What is Perimenopause?

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Perimenopause is defined literally as ‘around the time of the menopause’. Put simply, it is the stage of life when you’re still having periods but your hormones begin fluctuating, and diminishing, potentially triggering a number of physical and emotional changes.

When does perimenopause begin?

On average, women start experiencing perimenopause aged 46 and it typically lasts around four years before their periods stop and the transition into menopause takes place. For others this stage can last anything up to 10 years.[1]

What does it involve?

Perimenopausal symptoms commonly include hot flashes, tiredness, brain fog, low mood, headaches, stress and worry, feeling overwhelmed, forgetfulness, night sweats, joint aches, weight gain, vaginal dryness and itching and increasingly erratic periods. Your periods might become heavier and more frequent; lighter and spaced further apart or a combination of these. A number of women’s health studies [2] [3] have shown the changes to your menstrual cycle typically follow three distinct phases:

1. Early perimenopause

This is when you are still having regular periods but are experiencing some perimenopausal symptoms.

2. Mid perimenopause

This stage is indicated by increasingly irregular periods, but you are not skipping any. So more than seven days (could be longer or shorter) difference from the beginning of your given cycle to the next.

3. Late perimenopause

This is characterized by you missing periods and having more than 60 days between them.

What do the experts say about perimenopause?

Dr Kate Burns, a menopause specialist doctor, describes what is happening to you physiologically to create this unpredictable cycle during perimenopause: “Instead of having a regular periodical swing of estrogen and progesterone, which most women have if they have a 28-day cycle, the release of hormones can become very irregular. This causes random shedding of the lining without any sort of pattern.”

Whilst your hormones might be in freefall and your periods are all over the place it is important to remember that you can still get pregnant around perimenopause and menopause. As Dr Burns explains, “even though we may think pregnancy is one of the only things we don’t have to think about, it is possible for women to conceive and carry a child up to the age of 55, so effective contraception is important for the duration of menopause.”

Here is everything you need to know about contraception through menopause.

How do you recognize perimenopause?

Pinning down exactly when your perimenopause starts is tricky – complicated by the fact that no two women experience it in the same way – and many, completely understandably, don’t recognize that they are experiencing often classic signs of perimenopause because these are also normal responses to other things going on in their life. In fact, in a study of 1,000 women carried out by Health & Her in 2019, a whopping 90% failed to recognize their symptoms could be due to their fluctuating hormones and chalked them up to aging, stress and worry.[4] It took an average of 14 months for women to make the link according to the study.

Interestingly too, while period changes were reported as a common symptom of perimenopause – and this is often widely regarded as the onset market of menopause – findings showed this was not the case for 4 in 10 women.[5]

What is the difference between perimenopause and menopause?

Healthcare professionals define menopause as the 12 months after your last period. After those 12 consecutive months have passed without a period you are officially into menopause but whilst you might have stopped menstruating you are still likely to go on experiencing mental and physical symptoms associated with menopause. On average these can last for around four years, most commonly between the ages of 51 to 54[6] as your body adjusts to diminishing levels of estrogen, progesterone and testosterone. Unfortunately, even though most mental and physical symptoms will improve after this time, often those like low libido, sensitive bladder and painful sex can continue into later life.

What should you expect?

Your journey through perimenopause will be unique and how it affects you may be nothing like the way it affects your friends or relatives (if you even know how it has impacted them).

To give you more of an idea of what you might expect Health & Her recently conducted research involving 62,117 women going through perimenopause[7]. They were asked to reveal their most common symptoms and these are listed below in order of prevalence:


This might seem like a pretty daunting array of symptoms, and you can see how you might not make an immediate connection between feeling tired, stressed and having aching joints with fluctuations in your hormones. But as consultant gynecologist and menopause specialist, Dr Anne Henderson, points out, “There is barely a part of the body estrogen doesn’t affect. It impacts the central nervous system, the skeleton, the cardiac system, the bladder, skin, nails, hair, teeth – everything is affected.”

Interestingly, the same Health & Her study also highlights that mood and psychological symptoms typically present in the earlier stages of perimenopause, whilst physical ones like hot flashes or joint aches become more common later on. Symptoms can then become progressively, albeit temporarily, worse, as your hormone levels fluctuate and gradually decline [8].

Try our perimenopause symptom checker.

When to see a doctor about perimenopause

If your symptoms are impacting on your quality of life, consider seeking help from your doctor or a menopause specialist doctor. Getting support from an experienced specialist can help you get back to feeling like yourself again.

The information and advice provided on our website including expert advice, articles and resources, are not intended as a substitute for the advice provided by your own doctor or other health care provider.​

References and sources

[1] Research commissioned by Health & Her and carried out by Censuswide. 1,001 women between the ages of 45-60 were surveyed.

[2] Ref: Avis, N. E., Brockwell, S., Randolph Jr, J. F., Shen, S., Cain, V. S., Ory, M., & Greendale, G. A. (2009). Longitudinal changes in sexual functioning as women transition through menopause: Results from the Study of Women’s Health Across the Nation (SWAN). Menopause (New York, NY), 16(3), 442.

[3] Harlow, S. D., Gass, M., Hall, J. E., Lobo, R., Maki, P., Rebar, R. W., & STRAW+ 10 Collaborative Group. (2012). Executive summary of
the Stages of Reproductive Aging Workshop+ 10: addressing the unfinished agenda of staging reproductive aging. The Journal of Clinical Endocrinology & Metabolism, 97(4), 1159-1168.

[4] What Women Want At Menopause Survey, 2019

[5] What Women Want At Menopause Survey, 2019

[6] Research commissioned by Health & Her and carried out by Censuswide. 1,001 women between the ages of 45-60 were surveyed.

[7] Health & Her research conducted Oct 2020 – Sept 2022

[8] Health & Her research conducted Oct 2020 – Sept 2022

[9] https://www.tandfonline.com/doi/abs/10.1080/13697137.2020.1777965

Jane Collins

Jane Collins

Health & Her Editor

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