Perimenopause, as pre-menopause is usually called, begins when a woman starts to experience certain symptoms which are associated with a diminishing production of the hormones estrogen, progesterone and testosterone. At the end of this period, also known as late pre menopause, the ovaries gradually begin to produce less estrogen and progesterone and consequently for the most women the first typical symptoms of menopause appear. Falling estrogen and progesteron levels finally lead into the next stage of menopause called perimenopause . This stage, like pre-menopause, represents a transition between menstruation and menopause, but in addition can include some of the classical menopause symptoms such as hot flashes, mood changes and vaginal dryness. Most women experience this stage for about four years, but it is not uncommon for some to linger in this phase for up to ten years.