Perimenopause translates 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 flushes, tiredness, brain fog, mood swings, headaches, feeling increasingly emotionally fragile and overwhelmed, forgetfulness, night sweats, joint pain, weight gain, vaginal dryness and itching and increasingly anarchic and 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 characterised by you missing periods and having more than 60 days between them.
What do the experts say about perimenopause?
Dr Kate Burns, a GP with a special interest in menopause, describes what is happening to you physiologically to create this unpredictable cycle during perimenopause: “Instead of having a regular periodical swing of oestrogen 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.”
The diagram below illustrates how oestrogen fluctuates in the perimenopause stage:
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 know when perimenopause is happening?
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 recognise 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 UK women carried out by Health & Her in 2019, a whopping 90% failed to recognise their symptoms could be due to their fluctuating hormones and chalked them up to ageing, stress, anxiety and depression.[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 marker 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 oestrogen, 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.
Here is how perimenopause and menopause can affect testosterone
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:
- Low energy
- Stress & anxiety
- Low mood
- Sleeping problems
- Brain fog, memory loss & poor concentration
- Joint aches
- Bloating
- Weight gain
- Low libido
- Headaches
- Night sweats
- Hot flushes
- Digestive issues
- Sensitive bladder
- Skin changes
- Palpitations
- Dizziness
- Vaginal dryness
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 gynaecologist and menopause specialist, Dr Anne Henderson, points out, “There is barely a part of the body oestrogen 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 flushes or joint pain 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 to help identify what stage of perimenopause you are at.
What can you do about perimenopause?
If information about perimenopause can feel overwhelming – or sometimes infuriatingly vague – it can be reassuring to remember that you’re not alone. Perimenopause is a normal and natural stage of life, and millions of other women are currently going through it too. Equipping yourself with the basic facts and reading up on the latest research and evidence can help you to cut through what can be a potentially confusing time – making you better able to recognise the signs and be more able to cope with them. There are also a range of ground-breaking new options out there to help you get more of a handle on what is going on including symptom trackers and free personal online consultations to help support you through it.
Self-care & positive habits for perimenopause
Most menopause experts point out that women suffer less with perimenopausal and menopausal symptoms if they look after themselves – eating well, taking regular exercise, getting enough sleep and finding effective ways to manage stress. The perimenopausal phase is also a good time to discuss HRT with a healthcare expert to see if that is the right option for you.
A survey by the British Menopause Society, however, found that 95% of women would prefer to take natural remedies rather than HRT, plus not everyone can take it even if they want to. A healthy balanced diet and dietary supplements specifically tailored to help support your perimenopause can be hugely beneficial at this time as can relaxation techniques to help manage stress. Figuring out what is right for you, what your dominant symptoms are and finding things to help you navigate your way through this transitional time more seamlessly include:
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Supplements – Certain supplements can provide a much-needed source of natural phytoestrogens (oestrogen-like compounds derived from plants) and specific vitamins and minerals to help support you through your perimenopause. Health & Her’s Perimenopause supplementis specially formulated by experts and includes the phytoestrogens Red Clover and Wild Yam and vitamins and minerals including vitamin B6 which can help with hormone regulation, energy and normal psychological function. Health & Her’s Perimenopause Mind+ supplement is also designed for perimenopause to particularly support mind and wellbeing and contains phytoestrogens and hormone-balancing nutrients.
- Tracking your symptoms – To get a better sense of where you’re at on your menopause journey, it can be helpful to log your symptoms and cycle changes. The free Health & Her app offers perimenopause period tracking, symptom tracking and access to expert advice. Health & Her have also funded helpful research which evaluates the effects of symptom monitoring.
- Regular exercise – Perimenopause can put your body through a lot, both physically and mentally. Exercise can be key to helping you cope with this, so read our top 5 exercises for perimenopause & menopause. Regular exercise can also help to keep your weight down and studies show that women who exercise are less likely to suffer with symptoms like hot flushes than those who are more sedentary.
- Relaxation techniques – Practicing relaxation techniques like yoga & meditation or mindfulness and breathing exercises through your perimenopause and menopause can help you to manage stress, keep you fit and remain more positive. They can also help you to better manage hot flushes.
- Diet and lifestyle – A healthy, balanced diet rich in vitamins and minerals can help you to fight fatigue, stabilise your moods and potentially help reduce bloating and weight gain. Diet tips for a healthy perimenopause can include cutting down on certain foods (like ultra- processed or high fat and sugar ones) and drinks (including alcohol and too much caffeine) that make you feel lethargic or tired. Incorporating more lean protein and foods rich in fibre can help to stabilise blood sugar levels and your mood. There is also evidence to suggest you’ll experience fewer perimenopausal and menopausal symptoms the more fruit and vegetables you eat – so try to get your recommended quota of five (or ideally more) portions a day.
- Talking therapies – Cognitive behavioural therapy (CBT) is a type of talking therapy which teaches coping strategies including how to change negative thoughts, feelings and behaviours into more positive ones. There is evidence[9] to show that CBT can help with perimenopause and menopausal anxiety, low mood and sleep problems. It has also been shown to reduce the impact of hot flushes and night sweats.
When to see a GP about perimenopause
If your symptoms are impacting on your quality of life, consider seeking help from your GP or a menopause specialist GP. Getting support from an experienced specialist can help you get back to feeling like yourself again.
How is perimenopause treated?
By carefully considering your age, your symptoms, and ideally, your menstrual changes, a GP can help you determine if you are in perimenopause. If appropriate for you and your medical history, they may discuss hormone replacement therapy (HRT) with you.
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
