Perimenopause is the time around menopause before periods stop completely. Many women experience irregular bleeding and many disruptive menopausal symptoms such as temperature changes, hot flashes, night sweats, sleep disruption, vaginal dryness, low sex drive, pain with sex, and urinary symptoms starting in their 40’s. Some will start in their late 30’s Perimenopause can last for 3 – 10+ years before periods stop altogether.