Perimenopause: the phase before menopause

Siski Green / 21 May 2014

Perimenopause is the transition period before menopause, usually when a woman is between 40 and 50 years old.



What is perimenopause?

Perimenopause is the transition period before actually reaching menopause, usually when a woman is between 40 and 50 years old, although it can occur even earlier than that.

Peri means ‘around’ and so the term is simply used to describe the time in a woman’s life when she is not menopausal but going through changes that lead to that stage and experiencing early menopause symptoms. On average it lasts for four years.

The effects of oestrogen level fluctuation

When you’re of childbearing age, your oestrogen levels go up and fall consistently each month, but when you go through menopause itself your oestrogen levels fall and remain lower. Because of that, you stop having periods completely. If you’re over 50, after one year without periods you are considered to have gone through menopause (for women under 50, it’s 24 months).

The problem is that during perimenopause your oestrogen levels may fall and rise again – they fluctuate – and this can change the regularity of your periods without stopping them, making this period in life quite confusing and disruptive.

It’s not just oestrogen, progesterone and androgens level also change. Combined, these hormones affect many different aspects of your wellbeing, from the physical to the emotional.

What are perimenopause symptoms?

The most common symptom of perimenopause is irregular periods, although if your periods have never been regular or you’re not very consistent with checking the timing when they occur, this might not be evident to you.

For example, if you experience an extra week or so between periods, compared to usual, it could be a sign of early perimenopause. You might also notice that you don’t bleed for the same amount of time or in the same way, or that the symptoms you usually associate with menstruation – mood swings, swollen breasts, stomach cramps – may change. If you miss a period completely, you are likely to be in a later stage of perimenopause.

Hot flushes and how to cope with them

Hot flushes are a classic symptom of menopause but you may well experience them during perimenopause too, albeit less frequently. The intensity and effect of hot flushes varies widely from woman to woman, with some woman finding it affects their normal life, preventing them from going out for fear of experiencing one, to others barely noticing.

Exercise can help a great deal in reducing the effects of hot flushes. The NHS recommends that you get at least 150 minutes of exercise a week, which may include walking or swimming, for example.

Learn more about the best ways to deal with hot flushes

Sex can lose its appeal

Oestrogen is a hormone that’s linked to your libido and because of that, lower levels may affect your desire for sex. However, while it might reduce your physical desire for sex, it needn’t have an impact on your emotional desire for sex. Many women do not notice a difference in their libido and continue to have sex far beyond the menopause.

That said, even for women whose desire doesn’t dissipate, sex can become physically uncomfortable as the vagina doesn’t lubricate as well without higher oestrogen levels.

Is it normal not to want sex? Find out when and why you may not be in the mood

Osteoporosis poses a risk

Osteoporosis is a real risk as oestrogen levels fluctuate, calcium levels also fluctuate. That causes your bones to slow the renewal process. That's why it’s important to maintain calcium intake via yogurt or cheese, for example. It’s also extremely important to maintain or increase exercise, as this not only helps maintain muscle mass giving your bones support, it helps maintain bone density too.

Learn more about how to prevent osteoporosis

Cholesterol levels may rise

Bad cholesterol (LDL) is likely to increase, while HDL falls – all as a result of falling oestrogen levels. All the more reason to make sure you eat a healthy balanced diet, with an emphasis on fresh vegetables and fruit, wholegrains, pulses and quality protein.

Find out more about cholesterol and how to cut your levels if they are too high

Insomnia becomes a problem

Although sleep problems may well be connected to experiencing hot flushes (often called night sweats when they occur at night), it could also be a result of your mood swings, your bladder changes or the emotional aspect of going through this stage in your life.

If hot flushes are what you think are causing your sleep issues, try yoga. Research from the University of California, San Francisco, USA, found that women who undertook regular yoga classes experienced a drop in hot flushes of 30%.

Learn more about what you can do when insomnia strikes

Note your menstrual cycles

Aside from those listed above, other symptoms associated with perimenopause include

  • needing to urinate more often,
  • memory lapses,
  • aching sore joints and muscles,
  • indigestion,
  • flatulence,
  • exacerbation of existing conditions,
  • increase in allergies,
  • weight gain,
  • hair loss or thinning,
  • increase in facial hair...

Frankly, no wonder you feel a bit off-colour with all this going on!

For some women perimenopause is a breeze, a natural transition, part of life; for others, it’s a strange rollercoaster ride that can make them feel as though they’re going crazy. This is particularly so during perimenopause as the fluctuating levels of oestrogen can make it difficult to be certain that what you’re experiencing is something to do with your hormones and not something else.

How long will the perimenopause last?

On average perimenopause lasts four years. Perimenopause is over when you have gone through menopause. In the meantime, make a calendar of your symptoms and especially your menstrual cycles, so that you can get a better handle on what’s going on. Keep sanitary towels or tampons with you, so that you can deal with irregular periods, too.

Perimenopause treatment

If you’re finding any of the symptoms difficult, see your GP. He or she may prescribe hormone replacement therapy if necessary.

You can also explore alternative or complementary medicines. Research from the University of Exeter found that six out of ten women reported improvements by using therapies such as herbal remedies, soya products, evening primrose oil, relaxation and yoga. 

Read more about treatment options for hot flushes

The opinions expressed are those of the author and are not held by Saga unless specifically stated.

The material is for general information only and does not constitute investment, tax, legal, medical or other form of advice. You should not rely on this information to make (or refrain from making) any decisions. Always obtain independent, professional advice for your own particular situation.