Many women expect symptoms of the menopause to begin once their periods stop. In reality, the hormonal changes leading up to menopause often begin much earlier. This stage is known as perimenopause, and it can last for several years before menopause officially occurs.
Because the symptoms develop gradually and often affect many different parts of the body, perimenopause is frequently mistaken for stress, ageing, or simply being “run down”. Understanding the early signs can help you recognise what may be happening and explore the treatment options available.
What is perimenopause?
Perimenopause is the transition leading up to menopause.
During this time, your ovaries gradually produce lower levels of oestrogen and progesterone. These hormonal changes can affect many different systems throughout the body, resulting in a wide range of symptoms.
Unlike menopause, which is defined as having no periods for 12 consecutive months, women in perimenopause often continue to have menstrual cycles, although they may become less predictable.
For many women, this stage can begin in their 40s, although the exact timing varies. If menopause symptoms begin before the age of 45, it’s important to speak to your GP, as this may need further assessment.
Why do hormones fluctuate?
Hormones naturally rise and fall throughout life.
During perimenopause, however, these fluctuations become much more unpredictable.
One month, oestrogen levels may remain relatively stable, while the next they may change significantly. These changes are thought to contribute to many of the symptoms women experience during this stage.
Every woman’s experience is unique, and symptoms can vary considerably.
Common symptoms of perimenopause
Many women are surprised by how many different symptoms may be linked to hormonal changes.
Some of the most commonly reported symptoms include:
- Hot flushes
- Night sweats
- Irregular periods
- Mood changes
- Anxiety
- Brain fog
- Difficulty concentrating
- Poor sleep
- Fatigue
- Headaches
- Reduced libido
- Vaginal dryness
- Joint aches
- Changes in skin and hair
Not everyone experiences all of these symptoms, and their severity can vary.
Can you still have periods during perimenopause?
Yes.
One of the biggest misconceptions is that menopause begins as soon as symptoms appear, periods stop.
Many women continue having periods throughout perimenopause, although they may often become:
- More irregular
- Heavier
- Lighter
- Closer together
- Further apart
These changes can be a normal part of hormonal fluctuations during perimenopause. However, if your bleeding is very heavy, occurs after sex, happens between periods, or your symptoms are severe or significantly affecting your quality of life, it’s important to make an appointment with your GP surgery for further assessment
Why is perimenopause often mistaken for something else?
Many symptoms develop gradually.
Poor sleep may lead to tiredness.
Tiredness may affect concentration.
Mood changes may be mistaken for stress.
Joint aches may be blamed on ageing.
Because these symptoms often appear slowly over time, many women do not immediately associate them with changing hormone levels.
Can perimenopause affect mental wellbeing?
Hormonal changes may influence emotional wellbeing in some women.
Some women report:
- Feeling more anxious
- Becoming tearful
- Irritability
- Reduced confidence
- Feeling overwhelmed
These experiences are common, although everyone’s experience is different.
If symptoms are having a significant impact on your daily life, seeking medical advice can help identify possible causes and discuss available support.
Vaginal symptoms are common too
Many women don’t realise that vaginal symptoms can also develop during perimenopause.
Lower oestrogen levels may contribute to:
- Vaginal dryness
- Discomfort during sex
- Irritation
- Increased urinary symptoms including recurrent cystitis
Although these symptoms are common, many women do not seek advice because they assume they are simply part of ageing.
How is perimenopause diagnosed?
Healthcare professionals usually diagnose perimenopause by discussing:
- Your age
- Your symptoms
- Your menstrual history
- Your medical history
Blood tests are not always necessary, particularly in women over 45 with typical symptoms.
Can symptoms be treated?
Treatment depends on your symptoms and medical history.
Many women find lifestyle measures helpful, while others may wish to discuss treatment options with a clinician.
These may include:
- Lifestyle advice
- Hormone Replacement Therapy (HRT)
- Treatments for individual symptoms
- Vaginal oestrogen for vaginal or urinary symptoms
The most suitable option varies between individuals and depends on your preference.
When should you seek medical advice?
Consider speaking with a healthcare professional if:
- Symptoms are affecting daily life
- Sleep is regularly disrupted
- Mood changes become difficult to manage
- Periods become unusually heavy
- Bleeding occurs after menopause
- Vaginal symptoms persist
Frequently Asked Questions
At what age does perimenopause usually begin?
Many women begin experiencing symptoms during their 40s, with most reaching menopause between the ages of 45 and 55.
Can you be in perimenopause and still have regular periods?
Yes. Some women continue to have regular periods during the early stages.
How long does perimenopause last?
Perimenopause usually lasts between four and eight years, although for some women it may be shorter or longer.
Does everyone experience hot flushes?
No. Symptoms differ from woman to woman.
Is vaginal dryness part of perimenopause?
Yes. Lower oestrogen levels may contribute to vaginal dryness and discomfort.
Conclusion
Perimenopause is a natural stage of life, but that doesn’t mean women should simply put up with symptoms that affect their wellbeing. Understanding the changes taking place can help you recognise the signs earlier and make informed decisions about your health. If you’re experiencing symptoms that are affecting your quality of life, speaking to a healthcare professional can help you explore the support and treatment options available.