Premenopause: the phase before menopause

The terms perimenopause and premenopause are frequently confused or used interchangeably to describe perimenopause. However, premenopause is distinctly different; it refers to the phase before perimenopause. Although it is not part of menopause, it is important to acknowledge this stage. Even if your cycle remains regular, you may already experience subtle symptoms due to hormonal fluctuations. If you are experiencing hot flushes or vaginal dryness, experts suggest that perimenopause has likely begun (and that you are entering menopause).

From your first period, you are in premenopause. This phase precedes perimenopause and is not yet part of menopause. Hormonal symptoms often increase as you age and approach perimenopause. This is partly due to lower levels of progesterone relative to oestrogen (oestrogen dominance). Not all women experience symptoms during premenopause.

The timing of symptoms varies for each woman. Some women notice them in their mid-thirties, others in their forties, while some do not experience them at all. At a younger age, symptoms are often not recognised as menopause-related. Many women assume these issues only arise in their fifties. Furthermore, symptoms during this phase are not always identified as menopause-related, even by general practitioners.

You may interpret hormonal symptoms as typical menstrual symptoms, but there are key differences that distinguish "normal" menstrual symptoms from those signalling the approach of perimenopause:

• PMS symptoms: These occur one to two weeks before your period and subside afterward, following a predictable pattern. Common symptoms include irritability, tender breasts, mood swings, bloating, or headaches. PMS symptoms may gradually worsen due to declining progesterone and other hormonal fluctuations.
• Symptoms indicating the approach of perimenopause: These can occur at any point in the cycle and do not necessarily disappear after your period. There is no predictable pattern. You may also notice that your symptoms gradually worsen.

Your hormone levels fluctuate throughout your cycle. As you progress further into premenopause (around age 35), your oestrogen levels continue to fluctuate as usual, but progesterone levels begin to gradually decline.

Progesterone plays a crucial role in fertility, regulates the menstrual cycle, and helps maintain the balance of oestrogen levels. Additionally, it has a calming effect. As progesterone levels slowly decrease in the late thirties or early forties, you may begin to notice symptoms.

While your menstrual cycle may still be regular, it tends to become more irregular as you age. Although not every woman experiences menopause-related symptoms during premenopause, the following are commonly reported:

• Mood swings
• Poor sleep
• Feeling out of sorts
• Irritability
• Weight gain
• Tender or painful breasts
• Increased sensitivity to stress

Premenopause is an ideal time to focus on your lifestyle and health. Doing so can help prevent or minimise symptoms during perimenopause, such as bone loss and muscle mass reduction, emphasises hormone therapist Suzanne Rouhard. The following points are particularly important:

• Pay attention to your diet: Eat plenty of vegetables and fruits (the fibre, vitamins, and minerals in fruits can contribute to a healthy hormonal balance) and proteins, while reducing fast carbohydrates and sugars (this helps stabilise blood sugar levels, which benefits your hormonal balance). Ensure sufficient omega-3 in your diet (this positively affects blood lipid composition).
• Do strength training twice a week: As you age, you inevitably lose muscle mass and bone density. You can slow this process by taking good care of yourself. Strength training is proven to be effective in keeping bones, muscles, and joints strong and healthy for longer. Weight-bearing exercises stimulate bone formation. It also strengthens your muscles and joints. Additionally, it triggers dopamine production, which has an immediate positive effect on your mood.
• Prioritise your sleep: Sleep is one of the most important aspects for women in their thirties. Sleep affects your overall well-being, including your risk of cardiovascular disease and memory. However, it is easy to get insufficient sleep due to the many responsibilities you juggle during this phase of life, experts say. Explore what helps you achieve better sleep.
• Take more breaks: Due to hormonal fluctuations, you are more sensitive to stress during menopause and the years leading up to it. Take sufficient breaks, engage in relaxing activities (reading, walking, drawing), and try breathing exercises or mindfulness. You need this more during this phase of your life.
• Try to quit smoking and reduce alcohol consumption: Both have a negative impact on your overall health and can worsen menopause symptoms.
• Consider supplements: Dietary supplements can help alleviate specific symptoms. For example, Herbal Female Complex supports normal women's health and helps relieve hormonal symptoms*.

*Health claims pending approval by the European Commission.

Experts state that perimenopause typically begins around age 45. Whether you notice it varies from woman to woman. Some experience many symptoms, while others notice little—though the latter is rare. The biggest difference? Your menstrual pattern changes. Hot flushes and vaginal dryness are also clear signs that perimenopause has started. On average, your last period occurs at age 51. The day of your last period is called menopause. Afterward, you enter postmenopause. Are you unsure about your symptoms and want to know which phase you are in? A menopause test can provide insight.