Perimenopause: the first stage of menopause
Perimenopause is the start of menopause. Officially the start of perimenopause is marked by changes to your menstrual cycle, but experts agree that symptoms like hot flashes, night sweats and vaginal dryness are also hallmark signs of perimenopause. You may get these symptoms without noticing a change in your menstrual cycle.
I keep forgetting things, feel restless, have zero energy and get weird ringing sensations in my ears. Who knew menopause could be so bizarre? - Alexe (age 46)
What is perimenopause?
Perimenopause is the first stage of menopause during which your body prepares for menopause, the time when you stop having menstrual periods entirely. Perimenopause literally translates to ‘around menopause'. The start of perimenopause varies from person to person, but in general, you could say that most women aged 45 are in perimenopause. If you are under 40 and think you're in perimenopause, you should contact your GP.
On average, perimenopause lasts about five to seven years. Again, this can vary greatly from one woman to the next. For some women perimenopause lasts a few months; for others it can continue over 10 years.
The start of perimenopause is marked by increasing irregularity in menstrual cycles. The end of perimenopause is when a full year has passed since your last period. The stage before perimenopause is called premenopause. Premenopause is when you still have a regular menstrual cycle. Subtle changes in hormone levels may occur, which can make you feel restless at night or irritable.
Online Menopause Test
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Hormonal changes during perimenopause
During perimenopause, hormone levels fluctuate – a lot. Your progesterone levels are the first to decline (this happens from the age of 35, in premenopause). Then oestrogen levels start to fluctuate and then decline as you move closer to menopause.
During perimenopause, progesterone levels drop faster than oestrogen levels. This means the level of oestrogen in your body is still relatively high compared to progesterone. This imbalance, referred to as oestrogen dominance, can lead to various symptoms.
In the years leading up to menopause, your periods will start to become less frequent before they stop altogether. The production of progesterone and oestrogen gradually declines until the ovaries stop producing these hormones altogether.
Once you've gone through 12 consecutive months without a menstrual period, you've officially reached menopause and the next stage, postmenopause, begins. By this time your ovaries have stopped producing oestrogen and progesterone. During this stage, hormone levels are consistently low.
What are the symptoms of perimenopause?
The first symptoms of perimenopause are usually mild. In general, symptoms tend to worsen the closer you get to reaching menopause. Changes in your usual menstrual pattern is typically the first sign of perimenopause. Other signs include hot flashes and vaginal dryness. Do you have other or subtle symptoms, but your periods are regular? Then you are still in premenopause.
Symptoms of perimenopause include:
- Period changes (less frequent periods, periods getting closer together, or heavier periods)
- Hot flashes and night sweats (sudden feeling of warmth in the upper body, often accompanies by sweating and facial flushing)
- Difficulty falling asleep or staying asleep
- Mood swings
- Stress
- Dry mucous membranes
- Weight gain
- Heart palpitations
- Joint and muscle problems
- Low energy
- Reduced concentration
- Forgetfulness
- Urine leakage
- Low sex drive
When does postmenopause begin?
Most women stop having periods around the age of 51. The day of your last menstrual period is called 'menopause'. The next stage is postmenopause. In the years leading up to postmenopause, your periods will start to become less frequent before they stop altogether.
Do you suffer from severe menopausal symptoms?
Hormone replacement therapy (HRT) is an effective treatment for the relief of severe symptoms of menopause, such as hot flashes, psychological issues, sleep problems and vaginal dryness.
What can you do to alleviate menopausal symptoms?
Do you suffer from symptoms and don’t know what to do, or where to get support?
What dietary or lifestyle adjustments can help?
As you get older oestrogen levels drop. Low oestrogen levels can increase the risk of osteoporosis, muscle and joint problems (and osteoarthritis), and cardiovascular diseases. Adopting a healthy lifestyle can reduce your risk. There is also evidence that a healthy diet and balanced lifestyle can help to reduce the severity of menopausal symptoms.
It’s a good idea to make healthy changes to diet and lifestyle during perimenopause. That’s why experts say: up to the age of 40, your body takes care of you. After 40, it's your job to take care of your body.
Focus on incorporating healthy foods into your diet every day (fresh fruit and vegetables, fibre, healthy fats, proteins and complex carbohydrates) and get plenty of exercise (at least 30 minutes a day and strength training twice a week). Make sure you get enough relaxation (your body needs it during this stage of life) and a good night's sleep (sleep affects your overall well-being).
In my opinion, many women going through menopause are currently undertreated. This is a shame because there are many effective options available.- Dr. Erik Knauff, gynaecologist
Medical support and hormone therapy
Sometimes a healthy lifestyle isn't enough. Hormone replacement therapy (HRT) helps balance hormones and ease symptoms during menopause. Can't or don't want to use hormones? There are other options for treating the symptoms of menopause.
How do other women experience perimenopause?
Menopause affects different women in different ways. Read other women’s stories and get useful insights and tips.
FAQ
When does perimenopause begin?
This varies from person to person. For most women, perimenopause starts around the age of 45.
What are the first signs of perimenopause?
The start of perimenopause is marked by increasing irregularity in menstrual cycles. However, some women notice symptoms before their periods change. Symptoms may include hot flashes, mood swings, sleep problems, weight gain and restlessness.
What are the most common symptoms of perimenopause?
The most common perimenopause symptoms include changes in menstrual cycle length or flow, hot flashes and night sweats, mood swings, weight gain, vaginal discomfort and joint problems. It is important to remember that every woman's journey through menopause is personal and unique. There is no one-size-fits-all: some women may breeze through menopause with minimal symptoms, others may find it challenging and even debilitating. Use of medications and underlying health conditions may also affect how you experience menopause.
Can I still get pregnant during perimenopause?
Yes, although fertility is reduced, getting pregnant during perimenopause is still a possibility. So if you don’t want to have a baby, it is important to think about contraception. It's also good to think about the type of contraception you'd like to use.
How do you know for sure if you are menopausal?
A menopause self-test can tell you if you're in menopause. The self-test is based on a urine sample and is highly accurate (more than 99%). The test can be done from the comfort of your own home. View test.
What is the difference between perimenopause and menopause?
Menopause is the time when you stop having menstrual periods entirely. Technically, menopause lasts 24 hours. The preceding period is called perimenopause, during which your hormones start to fluctuate, the ovaries gradually produce less female sex hormones and your menstrual pattern changes (before stopping altogether). Due to these hormonal changes, many women experience symptoms during this stage. In English, the term menopause is popularly associated with the whole transition from a woman's childbearing years to her non-childbearing years.
Sources
- WebMD. (2023). Perimenopause. https://www.webmd.com/menopause/guide-perimenopause
- Nanette Santoro, Cassandra Roeca, Brandilyn A Peters, Genevieve Neal-Perry. 2021). The Menopause Transition: Signs, Symptoms, and Management Options, The Journal of Clinical Endocrinology & Metabolism. https://doi.org/10.1210/clinem/dgaa764
- Utian WH. (2005). Psychosocial and socioeconomic burden of vasomotor symptoms in menopause: a comprehensive review. Health Qual Life Outcomes. https://pmc.ncbi.nlm.nih.gov/articles/PMC1190205/
- Finkelstein JS, Brockwell SE, Mehta V, Greendale GA, Sowers MR, Ettinger B, Lo JC, Johnston JM, Cauley JA, Danielson ME, Neer RM. (2007). Bone mineral density changes during the menopause transition in a multiethnic cohort of women. J Clin Endocrinol Metab. https://pubmed.ncbi.nlm.nih.gov/18160467/
21-03-2025
