Perimenopause is the natural transition period between healthy, reproductive function and the onset of ‘official’ menopause (defined by 12 consecutive months without a menstrual period). Perimenopause, which is really more of a biological progression than a series of specific events, is often a time of hormonal imbalance and fluctuations in estrogen, progesterone and testosterone.

In many ways perimenopause is like puberty, when your hormones can be all over the map. The median age when perimenopause begins is 47.5 years, though for some women it can begin as early as their mid-30s, and for others, as late as their 50s. The median age of onset of menopause itself is 51.3 years.

When women ask me how they can be sure they’re in perimenopause, I suggest they look to their symptoms for clues. Are your symptoms new? Are some of them familiar, but now suddenly worse than before? Are your symptoms erratic, with no clear pattern to them? Any of these may indicate that you’re in perimenopause with hormones that are fluctuating wildly.