurse Midwife with Midwife Services of UnityPoint Health – Des Moines. She is proud to provide holistic, integrative, and compassionate care to women of all ages and stages of life. Her personal interests include family, friends, faith, food, and fitness.

Connect with UnityPoint Health — Des Moines


This post is part of a series of sponsored articles by UnityPoint Health — Des Moines.

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