What is perimenopause?

Perimenopause is the transitional phase before menopause. It’s a natural part of life, yet our Menopause Survey 2023 found that almost three-quarters of women felt unprepared for the changes associated with this life stage.

In this blog, we shine a light on perimenopause. We’ll explore what perimenopause means, the most common signs and symptoms, and how you can manage your perimenopause experience.

• What is perimenopause? 
• What's the difference between menopause and perimenopause?
• When does perimenopause start?
• How long does perimenopause last?
• What are the first signs of perimenopause?
• Am I perimenopausal?
• What are the treatments for menopause?
• Perimenopause FAQs

What is perimenopause? 

Perimenopause means around menopause – it’s when your body makes its natural transition to menopause and is sometimes called the menopausal transition. 

During perimenopause, your ovaries produce less of the hormones oestrogen and progesterone. This can cause your periods to become irregular as you move toward the end of your reproductive years. You may also experience other symptoms, such as hot flushes and mood changes. 

What's the difference between menopause and perimenopause?

Perimenopause is a transitional period that can last months or years, whereas menopause is a singular point in time, defined as the 12-month mark after your last period. So, when you haven’t had a period for 12 months, you will be at the end of perimenopause and will have reached menopause. 

Another key difference is that even though you’re less fertile, you can still get pregnant naturally during perimenopause, but not once you’ve reached menopause [1]. You will still have periods during perimenopause, although they may be more irregular and erratic than your usual cycle. 

What are the stages of menopausal transition?

The menopausal transition has four stages that are usually associated with fluctuating hormone levels: 

 

• Premenopause — from puberty, your oestrogen level fluctuates rhythmically each month with your menstrual cycle. During this time, you have periods, whether they’re regular or irregular, and you’re considered to be in your reproductive years.
• Perimenopause — as the transition to menopause begins, the fluctuations in your oestrogen level become more erratic, and you may notice some perimenopause symptoms, such as irregular periods. Throughout perimenopause, your oestrogen level gradually declines. 
• Menopause — this is a point in time when you’ve not had a period for a full 12 months. It signals the end of perimenopause. At menopause, your oestrogen level is constantly low with no fluctuations. 
• Postmenopause — you no longer have periods, and your oestrogen level remains low for the rest of your life. You may still experience menopause symptoms during this stage as your body adjusts to a lower oestrogen level.

When does perimenopause start?

Perimenopause typically starts in your 40s, but it can start much earlier or later. Most women begin to experience perimenopause symptoms in their mid-40s, with the average age being 47 [2].

The age you start perimenopause may be influenced by genetics. Studies have shown that your mother’s age at menopause can indicate the age you reach menopause [3]. So, if your mother had an early menopause, there’s an increased chance you could too. 

Most people transition into menopause between the ages of 45 and 55 — in the UK, the average age of menopause is 51 [2]. 

Sometimes, periods stop before the age of 45, which is known as early (or premature) menopause [4]. This can happen naturally or as a side effect of a medical condition, treatment, or procedure. Examples of medical or surgical causes include chemotherapy or radiotherapy and surgery to remove the ovaries. If periods stop before age 40, this is known as premature ovarian failure or primary ovarian insufficiency (POI).

If you’re under 45 and have noticed that your periods have become less frequent or have stopped altogether, we recommend you talk to your GP.

How long does perimenopause last?

Perimenopause lasts an average of four to seven years [5]. Of course, this can be much shorter or longer for you. 

If you’ve not had a period for more than 12 months, you’re no longer perimenopausal and you’ve reached menopause. By the age of 54, 80% of women will have stopped having periods [6]. Other factors like medications, medical conditions, and lifestyle factors can also affect your periods, making it difficult to know the specific stage of the menopause transition.

What are the first signs of perimenopause?

Usually, the first sign of perimenopause is irregular periods. Most people will go from having a predictable menstrual cycle to experiencing changes.

