What it is
Perimenopause usually begins about four years before the final period. The ovaries do not shut down on a schedule: ovulation becomes unpredictable, and hormones swing with it.
Cycles often shorten first, by a few days. Then they space out and skip. Flow can turn lighter one month and heavier the next. This is the normal shape of the transition.
Menopause itself is a single line: twelve months without a period. The average age is 51. Until you cross that line, pregnancy is still possible.
What you might notice
- Cycles a few days shorter than they used to be
- Skipped months, then a period that shows up anyway
- Flow that is lighter some months and heavier others
- PMS that feels stronger than it used to
- Hot flashes and broken sleep arriving around the erratic cycles
- Periods spacing further apart as the years go on
How Dr. Mueller evaluates it
- 1
Track the pattern
A few months of dates and flow tells more than any lab.
- 2
Your history
Dr. Mueller reviews your cycles, symptoms and health in a full visit.
- 3
Labs, rarely
Over 45, the pattern makes the diagnosis; hormone tests usually add nothing.
- 4
A closer look when needed
Very heavy flow or bleeding between periods gets an ultrasound.
- 5
Contraception talk
Pregnancy stays possible in perimenopause. Dr. Mueller tells you when it is safe to stop.
- 6
The plan
Treat what bothers you, from cycle control to hormone therapy, and recheck as things change.
Questions people ask
- Do I need a hormone test to confirm perimenopause?
- Over 45, usually not. Hormones swing day to day, so a single FSH level can mislead. The pattern of your cycles is the better test.
- Can I still get pregnant?
- Yes. Ovulation is erratic, not gone. The usual advice: contraception until one year after your final period, or two years if it comes before 50. Dr. Mueller covers options that also calm the cycles.
- What bleeding is not normal?
- Soaking a pad an hour for several hours running, bleeding after sex, or any bleeding after twelve months of none. Each deserves a prompt look.
- How long does perimenopause last?
- About four years on average, though it varies widely. The erratic-cycle stretch tends to come late in it.
- Why are my cycles shorter, not longer?
- Shorter cycles are often the first change: the egg matures earlier in the cycle. Longer gaps come later, as ovulation starts to skip.