These Are the Signs Perimenopause Is Ending

If you’ve been experiencing symptoms of perimenopause for months or years now, you may have a burning question on your mind: “Will this ever end?” We don’t blame you for wondering about the signs perimenopause is ending. With all the varied symptoms of this midlife phase leading up to menopause, it can often be an unpredictable, overwhelming, and, well, just really annoying time. 

You’re not alone if you’re counting down the days: Research suggests that nearly 90% of women seek advice from a healthcare professional for bothersome perimenopause symptoms. 

“Menopause occurs when our ovaries stop making estrogen, but it doesn't happen overnight,” says Kathleen Jordan, MD, Chief Medical Officer at Midi. “There is an approximately 4- to 8-year period before menopause, known as perimenopause, where we're seeing fluctuating estrogen levels that create a roller coaster of symptoms.” 

The biggest clue that perimenopause may be winding down is longer gaps between periods. But there's no reliable way to know which period will be your last, and menopause isn't officially confirmed until you've gone 12 consecutive months without a period.

The good news: Perimenopause does end. And with the right support, you can weather your symptoms and feel more prepared for what comes next. Midi’s trained menopause specialists can help you understand the “why” behind perimenopausal changes and offer a range of solutions, including prescription medications, supplements, and lifestyle coaching, to help you through this transition. 

Read on to learn more about the signs perimenopause is ending, what those changes can—and can't—tell you, when it's time to seek care, and how to prepare for the next stage in your journey. 

What Are the Signs Perimenopause Is Ending?

One of the clearest signs perimenopause is ending is also one of the earliest signs that it began: changes to your menstrual cycle. Research has found that as you get closer to menopause, longer gaps between periods—including going 60 days or more without a period—become more common. 

As perimenopause winds down, you may notice: 

• skipped periods, as well as longer time between periods 
• changes in menstrual bleeding, including lighter or more unpredictable periods
• hot flashes and night sweats that may peak before easing
• vaginal dryness or urinary symptoms that become more noticeable
• sleep problems or mood changes like increased anger
• brain fog or more frequent migraines
• weight changes 

Menopause isn't confirmed until you've gone 12 consecutive months without a period. These changes can offer important clues to whether menopause is getting closer, though they don't provide a defined countdown to menopause. 

Late-stage perimenopause at a glance 

As perimenopause winds down, it can look different for everyone. Recognizing some common signs can help you better understand where you are in the menopause transition:

Understanding Perimenopause 

Perimenopausal symptoms catch a lot of women off guard. In fact, many of us don’t even know we’ve entered this phase when it happens. When you learn about the root causes of perimenopause, you can better understand what’s going on in your body and seek out effective relief.‍ 

“Estrogen affects us everywhere,” says Dr. Jordan. “Estrogen receptors are not just in our breasts and our uterus, which is what people typically think. When our estrogen levels deplete, it can affect us all over, from our joints to our skin to our brain, which is why it interferes with our ability to concentrate.”

Defining perimenopause 

Perimenopause refers to the natural period when your body adjusts to the end of your reproductive years. Menopause, on the other hand, isn’t a stage, but a moment: You reach it after 12 consecutive months without a menstrual period. 

On average, perimenopause begins in your mid-40s, but it can start as early as your 30s or as late as your 50s. It usually lasts around 4 years, but it can last anywhere from a few months to 10 years. 

But why is this happening? One word: estrogen. During perimenopause, hormone levels—especially estrogen—fluctuate dramatically. Levels rise and fall daily and monthly as estrogen gradually trends downward, just not in a linear way. 

This is your reproductive system’s way of closing up shop. However, since your estrogen levels have been relatively consistent from puberty until now, your body can react dramatically. Common symptoms include hot flashes, insomnia, brain fog, weight gain, hair loss, and mood changes. 

Menopause is the same for all women in at least a few respects (no more birth control needed; no more periods, tampons, cramps, or wrecked underwear). But perimenopause is unique and looks different from woman to woman. How it feels, when it starts and how long it lasts vary enormously from one person to the next. 

To get personalized recommendations based on your symptoms and health history, you can book a virtual visit with a Midi menopause specialist.

