Perimenopause is a journey every woman experiences in her own way. For some, the changes are subtle; for others, they’re more intense and disruptive. By learning what’s normal and what to watch for, you can feel more prepared, supported, and connected to yourself during this important transition.
A new book, Menopause: What Your Ob-Gyn Wants You to Know (January 2026, ACOG) is the go-to guide for navigating the menopause transition. Developed by the American College of Obstetricians & Gynecologists (ACOG), this comprehensive resource delivers expert, evidence-based information about every aspect of the menopause transition, from signs and symptoms to treatment options and how to stay healthy long-term.
The following is an excerpt from Menopause: What Your Ob-Gyn Wants You to Know
Perimenopause is the body’s passage from regular menstrual periods to your final period. It’s the first part of your menopause transition. Typically, perimenopause starts in the 40s, though it’s possible for symptoms to start earlier. And perimenopause lasts several years. Four to 8 years is common, but some women are in this phase of life for a decade or more.
Some women do not experience any symptoms or have only a few mild symptoms. Others have multiple symptoms that can be severe. Each woman experiences menopause differently. It’s important to understand what symptoms are typical during perimenopause.
Staying connected to yourself and alert to changes in your body and emotions is key. Remember that perimenopause is natural—and a reminder to live healthfully and look forward. If you’re not feeling ready to embrace it right now, that’s OK. But it’s still good to learn about what may be ahead.
Tracking the Early Signs
For those who still have a uterus, the first thing that happens in perimenopause is a change in menstrual periods. A change can mean different things for different women.
At first the changes may be subtle, like a shorter cycle or fewer days of bleeding. As perimenopause goes on, the period flow may be lighter or heavier, or you may have spotting instead of a period. Later in perimenopause, you may skip a period one month and have a normal period the next month. This is all related to the decline in ovarian follicles, where eggs grow and mature, and the variations in estrogen and progesterone that come with it.
Although changes in menstrual bleeding are normal during this time, some bleeding changes may signal a problem. This is why you should talk with your obstetrician–gynecologist (ob-gyn) about any bleeding that is different from what you’re used to. It’s a good idea to keep a diary and track your period and any other symptoms you notice during your days of bleeding. You and your ob-gyn will have an easier time understanding what’s going on if you keep a record and can talk about details at your office visit.
Early in perimenopause you may also start to have hot flashes, rushes of heat that have you fanning yourself with whatever’s at hand. Night sweats are nighttime hot flashes and may interrupt your sleep. You may find your mood shifting, sometimes with symptoms like sadness or irritability, which can be worse with lack of sleep. Irritation of the vagina and vulva are also typical around this time. Remember that most women experience only some of these symptoms, and symptoms can be mild, moderate, or severe.
Many changes during these years are normal and mild. If they rarely bother you, they probably won’t require action. Some changes are normal but uncomfortable, and they may even interfere with your daily functioning. These can be addressed in different ways. And other changes may be a sign of a medical condition that needs attention.
As you learn more about perimenopause, you’ll notice that the symptoms may overlap with and influence each other. Night sweats can disrupt your sleep. Poor sleep can drag down your mood. A low mood can make you more likely to experience hot flashes, night sweats, and poor sleep. This cycle can be frustrating and impact your quality of life.
On the other hand, it’s a reminder that the body and mind are intertwined. In this context, doing what you can to take care of yourself is all the more important. Easing a particular symptom may have ripple effects that help you feel better in other ways, too. For example, if you experience vaginal dryness and treat it, you’ll likely find sex more pleasurable, with potential benefits for your mood, sleep, and relationship.
Benefits of Systemic Hormone Therapy
This book discusses many lifestyle changes and medical treatments that can support you through menopause. One of these is called hormone therapy. It’s available in different forms, and many women feel better when they take medications containing estrogen and progesterone. For some women, it is a safe and valuable tool for managing the menopause transition.
Still, hormone therapy is not right for everyone and should be discussed with your obstetrician–gynecologist (ob-gyn). Whether to go on hormone therapy is an individual decision and depends in part on your health status and medical history. Fortunately, there are other effective ways that menopausal symptoms can be treated for those who don’t want or cannot take hormone therapy.
If hormone therapy is your preferred treatment, know that it has a range of positive effects on menopausal symptoms. Medications can directly address some symptoms while indirectly addressing others.
Relief From Hot Flashes and Night Sweats
Systemic hormone therapy is the most effective treatment for hot flashes and night sweats. An analysis of research involving more than 3,300 women found that systemic therapy reduced the number of hot flashes by an average of 75 percent. For example, those who had 40 hot flashes a week before treatment had about 10 hot flashes a week while on treatment. Hormone therapy also makes hot flashes milder.
Relief From Vaginal Dryness
Systemic therapy can relieve vaginal and vulvar dryness and irritation, increase vaginal lubrication, and restore the structure of vaginal tissue. But if dryness and irritation are your only symptoms, your ob-gyn may recommend local estrogen therapy instead. You can read more on this later in the chapter.
Improved Sexual Health
If vaginal symptoms improve on systemic therapy, sexual functioning may also improve. Increased vaginal lubrication can help reduce pain and tissue tearing caused by sexual intercourse. It’s not clear whether taking estrogen improves sexual desire, but there are medications approved by the U.S. Food and Drug Administration that can help with desire.
Better Bone Health
Systemic estrogen protects against the bone loss that happens early in the menopause transition. Estrogen is not prescribed solely for bone loss prevention, but it’s a positive side effect for those who are taking systemic therapy for hot flashes and night sweats.
Improved Sleep
Systemic therapy can relieve sleep disruption linked to night sweats and insomnia during the menopause transition. It can improve sleep quality, help you fall asleep sooner, and reduce nighttime wakefulness. Estrogen taken through the skin may be more beneficial for sleep than estrogen pills.
Lower Risk of Depression
Systemic therapy may help with mood symptoms. In a U.S. study, 1 year on estrogen patches and oral progestin helped prevent depressive symptoms in women during perimenopause and after their last period. Sometimes estrogen is used alongside an antidepressant. It’s unclear whether hormone therapy helps with anxiety.
Improved Joint Pain, Skin, and Hair
In one U.S. study, systemic estrogen used after menopause was linked to a small reduction in joint pain that lasted several years. Meanwhile, there is little evidence that skin and hair benefit from hormone therapy, though some women and doctors believe this is true. Estrogen therapy may improve the texture, appearance, thickness, and elasticity of skin. It’s also important to note that hormone therapy should not be expected to be an effective weight loss treatment.
Reprinted with permission.
Copyright 2026 by American College of Obstetricians & Gynecologists
Menopause: What Your Ob-Gyn Wants You to Know was developed by an eight-member editorial board chaired by Dr. Nanette Santoro and co-chaired by Dr. Esther Eisenberg. These experts have extensive clinical experience caring for women in the menopause transition, and some have conducted many years of research to understand the effects of menopausal symptoms and how various treatments may be used.