Menstrual changes include:

• Shorter or longer cycles
• Lighter or heavier flows 
• Skipping periods altogether

Many women also experience some of the more common symptoms of perimenopause, such as mood changes and hot flushes, early in the menopausal transition. 

What are the symptoms of perimenopause?

Common symptoms of perimenopause include irregular periods, hot flushes, and trouble sleeping – though each woman’s experience of these will be unique. 

Sometimes, these symptoms are so gradual that they are hard to recognise. In the later stages of perimenopause, symptoms can become more noticeable and impact your physical and mental wellbeing. According to the British Menopause Society, over 75% of women will experience some perimenopause symptoms [7]. 

The most common symptoms of perimenopause include:

• Irregular periods or skipping periods
• Periods that are heavier or lighter than usual
• Hot flushes and night sweats
• Trouble sleeping (insomnia)
• Mood changes like low mood, anxiety, and irritability
• Weight gain and/or changes to your body shape
• Vaginal dryness
• Loss of interest in sex
• Muscle and joint pain
• Poor concentration and brain fog

Some symptoms of perimenopause, such as mood changes, low energy, and unexplained weight fluctuations, could be caused by a health condition or vitamin deficiency. Taking a comprehensive blood test like our Advanced Well Woman Blood Test can help you explore the cause of your symptoms, as well as provide a general health and wellbeing check.

 

Am I perimenopausal?

If you are experiencing any symptoms of perimenopause and are in your 40s or 50s, you may be perimenopausal. 

You can take a private blood test at home, such as our Menopause Blood Test to assess whether you’re likely to be perimenopausal. This blood test can also help you explore whether your symptoms are due to a condition that causes perimenopause-like symptoms, such as an underactive thyroid (hypothyroidism) or an overactive thyroid (hyperthyroidism).

Blood tests aren’t usually necessary to diagnose perimenopause, but they can be useful if you’ve begun to experience symptoms of perimenopause earlier than usual or if your symptoms are atypical. Your hormone levels can fluctuate a lot during perimenopause, so you may need to test several times over a few months to get a more accurate picture of your perimenopausal status.

You should reach out to your GP if your symptoms are affecting your day-to-day life or mental health. 
 

What are the treatments for menopause?

Perimenopause is a natural stage in a woman’s life. As such, there aren’t any treatments to prevent perimenopause, but there are treatments to help manage your symptoms.

These treatments will depend on the symptoms you’re experiencing. For example, if you have hot flushes, your treatment may include taking a low-dose birth control pill. 

Your doctor may recommend hormone replacement therapy (HRT), which can help to relieve symptoms such as hot flushes and vaginal dryness by helping to balance your hormone levels. HRT is available as gels, skin patches, implants, sprays, and tablets. Your doctor will discuss the risks and benefits of HRT with you and recommend the best treatment options based on your needs.  

How can I manage my perimenopause symptoms naturally?

There are also ways that you can manage your perimenopause symptoms naturally, such as lifestyle changes that could boost your general health and wellbeing. To ease your perimenopause symptoms, you can:

• Eat a heart-healthy diet – menopause is associated with an increased risk of heart disease due to several factors, such as increased cholesterol levels and an increased tendency to put on weight during perimenopause. Eating a heart-healthy diet full of fresh fruit and vegetables, healthy fats, lean proteins, and wholegrains can help you maintain a healthy weight and protect you from heart disease. The Mediterranean diet is a great choice.
• Get enough nutrients - women’s nutritional needs change in menopause. Hormonal changes can increase the rate of calcium loss from your bones, putting you at higher risk of osteoporosis. It’s important to make sure you’re getting enough calcium in your diet. A blood test can help you check if you've got optimum levels of vitamins and minerals or whether you need to take steps to treat a deficiency. 
• Exercise regularly – weight-bearing aerobic exercises like walking or strength training can help you maintain a healthy weight and improve your bone strength, reducing your risk of osteoporosis. These activities are also a great way to boost your mood and improve your sleep quality.
• Get into good sleep habits – perimenopause symptoms like joint aches and night sweats can make it challenging to get a good night’s sleep. Try to stick to a sleep routine, keep your bedroom cool at night, and avoid caffeine and looking at screens and smartphones before bed.
• Slow down and breathe – you may experience anxiety or rising stress levels in perimenopause, so it’s important to take time out to look after your mental health. Try a relaxing yoga class or a mindfulness session to help you slow down and relax when you need to.
• Get support – if you’re concerned about symptoms of perimenopause, reach out to your GP for support. They may recommend cognitive behaviour therapy (CBT) — a talking therapy that can help you manage symptoms such as anxiety and sleep disturbances by changing the way you think and behave. You can also self-refer for CBT online. It can also help to talk to a friend or loved one about your worries or concerns.  
   

