Dear Doctor: Are These Signs That Perimenopause is Ending?

Dear Doctor,

I’m writing because I’m honestly overwhelmed and confused about what’s happening with my body, and I’m hoping you can help me sort through it. I’ve been reading about signs perimenopause is ending, but the more I learn, the more unsure I feel. 

I am definitely in perimenopause–over the past year, my cycles have stretched out to 50 or even 60 days, and then I’ll have a random heavy bleed that throws me off completely. I’m also dealing with night sweats, mood swings that feel unpredictable, and a level of fatigue I can’t quite explain. Are these late perimenopause symptoms, or could something else be going on?

I keep reading that perimenopause can last anywhere from 4 to 8 years, and that the average age of menopause is around 51—I am in my late 40’s, is this too young to enter menopause?

I guess my real question is: how can I tell if perimenopause is truly ending for me, and is there anything I should be doing before my cycles stop altogether?

Thank you for helping me make sense of this.

Best,

The End of a Cycle (Literally)

Dear The End of a Cycle (Literally),

Thank you for writing with such honesty. What you’re describing is incredibly common, and many of my patients have similar questions during this time in their lives. Many women in midlife find themselves navigating a confusing mix of symptoms, wondering whether these changes mean perimenopause is ending—or whether something else is going on. Let me walk you through what we know.

First, when we talk about the signs that perimenopause is ending, the most reliable indicator is your menstrual cycle. During late perimenopause, menstrual cycles are much longer, sometimes over 60 days between periods. 

You may also notice an uptick in the intensity of other symptoms, such as hot flashes or night sweats, disrupted sleep,  or vaginal dryness. That’s due to a drop in estrogen; however, for many women, these symptoms mellow out during postmenopause, though some continue, such as vaginal dryness.

It may help to understand where you are in the broader phases of menopause:

• Perimenopause is the transitional stage leading up to menopause, and it often has two phases: early perimenopause (when cycles shorten or become unpredictable) and late perimenopause (when periods become widely spaced and symptoms tend to peak).
• Menopause itself is defined as twelve consecutive months without a period. 
• After that milestone, you’re officially in postmenopause.

With that in mind, you may wonder: How long does perimenopause last? While every woman’s experience is different, perimenopause commonly lasts 4-8 years. For some women, it may ot last as long, and for others, it’s longer. It depends on several different factors, like genetics, lifestyle, and underlying health conditions.

Another point you mentioned, the difference between perimenopause and menopause, is worth clarifying. Perimenopause is when your hormones are fluctuating, marked by inconsistent cycles. In contrast, menopause is a single point in time marking 12 months after your last menstrual period. Everything after that is postmenopause. 

So, are you too young for menopause? While ~51 is the average age of menopause, some women reach menopause earlier, either naturally or due to genetic, medical, or autoimmune factors. Having perimenopausal symptoms in your 30s or 40s doesn’t necessarily mean you’ll enter menopause early, but you should work with your Genesis provider for an assessment and care plan.

An assessment can rule out other conditions like thyroid disorders, fibroids, or endometrial changes that can mimic perimenopausal symptoms.

Finally, know this: you do not have to endure these changes without support. Whether you’re dealing with hot flashes, mood swings, painful sex, or sleep loss, effective treatments exist. And emotionally, you deserve space to process what this transition means for your identity, sexuality, and fertility.

Let’s take this one step at a time. With information, testing, and a thoughtful plan, you’ll have a much clearer picture of where you are—and what options are still open to you.

Wishing you good health,

Dr. Anna Nelson-Moseke

OB/GYN, Genesis Women’s Health

Anna Nelson-Moseke, MD, FACOG, is a board-certified OB/GYN and the Medical Director of Genesis OB-GYN. She practices at Pueblo in Tucson, AZ.