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What Is Perimenopause?

What Is Perimenopause?

Every woman’s experience of menopause can be different. Learn the first signs, symptoms and bust some myths about menopause. The best person to detect menopause as it approaches is probably you. And by being on the lookout for symptoms, you'll be able to gradually relieve them as they appear. 

Lifestyle insight
Reading time: 3 minutes


Most women know at least a little about menopause, and the changes that happen in your body as you reach the end of your reproductive years.

But you don’t just wake up in menopause it can take years for your body to transition to this stage of your life. The in-between period of hormonal changes – which can involve hot flushes, mood swings and night sweats – is called perimenopause.

Every woman’s experience of perimenopause and menopause is different. Twenty per cent of women experience no symptoms during perimenopause, 60 per cent have mild to moderate symptoms, and 20 per cent have severe symptoms that can affect their everyday life.1

By knowing and looking out for the symptoms of perimenopause, you’ll be able to navigate this time in your life more easily, and get help and advice when you need it.


When does perimenopause start?

Most women begin to experience perimenopause symptoms between the ages of 40 and 55.2 However, some women notice their menstrual cycle becoming irregular – which can be a sign of the beginning of perimenopause – in their mid-thirties.


How long does perimenopause last?

The average length of perimenopause is four years. When you have had 12 months without a period, perimenopause is over and you’re officially in menopause.


What causes perimenopause?

At perimenopause your ovaries are starting to run out of eggs. This causes the level of the female hormones oestrogen and progesterone to fluctuate. The change in hormones can result in your menstrual cycle becoming longer or shorter. The drop in oestrogen may also cause symptoms that continue into menopause, such as vaginal dryness and hot flushes.


What can start early perimenopause?

There are several factors linked to early perimenopause. These include:

  • Smoking3
  • Having your ovaries removed. Having your uterus removed, but not your ovaries (a hysterectomy) usually doesn’t cause perimenopause
  • Some cancer treatments4
  • Family history of early menopause5


Do I need a test to confirm I’m perimenopausal?

Most women don’t have a test to confirm they’re in perimenopause. However, if you’re under 45 and your periods have stopped, your GP might do a blood test to confirm that’s what’s happening. The test will check your level of the hormones FSH (follicle-stimulating hormone) and oestradiol, which fluctuate during perimenopause. However, these hormones fluctuate regularly, so the test isn’t always reliable.


What happens to my periods during perimenopause?

As your hormones fluctuate ovulation becomes unpredictable, and the length of your cycle can become longer or shorter. Some periods may be skipped altogether. Bleeding may also be noticeably lighter, or heavier, or last much longer than usual.

If there’s a consistent change of seven days or more in the length of your menstrual cycle, you may be in early perimenopause. If there’s a space of 60 days or more between periods, you are likely to be in late perimenopause. Perimenopause can also cause spotting between periods, and after sex.

You should see your doctor if your periods become extremely heavy and you have to change your tampon or pad every two hours, for two or more hours. You should also see a GP if your period lasts longer than seven days, if you’re bleeding between periods, or you are regularly having periods that are less than 21 days apart.


What are the symptoms of perimenopause?

Just like menopause, every woman’s experience of perimenopause will be different. However, there are some common signs and symptoms of perimenopause. These include:

  • Hot flushes and night sweats. The changing levels of oestrogen and progesterone can affect your body’s temperature control. Many women describe this affecting their face and neck in particular, and also affecting the quality of their sleep.
  • Mood changes. Mood swings and irritability may happen during perimenopause. This is caused by fluctuating oestrogen, which affects the mood-regulating hormone serotonin.
  • Vaginal dryness. Less oestrogen in the body can reduce vaginal secretions, resulting in decreased lubrication. Reduced oestrogen can also cause the lining of the vagina to become thinner and drier. Vaginal lubricants can help make sex more comfortable.
  • Loss of libido. Dropping levels of oestrogen and testosterone can affect sex drive in perimenopausal women.
  • Weight gain. Fluctuating oestrogen levels and a natural slowing of the metabolism can cause weight gain during perimenopause. The hormonal changes that happen at this time also promote fat storage around the abdominal area.
  • Loss of bone. Declining oestrogen results in loss of bone during perimenopause and menopause. This can increase the risk of osteoporosis.
  • Change in cholesterol level. Lower oestrogen can cause an increase in LDL (‘bad’) cholesterol, and a decrease in HDL (‘good’) cholesterol.
  • Changes in skin. The drop in oestrogen can affect the moisture in your skin. This can result in dry or itchy skin, irritation, bumps, and sometimes rashes.