Perimenopause FAQs

1. How can I lose weight during perimenopause?

During perimenopause, you may notice the pounds beginning to creep on. There are several reasons why this happens. Some are related to perimenopause, such as hormonal changes that can affect your metabolism. Other reasons include declining muscle mass that occurs naturally as we age, meaning that we burn fewer calories. 

If you make no changes to your diet or exercise activity levels during perimenopause, you may start to put on weight. But there’s a lot you can do to keep the extra pounds at bay. Focus on one small change to your diet or exercise routine at a time, such as cutting down on sugary snacks or adding a walk to your daily routine, and there’s no reason why you can’t maintain a healthy weight through perimenopause and beyond.   

2. Can I get pregnant during perimenopause?

Although there's a decline in fertility during perimenopause, you can still get pregnant. Until you’ve not had a period for 12 months, you should assume you’re still ovulating (releasing eggs from your ovaries) and able to conceive. And unless you’re planning a pregnancy, you should use contraception until you’ve not had a period for a year.

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

3. What can I expect after menopause?

Life after menopause (postmenopause) can be a new beginning. Many women experience a new-found sense of freedom due to the absence of periods and possibly the end of menopause symptoms. 

How you navigate your perimenopause can have a huge impact on your life after menopause. By being proactive and preparing for menopause, there’s no reason why you should dread this natural transition. Knowing what to expect can help you find what works for you and take steps to protect your future health and wellbeing.

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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.

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References:

1. NHS choices (2022) Menopause. Available at: https://www.nhs.uk/conditions/menopause (Accessed: 20 October 2023). 
2. Patient (2023) Are you going through perimenopause? Available at: https://patient.info/news-and-features/are-you-going-through-perimenopause#:~:text=%22Most%20women%20begin%20to%20experience,years%20before%20your%20periods%20stop. (Accessed: 20 October 2023). 
3. Steiner, A., Baird, D. and Kesner, J.S. (2008). Mother's menopausal age is associated with her daughter's early follicular phase urinary follicle-stimulating hormone level. Menopause, 15(5), pp. 940-944.
4. NHS choices (2021) Early Menopause. Available at: https://www.nhs.uk/conditions/early-menopause/#:~:text=Early%20menopause%20happens%20when%20a,ages%20of%2045%20and%2055 (Accessed: 18 October 2023).
5. Cleveland Clinic (2021) Perimenopause. Available at: https://my.clevelandclinic.org/health/diseases/21608-perimenopause (Accessed: 20 October 2023).
6. Devon Sexual Health (no date) What is the menopause? Available at: https://www.devonsexualhealth.nhs.uk/your-body/menopause/ (Accessed: 18 October 2023).
7. British Menopause Society (2021) The British Menopause Society response to the Department of Health and Social Care’s call for evidence to help inform the development of the government’s Women’s Health Strategy. Available at: https://thebms.org.uk/2021/08/the-british-menopause-society-response-to-the-department-of-health-and-social-cares-call-for-evidence-to-help-inform-the-development-of-the-governments-womens-health-strateg/#:~:text=Core%20Theme%202%3A%20Information%20and%20education%20on%20women’s%20health&text=Menopausal%20symptoms%20affect%20more%20than,over%2025%25%20describe%20severe%20symptoms (Accessed: 03 October 2023).