Picture this: it’s 2 p.m. and you’re sweating through your shirt in a perfectly air-conditioned room. At 3 p.m. you cry at a dog food commercial. At 3 a.m. you’re wide awake, staring at the ceiling, wondering who you are and why you walked into the kitchen earlier. 😅
Then someone tells you it’s “just stress.”
Girl. I hear “Am I in menopause?” in my Torrance office almost every single day, usually right after “I just don’t feel like myself.” So let’s settle it, with real science and zero judgment.
The 10-second answer: If you still get a period, even a chaotic, shows-up-whenever-it-wants period, you’re most likely in perimenopause, not menopause. Menopause doesn’t officially start until you’ve gone 12 months in a row with no period at all [1, 2].
Grab your iced coffee (or your ice pack, no judgment) and let’s get into it. Every claim here is backed by research, and the sources are numbered at the bottom for my fellow nerds. 🤓
Perimenopause: the “hormonal group chat” years
Perimenopause, also called the menopause transition, is the stretch of time leading up to your final period. It usually kicks off in your 40s [1].
The first official clue? Your cycle starts freelancing. Periods show up noticeably earlier or later than they used to. Later in the transition, you may skip a period for two months or more, then get one anyway just to keep you humble [1].
Here’s the part nobody tells you: your hormones don’t politely fade out. They rise and fall unpredictably, like a group chat where everyone’s replying at once and nobody’s making sense [1]. That’s why one month you feel totally normal and the next you’re sweating through your sheets and questioning every life choice.
You’re not crazy. Your hormones are just doing a lot right now. 💅🏼
Menopause: a single day (yes, really)
Plot twist: menopause isn’t a phase. It’s one moment in time. It’s the day you hit 12 months in a row with no period, when nothing else explains it, like pregnancy or hormonal birth control [1, 2].
The average age is 51 [3]. Everything after that day is called postmenopause. So if your friend says she’s “been in menopause for five years,” technically she means postmenopause. You may now correct her at brunch. 😈
Quick cheat sheet: which one are you in?
Still getting periods, even weird ones? Most likely perimenopause.
Cycles getting shorter, longer or skipping months? Classic perimenopause [1].
12 straight months with no period (and no other reason)? Congrats, you’ve reached menopause. Everything after is postmenopause [1, 2].
On hormonal birth control or had a hysterectomy? Your period can’t tell you much, so this is a great one to sort out with a provider.
Signs perimenopause has entered the chat
Your period is freelancing: shorter cycles, longer cycles or skipped months [1].
Hot flashes and night sweats [2]. And real talk, they can stick around. In a large U.S. study of more than 3,000 women, frequent hot flashes lasted a median of 7.4 years, and even longer for women whose hot flashes started early in perimenopause [4]. That’s why “just wait it out” isn’t a plan.
Sleep that’s gone rogue, especially waking up at 3 a.m. and staying up. Sleep trouble becomes more common as women move through the transition [5].
Mood changes: even women with no history of depression are more likely to have depressive symptoms during this time [6]. It’s biology, not a character flaw.
Brain fog: walked into a room and forgot why? A temporary dip in learning and memory is common in perimenopause, and the good news is it tends to improve afterward [7].
Vaginal dryness, pain with sex and bladder changes, like more urgency or more urinary tract infections [8]. Yes, we’re talking about it. That’s what I’m here for.
Lower libido and achy joints or muscles [2].
You don’t need all of these to be in perimenopause. Some women get one or two. Others feel like they ordered the entire menu. 😂
“Can’t you just run a blood test?”
I get this one a lot, and the honest answer is: usually, no.
Because your hormones are swinging all over the place, one blood test is just a snapshot of one moment. Your levels can look “normal” on Tuesday and totally different by Friday [1]. That’s why national guidelines say that for healthy women over 45, perimenopause should be diagnosed based on your symptoms and cycle changes, and they advise against using an FSH blood test to diagnose it at that age [2].
But labs still have a job. Thyroid problems can cause hot flashes, fatigue, sleep trouble and mood changes that look a lot like perimenopause. So when symptoms overlap, checking your thyroid can make sure we’re treating the right thing [9].
Translation: you are not a lab value. Your story matters more than one blood test. ✨
Okay, so what actually helps?
Here’s my favorite part: you don’t have to white-knuckle your way through this. Depending on your symptoms, health history and goals, research-backed options include:
Hormone therapy: the most effective treatment for hot flashes and night sweats. For most healthy women under 60, or within 10 years of their last period, the benefits outweigh the risks [10]. It’s not one-size-fits-all, which is exactly why we talk it through together.