Can I get pregnant during perimenopause?

Yes. Conceiving becomes less likely as ovulation becomes irregular during perimenopause, but if you’re still having periods, it’s still possible to fall pregnant. If you don’t want to get pregnant, use contraception for 12 months after your last period.


Do I need to see a doctor about perimenopause?

If you’re noticing changes in your body that you think may be linked to perimenopause, it’s worth talking to your healthcare professional. Because symptoms can come on gradually, it’s not always obvious they are connected. There are lots of strategies for managing perimenopausal symptoms, and it’s always worth seeking professional advice.


How can I help my perimenopause symptoms?

It’s always a good idea to see your GP if your symptoms are bothering you. However, there are some ways of relieving your symptoms at home.

How to help hot flushes:

  • Reduce the amount of caffeine you consume, including tea and coffee.
  • Avoid spicy food and alcohol.
  • Dress in layers so you can remove clothing if you get too hot.
  • Keep a portable fan with you.
  • Have a fan or aircon in the bedroom to help with night sweats.
  • Eat foods that contain phytoestrogens. These naturally occurring oestrogens have been found to reduce hot flushes in perimenopause.6 They are found in foods including tofu, whole grains, beans and lentils.

There are other general things you can do to increase your wellbeing during perimenopause. These include:

  • Exercising regularly, including weight bearing exercise to promote bone density.
  • Stopping smoking.
  • Maintaining a healthy weight.
  • Drinking minimal alcohol.
  • Getting enough sleep.


Can I take supplements to help with perimenopause?

Some supplements and herbal medicines can help with perimenopause symptoms. Black cohosh, which is the main ingredient in Femular and Femular Forte, can act as a natural painkiller7 and help relieve symptoms of perimenopause and menopause.8 Always speak to your healthcare professional before taking herbal supplements.


Did you know?

FACT: The age you begin perimenopause and menopause runs in families, so it’s likely your perimenopause will begin at around the same age as your mum’s did.9

FACT: Your ethnicity may have an influence on when you begin perimenopause. Hispanic and African-American women tend to start perimenopause earliest, then Caucasian woman, then Asian women.10

FACT: Women who smoke begin perimenopause earlier than non-smokers.11

FACT: Starting your period earlier means you’ll reach perimenopause earlier. If you started menstruating before the age of 12, you’re 31 per cent more likely to begin perimenopause between the ages of 40 and 44.12

FACT: Pregnancy and breastfeeding are linked to the later onset of perimenopause.13

Speak to your health professional if you’re concerned about any symptoms of perimenopause.



  1. https://www.jeanhailes.org.au/resources/perimenopause-fact-sheet
  2. American Journal of Epidemiology https://academic.oup.com/aje/article/153/9/865/124589
  3. Cigarette Smoking and Risk of Early Natural Menopause https://academic.oup.com/aje/article/187/4/696/4080179
  4. Menopausal symptoms in relationship to breast cancer-specific quality of life after adjuvant cytotoxic treatment in young breast cancer survivors https://hqlo.biomedcentral.com/articles/10.1186/s12955-020-1283-x
  5. Genetics play strong role in determining age of menopause and overall longevity https://www.sciencedaily.com/releases/2019/06/190612110127.htm
  6. Efficacy of phytoestrogens for menopausal symptoms: a meta-analysis and systematic review https://www.tandfonline.com/doi/full/10.3109/13697137.2014.966241
  7. Black Cohosh has Central Opioid Activity in Postmenopausal Women: Evidence from Naloxone Blockade and PET Neuroimaging Studies https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2915573/
  8. https://ods.od.nih.gov/factsheets/BlackCohosh-HealthProfessional/#:~:text=The%20black%20cohosh%20group%20showed,(e.g.%2C%20vaginal%20dryness)
  9. Mother’s Menopausal Age is Associated with her Daughter’s Early Follicular Phase Urinary, Follicle Stimulating Hormone Level https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2856641/
  10. Is menopause still evolving? Evidence from a longitudinal study of multiethnic populations and its relevance to women’s health https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-020-00932-8#:~:text=This%20study%20has%20identified%20a,%2C%20Chinese%2C%20and%20Japanese%20descent
  11. Effects of Smoking on Menopausal Age: Results From the Korea National Health and Nutrition Examination Survey, 2007 to 2012 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4542296/
  12. Pregnancy outcomes in women with endometriosis and/or ART use: a population-based cohort study  https://academic.oup.com/humrep/advance-articles
  13. Association of Parity and Breastfeeding With Risk of Early Natural Menopause https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2759124



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