We've long talked about menopause as if it were a light switch — as though a woman turns 50, her period vanishes, and hot flashes show up. But the body doesn't work that way. Years before the final period arrives, there's often a long transitional stretch in which hormones swing wildly and physical and emotional changes start to surface. This is called perimenopause.
© AvalonPenélope Cruz, 52, just put a very public and candid face to the process. In a conversation with her "The Invite" co-star Olivia Wilde, Cruz was asked what she thinks women understand least about perimenopause. Her answer was blunt: "It can last 10, 12 years. It can start as early as 40. The ups and downs can be crazy," she told Allure.
"I remember when I was 41, and my doctor told me, 'Your hormones are going to be doing this crazy dance for the next 10 or 12 years,'" Cruz said. "I thought it was a really bad joke, and I thought it was not possible to handle that."
More than ten years later, Cruz still gets her period every month — and still rides the hormonal swings that came with that early warning. Her experience puts a spotlight on a distinction that a lot of people still get wrong: perimenopause and menopause are not the same thing.
A transition that can start years before the last period
© Getty ImagesPerimenopause is the runway to menopause, not menopause itself. During this window, ovarian function starts to shift and hormone production becomes less predictable — which means a woman can still be getting her period every month while already dealing with symptoms typically associated with menopause.
The World Health Organization notes that the menopausal transition usually announces itself through changes in the menstrual cycle, and defines perimenopause as the period that begins with the first signs of that transition and continues until one year after the final period. It can stretch on for years and touch physical, emotional, mental and social wellbeing along the way.
Cruz's own description is vivid: her hormones spike and crash on a rolling basis. She also described developing ovarian cysts almost every month, cysts extreme enough to throw off her lab results entirely. "You can go from a number 30 of estrogen to a number 500," she said, describing how doctors would initially assume the reading was a lab error and rerun the test — only to find it accurate. Her case is a single, individual data point, not a universal blueprint; not every woman experiences perimenopause the same way, or with the same intensity.
Some women barely notice the transition. Others find it genuinely disruptive to daily life. And one of the core problems is that most of us are trained to associate menopause with hot flashes specifically — while perimenopause often creeps in through far subtler signals first.
Periods can arrive early or late, get heavier, or come more often. Night waking, persistent fatigue, irritability, brain fog, heart palpitations, muscle aches, and vaginal dryness can all show up alongside — or instead of — the more familiar hot flashes and night sweats.
"One of the main challenges of perimenopause is that its symptoms tend to appear gradually and get attributed to other causes. Many women see a doctor for insomnia, irritability or fatigue without connecting it to a hormonal origin. Recognizing this stage allows for earlier intervention and a better overall process," explains Ana María Román, head of the Gynecology Department at Sanitas La Moraleja, to our sister website HOLA! Spain.
There's an emotional dimension too. Hormonal fluctuations affect the neurotransmitters that regulate mood, and can heighten sensitivity to stress or trigger anxiety. Those shifts can also collide with other life circumstances typical of this stage, which can intensify how the symptoms are experienced.
© Getty ImagesWhat actually helps
Not every woman needs treatment for perimenopause — but that doesn't mean discomfort is simply the price of admission. If symptoms are disrupting sleep, work, emotional wellbeing or sex life, it's worth consulting a healthcare provider to walk through the options case by case, hormone therapy included where appropriate.
There are everyday steps that help too. Specialists at Sanitas recommend tracking changes to the menstrual cycle — noting whether periods are arriving early, spacing out, or changing in intensity — since that record can be genuinely useful in a medical consultation.
They also point to the basics: protecting sleep, staying physically active, and paying attention to diet. Exercise supports both rest and mood, while also helping preserve physical function and bone health. On the nutrition side, adequate protein, calcium, and vitamin D intake matter.
One flag worth taking seriously: if bleeding becomes unusually heavy, lasts longer than normal, shows up between periods, or returns after a long stretch without a period, don't assume it's "just" perimenopause. That's a reason to see a doctor and rule out other causes.
So when does it actually become menopause?
Colloquially, "menopause" gets used as a catch-all for this entire stretch of life. Medically, though, menopause refers to one specific moment: it's confirmed once 12 consecutive months have passed without a period, provided nothing else — no other physiological or medical cause, no medical intervention — explains that absence.
The WHO places natural menopause typically between ages 45 and 55. In Spain, the average age is around 49.
In other words: being 40, 41, or 45 and noticing symptoms doesn't automatically mean menopause has arrived. It may simply mean the transition leading up to it has already begun.
© Corbis via Getty Images