Non-hormone prescriptions: can’t or don’t want hormones? Certain antidepressants (SSRIs and SNRIs), gabapentin and fezolinetant can all reduce hot flashes [11].
Non-medication options that actually have evidence: cognitive behavioral therapy (CBT) and clinical hypnosis can make hot flashes less frequent or less bothersome [11].
Vaginal estrogen: a low dose treats dryness and pain with sex, and can help with some bladder symptoms, including recurring urinary tract infections [8].
Pelvic floor training: if you leak when you laugh, sneeze or jump (hi, trampoline parks), a supervised program of at least three months is the recommended first step [12].
Strength training and weight-bearing exercise: recommended to protect your bones as estrogen drops [13]. Lift the heavy things, queen. 💪
Real talk about supplements: that pricey “hormone balance” gummy on your feed? Most supplements and herbal products haven’t been shown to help hot flashes [11]. Save your money for something fun. 💰
The right plan is personal. What worked for your best friend or your sister might not be your perfect fit, and that’s okay.
When to stop scrolling and book a visit
Come see me if your symptoms are messing with your sleep, work, relationships or overall quality of life. Or honestly, if you just want answers. That’s a good enough reason.
No jokes here: see a provider promptly if you have very heavy bleeding or bleeding between periods [14]. And any bleeding after you’ve gone 12 months without a period always needs to be checked [15]. Don’t wait on that one.
You deserve to feel like yourself again
I’m Dr. Abigail Prushansky, DNP, APRN, FNP-BC, CNM, and helping women through perimenopause and menopause is one of my favorite parts of my job. I’ll actually listen, we’ll make a plan together, and you’ll leave feeling heard.
Visits are in person at my Torrance office or by video visit anywhere in California. We accept most major insurance plans (contact us to verify yours). Serving Los Angeles, the South Bay, the Westside and Beverly Hills.
Learn more about perimenopause and menopause care →
And if you have a friend who keeps saying she doesn’t feel like herself? Send her this. ❤️
This article is for education and isn’t medical advice for you specifically. For that, come see me (or your own provider) before starting or changing any treatment. 😉
Sources
Harlow SD, et al. Executive summary of the Stages of Reproductive Aging Workshop +10 (STRAW+10). Menopause. 2012;19(4):387–395. PubMed
National Institute for Health and Care Excellence (NICE). Menopause: diagnosis and management (NG23), recommendations 1.2.1 and 1.2.5. Updated 2019. nice.org.uk/guidance/ng23
Endocrine Society. Menopause Map: Natural menopause. endocrine.org
Avis NE, et al. Duration of menopausal vasomotor symptoms over the menopause transition (SWAN). JAMA Intern Med. 2015;175(4):531–539. doi:10.1001/jamainternmed.2014.8063
Kravitz HM, et al. Sleep disturbance during the menopausal transition in a multi-ethnic community sample of women (SWAN). Sleep. 2008;31(7):979–990. PubMed
Freeman EW, et al. Associations of hormones and menopausal status with depressed mood in women with no history of depression. Arch Gen Psychiatry. 2006;63(4):375–382. PubMed
Greendale GA, et al. Effects of the menopause transition and hormone use on cognitive performance in midlife women (SWAN). Neurology. 2009;72(21):1850–1857. doi:10.1212/WNL.0b013e3181a71193
The North American Menopause Society (now The Menopause Society). The 2020 genitourinary syndrome of menopause position statement. Menopause. 2020;27(9):976–992. PubMed
Adams K. Menopause or thyroid problems? Knowing the difference matters (quoting endocrinologist Israa Ali, MD). UTMB Health. October 2, 2026. utmb.edu
The North American Menopause Society. The 2022 hormone therapy position statement. Menopause. 2022;29(7):767–794. PubMed
The North American Menopause Society. The 2023 nonhormone therapy position statement. Menopause. 2023;30(6):573–590. doi:10.1097/GME.0000000000002200
National Institute for Health and Care Excellence (NICE). Urinary incontinence in women (QS77), quality statement 4: supervised pelvic floor muscle training; and NG123 (2019). nice.org.uk
The North American Menopause Society. Management of osteoporosis in postmenopausal women: the 2021 position statement. Menopause. 2021;28(9):973–997. doi:10.1097/GME.0000000000001831
Cleveland Clinic. Abnormal uterine bleeding: causes, diagnosis and treatment. clevelandclinic.org
American College of Obstetricians and Gynecologists. Committee Opinion No. 734: The role of transvaginal ultrasonography in evaluating the endometrium of women with postmenopausal bleeding. Obstet Gynecol. 2018;131(5):e124–e129.