Navigating midlife changes can feel confusing, especially when your body starts doing things it hasn’t done before—like irregular periods, unexpected mood swings or waking up drenched in sweat. If you’re wondering whether these changes mean you’re entering menopause or something else, you’re not alone. To help you learn more about these shifts so you can feel more in control and supported, we spoke with Rebecca Previs, MD, a board-certified obstetrician and gynecologist, gynecologic oncologist, and senior director of medical affairs at Labcorp, about menopause symptoms, the differences between perimenopause and menopause and more.
What’s the difference between perimenopause and menopause?
Perimenopause is the phase leading up to menopause. It usually starts in your 40s and can last several years. During this time, your hormone levels—especially estrogen and progesterone—start to fluctuate. This can cause changes in your menstrual cycle, like periods that come more or less often, or are heavier or lighter than usual. You might also notice symptoms like hot flashes, trouble sleeping, mood changes or vaginal dryness.
Menopause itself is defined as the point when you’ve gone 12 months without a period. The average age is around 51, but it can happen earlier or later depending on your genetics, lifestyle and health history. Once menopause occurs, your hormone levels settle at lower levels, and your ovaries stop releasing eggs.
“This marks the end of your reproductive years, but it also signals a new phase of health that deserves attention and care,” says Dr. Previs.
When does menopause usually start?
Most women reach menopause around age 51, but it can happen earlier or later. Perimenopause often begins in your mid-to-late 40s. Some women experience early menopause—before age 40—which can be due to genetics, autoimmune conditions or medical treatments like chemotherapy.
“If you’re experiencing symptoms earlier than expected, it’s important to talk with your doctor to understand what’s going on and how to support your health,” says Dr. Previs.
How do I know if I’m in perimenopause?
If you’re over 45 and noticing changes in your periods or experiencing symptoms like hot flashes, mood shifts or sleep problems, it’s very likely you’re in perimenopause.
“We don’t usually need blood tests to confirm this, because hormone levels fluctuate so much that a single test doesn’t give us the full picture,” explains Dr. Previs. “However, if you’re under 45 or have unusual symptoms—like very heavy bleeding or signs of another condition—your doctor may recommend testing to rule out other causes. And if there’s a chance you could be pregnant, we’ll check for that, too.”
What symptoms should I expect—and how long do they last?
Hot flashes are one of the most common symptoms. They can feel like a sudden wave of heat starting in your chest or face, sometimes followed by sweating or chills. When they happen at night, they’re called night sweats and can disrupt your sleep. These symptoms can begin during perimenopause and may last for several years—sometimes even a decade.
Sleep problems are also common. You might have trouble falling asleep or staying asleep, even if you’re not having night sweats. Hormonal changes, mood shifts and even conditions like sleep apnea can all play a role.
Mood changes—like feeling more anxious, irritable or down—can happen even if you’ve never had issues before. Some women describe feeling emotionally sensitive or just “off.”
“These changes are often temporary, but they’re real and deserve attention,” says Dr. Previs.
You might also notice changes in memory or concentration—what many call “brain fog.” While frustrating, these symptoms are usually mild and tend to improve over time.
Later in the transition, vaginal dryness and discomfort during sex can become more noticeable. These symptoms are part of what we now call genitourinary syndrome of menopause (GSM), and they tend to persist if not treated. Fortunately, they respond well to local estrogen therapy.
Other symptoms can include joint pain, breast tenderness, migraines and changes in skin or body composition. Dr. Previs points out that every woman’s experience is different, and not all symptoms happen to everyone. It’s important to talk to your healthcare provider about any new or concerning symptoms you experience.
How does menopause affect my health long-term?
Beyond the day-to-day symptoms, menopause can have longer-term effects on your health. The drop in estrogen affects several systems in your body:
- Bone health: You start to lose bone density, which increases your risk for osteoporosis and fractures
- Heart health: Cholesterol levels may shift, and your risk for heart disease can increase
- Bladder and pelvic health: You may notice more urinary urgency or leakage
- Mental health: Mood and cognitive changes can occur, though they’re often manageable
- Joint and muscle health: You might feel more stiffness or notice changes in strength and flexibility
These changes are common, but they’re not inevitable—and they’re treatable. There are many ways to support your health during and after menopause, from lifestyle changes to medical therapies.
What can I do to feel better?
There are many options to help manage symptoms and improve your quality of life. Hormone therapy is one of the most effective treatments for hot flashes, sleep issues and vaginal dryness. It’s considered safe for most women, but not recommended if you’ve had breast cancer, a stroke or certain other conditions.
Other treatments may include antidepressants for mood or hot flashes, vaginal estrogen for dryness and lifestyle changes like regular exercise, stress management and good sleep habits. “Some women explore natural remedies, but it’s important to talk with your doctor before trying herbs or supplements—especially if you have a history of hormone-sensitive conditions,” says Dr. Previs.
You’re not alone—and you don’t have to just “deal with it”
Menopause and perimenopause are natural, but that doesn’t mean you have to suffer through them. Whether your symptoms are mild or disruptive, there are ways to feel better and protect your long-term health. Talk to your healthcare provider about what you are experiencing.
“You deserve compassionate, personalized care,” says Dr. Previs. “And your healthcare team is here to help you navigate this transition with confidence.”
To learn more about menopause, perimenopause and other fluctuations in hormone health, visit Labcorp OnDemand or download the Ovia app to track your symptoms and access clinically-backed resources.