The duration and phases of perimenopause 

While perimenopause is a complex and individualized experience, most healthcare professionals describe it in two stages: early perimenopause and late-stage perimenopause. While you can experience a range of symptoms during both phases, the dividing line is usually dictated by the frequency of your periods. Here’s a breakdown:

• Early perimenopause: The hormonal variations at this stage are subtle, as estrogen is only beginning to decline. You may experience irregular periods, mood shifts, night sweats, and libido changes. The length of this stage varies from person to person. For some, it can last 3 to 5 years; for others, symptoms may progress as quickly as 1 year after their onset. ‍ 
• Late perimenopause: On average, this stage lasts 1 to 3 years. Once you’ve gone at least 60 days between periods, you’ve likely entered the late stage of perimenopause. As you approach the end of this transition, some of your symptoms may subside, or they can persist or intensify. Your periods will also become less frequent, eventually stopping entirely. You may also notice symptoms of the genitourinary syndrome of menopause (GSM) like vaginal dryness, pain during sex, or urinary challenges. Vasomotor symptoms like hot flashes and night sweats may also be more intense during this stage. 

Once your periods have stopped for a full 12 months, you’ve officially reached menopause. ‍

Recognizing the End of Perimenopause 

If you've been dealing with perimenopause symptoms for years, it's understandable that you might be ready to get to the end of this particular chapter. While there’s no way to predict or pinpoint exactly when it will end for you, changes in your menstrual cycle and other symptoms can provide important clues about where you are in the menopause transition.

Changes in menstrual patterns 

The frequency and flow of your periods can tell you a lot about which stage of this transition you’re in. That said, there is a wide range of “normal” when it comes to period-related symptoms of perimenopause. 

Because estrogen and progesterone levels fluctuate so much during this transition, your periods will change, too. When estrogen is up between cycles, your uterine lining is thicker and your period, in turn, tends to be heavier. When estrogen is low, there’s less buildup of your uterine lining, so periods tend to be lighter (more like spotting).

For most women, studies find, cycles become increasingly unpredictable during perimenopause. The stretch between periods can be longer one month and shorter the next. The flow can be heavier one time around, then suddenly lighter. Your period may go missing entirely for months on end, then come roaring back. 

As you progress through perimenopause, you’ll notice more missed cycles. But every woman is different. Some will miss one cycle, while others may miss many in a row. You may have a stretch where your periods return to their monthly cadence before they start skipping around again. Typically, though, cycles will start coming further and further apart until they stop completely. 

Not sure how to make sense of your periods? A menopause specialist (like the clinicians at Midi) can help analyze your menstrual patterns and give you personalized recommendations based on your symptoms.

Physical and emotional symptom shifts 

You might assume that perimenopause symptoms improve as you approach your last period, but that’s not necessarily the case. Even after your hormone levels have bottomed out, your body may still need time to adjust, which is why it’s common to experience ongoing symptoms. For example: 

• Some symptoms tied to hormone fluctuations can become less disruptive once those ups and downs settle. Mood shifts, some sleep issues, hormone-triggered migraine, and brain fog or memory lapses may all improve after menopause.
• Hot flashes, night sweats, and sleep concerns related to night sweats may get worse before they get better. You might notice that these symptoms become more frequent or intense in late perimenopause and continue after menopause before gradually improving. 
• Other symptoms may also persist after menopause or worsen without treatment, including vaginal dryness, pain during sex, urinary urgency, and urinary tract infections (UTIs). Lower estrogen also speeds up bone loss, increasing the risk of osteoporosis and fractures over time.

Many women do start feeling better after perimenopause, but it's not automatic for everyone. If menopause symptoms affect your physical or mental health, a healthcare professional, like a Midi clinician, can help you find treatments that fit your symptoms, health history, and goals.

Transitioning to Menopause 

So, what happens when you officially transition from perimenopause to menopause? As epic as it would be, you won’t get a Certificate of Completion of Perimenopause from your gynecologist—but your body will show you some signs that you’ve officially graduated to menopause.

The menopause threshold 

Remember, you reach the menopause threshold after you've gone 12 consecutive months without a period. It can be helpful to track your periods after you start noticing erratic cycles, so you can remember how long it’s been since your last one. 

But your final menstrual period isn’t the only change. After estrogen levels drop during late perimenopause, your body gradually adjusts to its new hormonal normal, which can affect your symptoms over time. 

