It hits like a wave: Heat suddenly builds across your face, neck and chest. Your cheeks flush. Beads of sweat form on your forehead. It's a hot flash, and it's one of many symptoms that women can experience as they move through perimenopause.

Perimenopause means "around menopause." In this stage, your body prepares to shift from the hormone patterns that allow pregnancy to the lower hormone levels of menopause.

Perimenopause may last 4 to 8 years before your final period, and unpredictable swings in your hormone levels can kick off a range of symptoms. Here's what Mayo Clinic experts want you to know about perimenopause.

Hormones are to blame

Most likely, you've been going through the same monthly hormone patterns since you were a teenager. Your body is used to this rhythm. But as you approach your early to mid-40s, your body's production of estrogen and progesterone — key female hormones — begins to rise and fall unevenly and dramatically.

Many perimenopause symptoms are related to changing estrogen levels. Estrogen is made mainly in the ovaries and released into your bloodstream, where it travels to cells all around your body. Because it helps to control many bodily functions, dramatic shifts in estrogen mean you may feel it from head to toe.

Perimenopause can start earlier than you might think

Women start perimenopause at different ages. Most notice signs of perimenopause in their early to mid-40s. But some women notice changes as early as their late 30s or as late as their early 50s.

The first symptoms of perimenopause are often overlooked. That's because symptoms can start when your periods are still fairly regular. And some symptoms, like fatigue or joint pain, may not have an obvious connection to hormones.

Everyone experiences perimenopause differently

Your journey through perimenopause will be unique. This is partly because your overall health and behavior, as well as social factors, affect how you react to symptoms. This means that your perimenopause experience is influenced by a range of things, including stress, social pressures and mental health.

Ethnicity and race also affect perimenopause symptoms. For example, researchers have found that African American women may experience more-frequent hot flashes and night sweats. This group also reported more discomfort with symptoms. Experts don't yet fully understand the racial and ethnic differences related to perimenopause.

There's a wide range of symptoms

Some people experience a variety of perimenopause symptoms, while others experience few or even no symptoms. Some common symptoms include:

• Irregular periods. Periods may be longer or shorter, lighter or heavier, and more or less frequent.
• Hot flashes. A hot flash is a sudden feeling of warmth or heat that spreads over your body. It usually lasts 1 to 5 minutes. It can happen several times an hour, a few times a day, or just once or twice a month.
• Sleep problems. Night sweats, which are hot flashes that happen at night, can interrupt sleep. Many people also find it more difficult to fall asleep or stay asleep during perimenopause.
• Mood changes. Mood swings, irritability or increased risk of depression may happen during perimenopause.
• Brain fog. Changing hormone levels and interrupted sleep may affect concentration and memory.
• Migraines. Hormone-related migraines may get worse or happen more often during perimenopause.
• Joint pain. Research has shown a connection between joint pain and the loss of estrogen. Some women notice joint pain for the first time during perimenopause.
• Vaginal dryness. This can make sex more painful.
• Changes in sexual function. During perimenopause, sexual arousal and desire may change.
• Loss of bone. With declining estrogen levels, you start to lose bone more quickly than you replace it, increasing your risk of osteoporosis.

There's a connection between premenstrual conditions and perimenopause

Some studies have found that women who are more sensitive to premenstrual syndrome (PMS) also may have stronger reactions to the hormonal changes of perimenopause.

Tell your healthcare team about the symptoms you typically experience before your period starts. When your care team understands this part of your health history, your team can better help you plan for and manage your perimenopause symptoms.

You can still get pregnant

The chance of getting pregnant decreases during perimenopause. But that doesn't mean it can't happen. As long as you have periods, pregnancy is possible. If you want to avoid pregnancy, use birth control until you've had no periods for 12 months.

Treatment can help ease the symptoms

Perimenopause doesn't require treatment. But there are several medicines that can help manage the symptoms.

If perimenopause symptoms affect your quality of life, talk to your healthcare team. Your care team may recommend:

• Hormone therapy. Estrogen therapy works best for easing hot flashes and slowing bone loss. It's usually given at the lowest dose needed to relieve symptoms. If you still have your uterus, you'll need progestin with estrogen. Your healthcare team can help you decide if hormone therapy is a safe option for you.
• Vaginal estrogen. This treatment releases just a small amount of estrogen. The estrogen is absorbed by the vaginal tissue and can help relieve vaginal discomfort during sex.
• Antidepressants. Certain antidepressants called selective serotonin reuptake inhibitors (SSRIs) may reduce hot flashes.
• Gabapentin (Neurontin). Gabapentin is used to treat seizures, but it also has been shown to help reduce hot flashes.
• Fezolinetant (Veozah). Fezolinetant is a hormone-free option for treating hot flashes. It works by blocking a pathway in the brain that helps regulate body temperature.

Self-care makes a difference

You can do a lot at home to help ease perimenopause symptoms and improve your overall health.

• Nourish your body. A healthy diet is more important than ever. Adopt a low-fat, high-fiber diet that's rich in fruits, vegetables and whole grains. Add calcium-rich foods. Avoid alcohol and caffeine if they seem to trigger hot flashes.
• Get moving. Regular exercise and physical activity help prevent weight gain, improve your sleep and elevate your mood. Try to exercise for 30 minutes or more on most days of the week, although not right before bedtime. Regular exercise also has been shown to strengthen bone density.
• Make sleep a priority. Try to keep a consistent sleep schedule. Avoid caffeine, which can make it hard to get to sleep. Limit alcohol, as it can interrupt sleep.
• Focus on the mind-body connection. Mind-body practices can ease stress, improve mood and sleep patterns, and increase the ability to cope with this life transition. Try yoga, tai chi or meditation. Don't know how to get started? Look online or for a local class.
• Ease vaginal discomfort. Try a water-based or silicone-based vaginal lubricant or moisturizer. Choose products that don't contain glycerin, which can cause burning or irritation in women who are sensitive to that chemical. Staying sexually active also helps by increasing blood flow to the vagina.

Perimenopause is a time of change, and sometimes that change can feel overwhelming. But by understanding what's happening in your body, you'll be better prepared to deal with the symptoms and manage the transition smoothly.