Perimenopause is the years of hormonal transition before periods stop for good. It usually begins in the early forties, lasts four to eight years, and ends twelve months after your final period — the point at which menopause is confirmed.

When does menopause start?

Most women in India reach menopause between 46 and 51. Perimenopause begins several years earlier, which is why cycle changes in your early forties are expected rather than alarming. The length of the transition varies widely: some women pass through it in two years, others take a decade.

Perimenopause symptoms

The common symptoms are irregular cycles, hot flushes, night sweats, disturbed sleep, mood changes, vaginal dryness, reduced libido and difficulty concentrating. These are driven by oestrogen that fluctuates rather than declines steadily, which is why symptoms come and go and why a single blood test rarely settles the question.

Signs of menopause at 40

Symptoms appearing before 45 are classed as early menopause. Before 40, it is premature ovarian insufficiency, which needs proper assessment — it carries long-term bone and cardiovascular risk that benefits from early treatment rather than watchful waiting.

Hormone replacement therapy for perimenopause

HRT replaces the oestrogen your ovaries are no longer producing consistently, with progesterone added if you still have a uterus. It is the most effective treatment available for hot flushes, night sweats and vaginal dryness, and it protects bone density. Suitability depends on your personal and family history, so it is a conversation rather than a default.

When to see a gynaecologist

Book a review if you have bleeding between periods, unusually heavy bleeding, symptoms starting before 45, or any bleeding at all after twelve period-free months. Each of these needs assessment rather than reassurance.

Perimenopause care at Tulsi Maternity & Gynaecology Clinic, Matunga, covers symptom assessment, hormone evaluation and HRT suitability. Book a consultation with Dr. Asavari Karani.