Q: Where does the pendulum of perimenopause symptoms stop?

Given all of the unpredictability of perimenopause, you're wondering which symptoms carry over into menopause and which are resolved: Will you feel your best all the time? Or your worst?

I so wish I could give you a solid answer. The reality is that multiple factors are at play, and your genetics, overall health, and lifestyle will affect how they combine.

What's happening during perimenopause is that your hormone levels fluctuate wildly. Symptoms will vary, from person to person and from week to week. The key issue with the transition into menopause is the drop in estrogen. At the time of that change, in early menopause, many women experience the most symptoms: hot flashes, irritability, sleep issues, memory and concentration, dry skin, joint pain, and weight gain.

Most of those symptoms "resolve," as we medical people say, which means they diminish or go away entirely. The two areas where the loss of estrogen has continued effect for post-menopausal women are bone health and genital tissue (especially what we recognize as vulvar and vaginal dryness).

So back to those other symptoms: If it's irritability you're wondering about, you're likely to come "back to center" on mood, assuming that there aren't other unresolved (or, heaven forbid, new) issues in your life. For memory and concentration, remember that staying mentally engaged and challenged is important for brain health for both men and women!

And, because I'm a physician, I need to reiterate: A healthy diet and regular exercise minimize symptoms at any point.

Q: How afraid of menopause should I be?

You refer to hot flashes, weight gain, mood swings, and loss of libido as symptoms of menopause, and all of those happen for some women. Menopause doesn't equate absolutely to those symptoms for everyone, though; each woman's menopausal transition will be unique to her. Not every woman has every symptom, and even those women who share a symptom may experience it differently. About two-thirds of women have hot flashes, for example, but for some it means loosening a top button and for others it means running for the ice cubes!

What I've seen in my practice is that the healthier you are overall, the easier the transition is likely to be for you. That means being as close as you can manage to your ideal weight, eating well and nutritiously, exercising regularly, and getting enough sleep. My motto for women at our age: "You're now high maintenance, so you need to behave that way!"

The good news is that the healthy habits that help you through menopause also enrich the rest of your life, so you can be as active as you choose to be for longer. And being well-informed about what's to come will help you be calm and adaptable, which will also help keep symptoms managed.

If you'd like some company along the way, subscribe to this blog or our twice-a-month newsletter or like us on Facebook. And talk to your women friends! We can learn a lot from each other about how we're compensating for the changes we'll all go through.

Q: How long can perimenopause go on?

Perimenopause, also called menopause transition, starts with variation in menstrual cycle length. Cycles can go from every 28 to 30 days to every 21 to 24 days—or 21-40 days. Cycles that are closer, further apart, longer, shorter, heavier, or lighter are all considered normal for perimenopause. Rarely, women go from having regular periods to having none, skipping the "transition."

98 percent of women experience a natural menopause—one year without menstruating—between ages 40 to 58. I have seen one or two women at age 60 still menstruating—but somebody has to be that 1 to 2 percent! We really are unable to predict the age of menopause for any given woman. Again, for most women the symptoms of perimenopause last for four to eight years, but, again, there are a few stragglers who have them longer than most.

Any bleeding after menopause deserves investigation and evaluation, so it is important to differentiate post-menopausal bleeding from a few lingering periods.

I sense from the question that you're ready for a "change"! Hang in there. It's coming.