When the 12-month mark isn't clear 

The 12-month mark is usually the clearest way to identify menopause, but for some people, it isn't that straightforward. 

This can include those who:

• use hormonal birth control, including a progestin-only IUD, which may lighten or stop periods
• have had a hysterectomy, so they don’t get periods, but still have one or both ovaries
• have irregular bleeding caused by a medical condition like uterine fibroids

In these situations, a healthcare professional can help you determine whether you've reached menopause. 

It's also important to remember that pregnancy is still possible during perimenopause if you're ovulating and having periods. If you want to prevent pregnancy, keep using birth control until you’ve reached menopause. (It’s rare, but there are documented spontaneous pregnancies in women in their 50s.)

Do I need a menopause test?

Not usually. For most women over age 45, healthcare professionals typically diagnose menopause after you've gone 12 consecutive months without a period. Because hormone levels fluctuate throughout perimenopause, a single hormone test usually can't show exactly where you are in the transition.

Testing or additional evaluation may be helpful in some situations, including if you:

• develop menopause symptoms before age 40
• may be entering early menopause before age 45
• have unusual bleeding that could be caused by another condition, such as a thyroid disorder 
• use hormonal birth control or other medications that make it hard to interpret your menstrual cycles

A Midi clinician can review your symptoms, menstrual patterns, medical history, and health goals to determine whether additional testing is appropriate.

What happens after perimenopause ends 

Menopause marks the beginning of a new stage and provides a good opportunity to focus on your long-term health and well-being. That’s important, because this life stage has an impact on many aspects of your body. A menopause-trained clinician can help you manage lingering symptoms, reduce future health risks, and support your well-being as your needs change.

Personalized care might include strategies to manage: 

• bone health, since lower estrogen accelerates up bone loss 
• heart health, because the risk of cardiovascular disease increases after menopause 
• metabolism and weight changes 
• sleep, mood, and memory 
• vaginal and urinary health 
• sexual health and wellness 
• hair and skin changes 

The goal isn't just to ease your symptoms, though. It's to help improve your whole-body health and let you feel your best throughout the years ahead.

Treatment Options and Lifestyle Adjustments 

The best treatment plan for perimenopause and menopause symptoms usually involves a holistic approach that combines medication and lifestyle adjustments to meet your needs. 

Hormone replacement therapy (HRT, now commonly referred to as menopause hormone therapy, or MHT) is the most effective treatment for hot flashes, night sweats, and other vasomotor and genitourinary symptoms. 

The name is a bit misleading—you’re not replacing any hormones in your body as much as you’re supplementing them. A healthcare professional may prescribe supplemental estrogen and, for women with a uterus, progesterone to help ease the symptoms caused by hormone shifts. Hormone therapy comes in many forms, such as patches, pills, gels, and creams. 

Other treatment options may include: 

• Hormonal birth control to regulate periods, improve symptoms, and prevent unintended pregnancy during perimenopause
• Vaginal estrogen or DHEA to help relieve vaginal dryness, pain during sex, and some urinary symptoms
• Vaginal lubricants or moisturizers that provide a non-hormonal way to increase lubrication and comfort
• Non-hormonal prescription medications to help manage menopause symptoms when HRT isn't a suitable option
• Lifestyle changes, including regular movement, strength training, and a balanced diet, to ease some menopause symptoms and support overall health. Healthy sleep habits and stress-management practices, such as meditation and mindfulness, can also boost well-being.
• Natural remedies, including certain vitamins and supplements, can help manage fatigue, memory issues, or stress during the menopause transition. They may help some people, but evidence varies, and supplements aren't right for everyone.

A Midi clinician can help you build a personalized Care Plan with hormone therapy, non-hormonal treatments, and/or lifestyle strategies, depending on your symptoms, health history, and goals.

Seeking Professional Guidance for Perimenopausal and Menopausal Symptoms

Consider this: An estimated 75% of women going through menopause don’t get the treatment they need. Here at Midi, we think that’s unacceptable. The stigma around middle-aged women’s health has too many of us believing that uncomfortable menopause symptoms are just something we have to suffer through. That couldn’t be further from the truth. Trained menopause specialists, like the ones at Midi, can help relieve your perimenopause symptoms and support your overall well-being.

