Perimenopause is the time during your life before menopause, it’s a natural change that we all go through. Natural menopause doesn’t happen overnight, and the hormonal changes leading up to it can happen over many years.

During perimenopause, progesterone levels initially start to fall which often causes changes to your periods such as heavier or more irregular bleeds. Oestrogen levels fluctuate up and down at the same time while the ovaries are trying hard to release eggs despite there not being many left! Overall, your oestrogen levels slowly drop during the perimenopause.

1 in 4 people won’t get any symptoms at all. However, you may experience a wide range of symptoms including anxiety, brain fog, poor sleep, hot flushes, headaches and symptoms similar to premenstrual syndrome (PMS) which can affect your quality of life.

Perimenopause may last for several years with symptoms coming and going or becoming more and less intense until menopause is reached. You reach menopause when you have not had a period for 12 months.

Perimenopause means that you’re going through the changes towards menopause. Menopause is actually only one day in your life — the day when it’s been exactly 12 months since your last period. After this date, you are clinically described as being postmenopausal.

The symptoms felt during perimenopause are due to changes in your hormones. During perimenopause progesterone levels initially fall, which often causes changes to your periods and sleep pattern. As the number of eggs in your ovaries reduces, oestrogen levels fluctuate up and down, sometimes wildly, which can cause symptoms such as hot flushes, headaches and irritability. Your overall oestrogen and progesterone (alongside testosterone) levels gradually decrease until they reach a baseline level at menopause.

After menopause, your baseline hormone levels are lower than during your reproductive years and can cause long-term symptoms such as vaginal dryness and itching, discomfort when urinating, and brain fog. Fun fact — “peri” means “around” in ancient Greek and “post” means “after” in Latin so that’s where these descriptions have come from!

Perimenopause can start at different ages but usually begins in your mid-40s. Perimenopause lasts an average of 4 to 8 years before menopause. The average age of menopause in the UK is 51. Symptoms can come on slowly or be quite sudden depending on the changes in your hormones. You can learn more about the symptoms of perimenopause in our blog. Some women may find that their perimenopausal symptoms start as a worsening of premenstrual syndrome or premenstrual dysphoric disorder and the changes are gradual.

It is very important to speak to your GP if you think you may be perimenopausal under the age of 40, especially if you haven’t had a period for 4 months. This is because untreated premature or early menopause can impact your long-term health so an accurate diagnosis is key to getting the right support. 

Early menopause may run in some families but, of course, every family is different. Genes may play a role in what age you start perimenopause but it’s not a definite way to predict.

It’s also worth noting that certain medical conditions or treatments can cause perimenopause or menopause early such as autoimmune conditions, genetic conditions such as Turner syndrome or treatment with surgery, chemotherapy or pelvic radiotherapy.

You will often see it stated that there are 34 symptoms of menopause and perimenopause – but there are more, especially as people describe their symptoms in a variety of ways. You may only experience a couple of symptoms throughout perimenopause or experience every symptom — everyone is different. The average number of symptoms to have is seven, according to a survey by the British Menopause Society.

Symptoms can be caused by the fall in progesterone levels during perimenopause or the fluctuations in oestrogen.

Perimenopause symptoms might include:

• Changes to your periods
• Hot flushes
• Changes to sleep
• Breast pain
• Cyclical headaches
• Palpitations
• Anxiety
• Mood change
• Irritability
• Fatigue
• Skin and hair changes
• Joint and muscular pain
• Genital or urinary symptoms such as vaginal dryness, painful sex and urine infections
• Loss of libido

….but can include more or less than the ones listed above.

Often, you might start to notice changes in your body that are hard to connect and understand. Keeping a record of all your symptoms, writing them down and taking them to show your GP, can often make it easier to discuss whether these symptoms are due to perimenopause. Our fabulous perimenopause partners at Myla Health have a downloadable perimenopause symptom checker to help make sense of how you are feeling, and they can support you with accessing care and treatment.

Perimenopause usually starts between the ages of 40 to 45. Symptoms may only last for a few months or up to 12 years, but the average is between 4 to 8 years. This sounds terrifying, but don’t worry. 1 in 4 of you won’t have any symptoms at all. Symptoms can also come and go throughout this time, with some periods of worse symptoms before they may improve or disappear.

You may wish to speak to any female family members to see how long their symptoms lasted, you may find that your experience is similar to theirs. If you are struggling, there are lifestyle changes and treatment options to support you through this time. Keep reading for the lowdown on this!

There is a test for perimenopause, but it’s unreliable and the majority of people do not need to be tested. 

Over the age of 45, perimenopause should be diagnosed clinically, meaning diagnosis is purely based on your symptoms and does not require any blood tests. A blood test would be unreliable because, during perimenopause, your hormones fluctuate constantly. So a blood test would only show the hormonal levels on that particular day and not the overall picture.

The exceptions to this are if you are under the age of 45 with perimenopausal symptoms, if you are under the age of 40, or if you are on hormonal contraception which stops your periods and want to know if you can stop taking it.

If you are under the age of 40 and have not had a period for 4 months alongside perimenopausal symptoms, you should have a blood test to look for primary ovarian insufficiency (POI) (sometimes called premature ovarian failure or premature menopause). The blood test looks at the level of a hormone called follicular stimulating hormone (FSH) which rises during perimenopause and menopause. Your FSH level is measured twice, 4 to 6 weeks apart, to get an accurate reading and a clear diagnosis. Accurate diagnosis of primary ovarian insufficiency under the age of 40 is important as this can impact your long-term health if untreated and you can access treatment and further support.

Yes, you can still get pregnant during perimenopause. It may seem unlikely, but your body may still be ovulating (releasing eggs) so fertilisation and pregnancy can still happen. Ovulation may be less frequent and more irregular but while you are still having periods, your body can still release eggs. It is still important that you consider contraception during perimenopause if you want to prevent pregnancy. Contraception can be combined with, or used as part of, hormone replacement therapy (HRT). HRT by itself isn’t a contraceptive! We also have a blog that will help you navigate which contraceptive pill is best during perimenopause. 

If you are trying to conceive during perimenopause, there may be fertility support available and it’s worth discussing this with your GP early on or speaking to our experienced fertility nurse specialist.

Perimenopause symptoms can be variable throughout and may increase and decrease in severity. It’s hard to know whether perimenopause is ending based on symptoms alone. The medical definition of menopause is the day that is 12 months after your last period. This is also the day that perimenopause ends. Therefore the best indication that perimenopause is ending can be your periods.

As the length of time between periods stretches out more and more, it is a suggestion that you’re nearing menopause. Annoyingly, you can go many months without a period then suddenly have one at 10 months, and the 12-month count down to menopause begins again. Still, these large gaps between bleeds suggest perimenopause is ending.

Unfortunately, perimenopausal symptoms may extend after menopause, but it’s difficult to predict which symptoms and who will get them. It’s important to know where to access support if your symptoms are persisting and affect your quality of life. Our partners Myla Health are a great place to start.