One thing almost all women must come to terms with as they age is the reality of menopause: the sometimes-drastic changes their bodies endure at the end of their reproductive cycles. But what many women don’t realize is that bodily changes can start to affect them years before menopause truly begins.

This process is called perimenopause, and it may start sooner than you’d think.

What is perimenopause?

There are a lot of terms to describe specific points of a woman’s reproductive cycle, which can cause some confusion. Perimenopause joins a list including PMS, premenopause, menopause, post-menopause and more. So what exactly is perimenopause, and how does it differ from other stages?

Perimenopause describes the gradual changes to the female reproductive system as the ovaries decrease estrogen production and menstruation slows and eventually stops. However, during this time, hormone levels continue to fluctuate—sometimes wildly—causing symptoms.

Whereas menopause is a description for a specific point in time (the 12 months after menstruation ends), perimenopause is a transitional period of time denoted by symptoms of change. The transition is caused by a shift in hormone levels as your body prepares to end your menstrual cycle.

During their peak reproductive years, women typically experience regular menstruation caused by rising and falling levels of estrogen and progesterone. By their late 30s, women don’t make as much progesterone or estrogen. This causes periods to become more irregular by the early 40s, when they typically enter perimenopause.

Perimenopause usually last between three and four years, but it could last as little as a few months or as long as 10 years.

Sometimes, people use the term “premenopause” to describe women approaching menopause. While this term is somewhat correct, many physicians prefer the term perimenopause, as it most accurately describes being close to menopause. Premenopause could describe any woman who has not yet reached menopause.

Additionally, pregnancy is still possible during perimenopause, so it’s important to practice safe sex and use contraception if you do not want to conceive.

Symptoms of perimenopause: What to expect

Not all women will experience the same symptoms of perimenopause. The transitional stage affects all women a little differently, so your experience may not be the same as someone else’s. Some women have no symptoms, while others experience many of the same symptoms of menopause during this time.

Sometimes, perimenopause symptoms can be conflated with side effects of other bodily and lifestyle changes that occur around the same time, which is why many women don’t notice them or are taken by surprised.

Generally, symptoms of perimenopause get more intense the closer a woman gets to menopause.

Here are a few common symptoms that tend to appear in women at this stage of life:

• Hot flashes: Hot flashes are one of the most common symptoms reported, and can include facial and bodily flushing, sweating and chills. Hot flashes are typically thought of as solely a menopause symptom, but they can start in perimenopause and continue for a year or two after menopause.
• Erratic menstrual cycles and heavy bleeding: Irregular periods are usually what clues women in to their entrance into perimenopause. These are caused by fluctuating levels of estrogen. Heavy bleeding during periods is typically caused by reduced progesterone, which helps regulate endometrium growth, causing the uterine lining to become thicker before it is shed.
• Vaginal dryness: Lowered estrogen can cause natural lubricant in the vagina to decrease, potentially causing pain, itching and irritation during sexual intercourse.
• Insomnia: Some women report having trouble sleeping during perimenopause.
• Moodiness: Fluctuating hormones may lead to sudden mood swings, similar to those during menstruation or worse.
• Hair loss or thinning: Hair loss can sometimes be caused by an imbalance of hormones, leading to follicle shrinkage and hair thinning.

How to manage perimenopause

Discovering you’ve entered into perimenopause can be distressing to some women, both because of the sudden changes and the symptoms that may occur.

Unfortunately, it’s difficult to truly stop the negative symptoms of perimenopause. However, there are some remedies that may help you manage symptoms to improve comfort.

Avoid triggers for hot flashes, including spicy foods, hot beverages and warm temperatures. Stay proactive against hot flashes by dressing in layers and practice deep breathing techniques, which have been shown to alleviate hot flashes.

Libido enhancers and lubricants can help alleviate the effects of vaginal dryness and allow for a more comfortable and arousing sexual experience.

Additionally, taking an oral contraceptive pill may help stabilize hormone levels and regulate menstruation. If you’re not already taking a birth control pill, speak to your doctor about whether a prescription is the right move for you.

Prepare for your next stage in life

Once you know you’re in perimenopause, it’s also important to start preparing for menopause, since you can’t know when your menstrual cycle will stop for certain.

During and after menopause, women are more likely to encounter health problems like osteoporosis and heart disease. Planning ahead for these troubles and getting the necessary vitamins and minerals can help make your transition into menopause and post-menopause easier and safer.

Overall, it’s important that you take time to take care of your body and mind. Exercise, get sleep, eat healthily and spend time destressing to help make all your symptoms easier to manage and mitigate the potential for chronic stress, anxiety or depression.