When to consult a healthcare professional 

A lot of menopause symptoms are common, but that doesn't mean you have to live with them. If symptoms are affecting your sleep, work, relationships, or daily life, it's time to see a healthcare professional. 

Abnormal bleeding is a definite reason to schedule a visit. This includes:

• very heavy bleeding (such as soaking through a pad or tampon every hour)
• bleeding that lasts more than 10 days
• bleeding after 12 consecutive months without a period
• bleeding or spotting between periods
• large blood clots
• new or severe cramping

Mental health changes—including persistent low mood, hopelessness, anxiety that feels hard to manage, or loss of interest in things you usually enjoy—are worth flagging, too.

Don't ignore genitourinary symptoms, either, such as vaginal dryness or irritation, pain during sex, recurrent UTIs, or urinary urgency. These symptoms, while common after menopause, are often treatable.

And finally, if your symptoms start before age 40 or you suspect you're entering menopause before age 45, that's worth a conversation with a healthcare professional.

Key Takeaways 

• Perimenopause is the natural transition leading up to menopause, when reproductive hormones like estrogen fluctuate and decline. It typically begins in your mid-40s but can start as early as your 30s or as late as your 50s, and it usually lasts about 4 years.
• One of the clearest signs that perimenopause is ending is longer intervals between periods—like going 60 days or more without one. Other common signs include lighter or more irregular periods, hot flashes and night sweats, and vaginal dryness or urinary symptoms.
• These signs can point to late-stage perimenopause, but there's no reliable way to know which period will be your last. You're officially in menopause after 12 consecutive months without a period.
• Some symptoms may improve after menopause, while others can persist or worsen. Tracking changes in your physical and mental health can help you know when it's time to seek care.
• You can work with a healthcare professional, like one of the menopause specialists at Midi, to create a personalized treatment plan based on your symptoms, health history, and goals. Options may include menopause hormone therapy, nonhormonal medications or supplements, and lifestyle changes like regular strength training.

Frequently Asked Questions (FAQs)

What is perimenopause? 

Perimenopause is the transitional phase before menopause, characterized by hormonal fluctuations and irregular menstrual cycles. Menopause, on the other hand, isn’t a stage but rather a moment: You reach it after 12 consecutive months without a menstrual period.

What are the last stages of perimenopause? 

The last stages of perimenopause are marked by increasingly irregular menstrual cycles, including longer gaps between periods, more missed cycles, and often lighter periods. Other signs that perimenopause is ending may include new or worsening hot flashes, night sweats, or vaginal dryness.

How do you know when perimenopause is almost over? 

Perimenopause is almost over when menstrual periods become highly irregular or stop for several months at a time, though there's no way to predict when menopause will happen. 

Will I feel better after perimenopause? 

Every woman’s experience is different. Some symptoms may improve after perimenopause, but others may continue or intensify. Hot flashes and night sweats, for example, often peak 1 year after menopause. 

How long does perimenopause typically last? 

Perimenopause typically lasts around 4 years, but for some people it can last up to 10 years. 

Can you still get pregnant during perimenopause? 

Yes, pregnancy is still possible during perimenopause because ovulation can occur sporadically, so it’s important to use contraception if you don’t want to get pregnant.

What are the common symptoms of perimenopause? 

Common symptoms of perimenopause include hot flashes, night sweats, mood shifts, sleep disturbances, irregular menstrual cycles, brain fog, vaginal dryness, and weight changes.

Are treatments available for perimenopause symptoms? 

Yes, treatments for perimenopause symptoms include hormone therapy, hormonal birth control methods, other prescription medications that address individual symptoms, lifestyle changes related to diet and exercise, and alternative remedies. Talk with a healthcare professional or menopause specialist about the best treatment plan for your symptoms and health history.

What lifestyle changes can help manage perimenopause symptoms? 

Lifestyle changes that can help manage perimenopause symptoms include maintaining a healthy diet, exercising regularly, reducing stress, and ensuring adequate sleep. 

How does perimenopause affect mental health? 

Perimenopause can affect mental health by causing mood shifts and increased anxiety or depression due to hormonal changes. Seeking support from healthcare professionals or support groups can be beneficial.