Perimenopause – why we need to talk about it

Do you know what happens around menopause? In this blog, we look at the menopausal transition, also known as perimenopause.

Author: Lizzie Lynch - Content Lead

Reviewed by: Dr Sam Rodgers Chief Medical Officer, MBBS, MRCGP

Published on: 20 September 2021

Ever wondered what happens around menopause? That's probably because the length, signs and symptoms of perimenopause (which means around menopause) are just as individual as the people going through it.

In this blog, you'll learn about the common signs and symptoms of perimenopause, including when perimenopause and menopause can begin and how long they last. And, most importantly, why we should be talking more about perimenopause.

What is perimenopause?

Perimenopause is the time when your body makes the natural transition to menopause, also known as the menopausal transition.

In medical terms, the prefix peri means around or about. Think pericardial, which means around the heart. The word menopause is split into ‘meno’ meaning your menstrual cycle and pause or stop. Around when your menstrual cycle stops.

The medical definition of menopause is when a woman stops having periods. Menopause and post-menopause are both times when a woman is no longer able to get pregnant naturally [1]. However, it is still possible to become pregnant during perimenopause, which is an important difference.

Even though perimenopause and menopause are entirely natural and healthy phases of life, menopause is rarely a topic of open discussion. This lack of exposure can contribute to feelings of fear, shame, and uncertainty around menopause.

What's the difference between menopause and perimenopause?

Menopause is a retrospective diagnosis for when you do not have a period for at least 12 months. Whereas perimenopause (or around menopause), you may be experiencing the symptoms of menopause, but you are still having periods. Although, the frequency of your periods may have changed.

When does perimenopause start?

Perimenopause starts when the amount of oestrogen made by the ovaries begins to decline. This usually begins in your 40s, although it can start earlier. If you're 45 or younger and are experiencing symptoms, it could be a good idea to visit your GP.

Some symptoms of menopause, such as changes in mood, energy, or weight fluctuations, could also be present in other conditions or even vitamin deficiencies. Investigating with an overall blood test like an Advanced Well Woman Blood Test or Well Woman Blood Test could be helpful in these changes as a general wellbeing check-up.

Menopausal timeline:

Pre-menopause - When you have no symptoms of perimenopause or menopause. You still have periods, whether they’re regular or irregular, and you are considered to be in your reproductive years.
Premature menopause or Premature Ovarian Insufficiency (POI) – This is the name given if you start before the age of 40.
Early menopause - If you start menopause before the age of 45, it is early menopause [2].
Perimenopause - Most women begin to experience perimenopause symptoms in their mid-40s, with the average age being 47 [3].
Menopause – In the UK, the average age for a woman to reach menopause is 51[4], but it usually happens between 45-55. Menopause is diagnosed when a woman has gone without a menstrual period for 12 consecutive months.
Post-menopausal – After a woman has not bled for an entire year, she is post-menopausal [5]. It can be a very empowering time of life - look at our blog to find out the advantages of menopause.

How long does perimenopause last?

Perimenopause lasts an average of four to seven years. For some people, perimenopause will only last a few months, while for others, this transition phase may last for more than four years [6].

If you have gone more than 12 months without having a period, you are no longer perimenopausal. And, by the age of 54, 80% of women will have stopped having periods. Other factors like medications, medical conditions or lifestyle factors can also affect periods, making it difficult to know the specific stage of the menopause transition.

What are the first signs of perimenopause?

Some subtle and some not-so-subtle signs and symptoms occur throughout the menopausal transition. The symptoms of perimenopause and menopause are the same. It's just if you still have periods, you may rule out menopause as a cause. But having periods, albeit somewhat irregular periods, during perimenopause is very common.

First signs of perimenopause:

Irregular periods
Hot flushes and sleep problems
Mood changes
Vaginal and bladder problems
Decreasing fertility
Changes in libido
Loss of bone
Changing cholesterol levels

Am I perimenopausal?

If you are experiencing any of the first signs of perimenopause and are in your 40s or 50s, then you may be experiencing perimenopause.

A private blood test, such as a Menopause Blood Test, measures five key hormones to assess your menopausal status. A blood test can also be helpful as menopausal symptoms can be like the symptoms of a thyroid condition, so some tests will enable you to check the status of both, giving you the confidence to decide how to move forward.

It is worth visiting your GP to investigate if your symptoms are troublesome and interfere with your daily life. If you're under 45, your GP can investigate the underlying reason for your symptoms.

What are the treatments for menopause?

Treatments for perimenopause and menopause will depend on the symptoms that you are experiencing. If you are experiencing hot flushes, then treatment may include taking a low-dose birth control pill. But talk to a doctor to find the right treatment for you.

In general, though, this is certainly a time of life when you would benefit from taking care of yourself mentally and physically to make sure that you're feeling the best you possibly can.

Ways to take care of yourself during perimenopause:

Make sure to get enough vitamins and minerals through your diet - If you're unsure, a blood test can help you to see if you've got optimum levels or whether you're deficient in anything.
Find a regular exercise routine - That could be going for a regular walk, taking up yoga or cycling at the weekend. Maintaining a healthy weight can help you to feel well.
Prioritise a good sleep pattern - This may be a tough one, especially if you're experiencing hot flushes, so this may be a time when your sleep routine needs extra attention. Try to stick to a sleep routine, eliminate screens before bed and try to avoid caffeine.

Perimenopause and menopause are both natural parts of the female cycle. If you recognise any of these signs in yourself, a friend or a loved one then it can help to talk about it. Share experiences and tips, and if you feel worried or concerned, or any of the symptoms start to impact your life, then there’s medical help available to support you.

Perimenopause FAQs

1. How can I lose weight during perimenopause?

During menopause, muscle mass reduces, which means you may need fewer calories. If your calorie intake is not adjusted, this could lead to weight gain over time. Eating a healthy diet, regular exercise and prioritising sleep are all ways to help you maintain a healthy weight during perimenopause. Remember, bone health and density are both important too. From age 35, we slowly lose calcium from our bones, and losing oestrogen during menopause increases the loss rate. Having a diet that supports bone health could also be important for you.

2. Can you get pregnant during perimenopause?

Yes, you can get pregnant during perimenopause. Although there's a decline in fertility during the perimenopause stage, you can still become pregnant.

If you are planning a pregnancy, then a fertility blood test can help you to monitor hormones such as anti-Mullerian hormone (AMH), progesterone, oestradiol, luteinising hormone (LH) or follicle-stimulating hormone (FSH).

3. What can I expect after menopause?

After menopause (post-menopause) can be an interesting new stage of life. Each person's experience is different; you may find demands at home have changed recently or that you'd like to focus on a new venture for yourself. Either way, taking care of your physical and mental health with a healthy diet and regular exercise can help you to feel your best. Read our blog, which includes the nutritional needs of women in menopause.

Related tests

Menopause Home Blood Test – Measure five key hormones to assess your menopausal status.
Female Hormone Home Blood Test – Measure the levels of female hormones and thyroid hormones, which regulate fertility, mood, and energy.
Advanced Female Hormone Blood Test – This advanced hormone profile includes male and female hormones, with a full thyroid function test and thyroid antibodies.
Future Fertility (with AMH) Home Blood Test - Test for AMH, FSH and oestradiol to check your ovarian reserve and menopausal status.