Perimenopause: Your questions answered

Experiencing mood changes, night sweats, and hot flashes are some of the common symptoms of menopause. 

Sometimes, these symptoms start many months or years before menopause, in a stage known as perimenopause.   

Perimenopause is a transitional phase during which the levels of female sex hormones — estrogen and progesterone — that your ovaries produce fluctuate and then gradually decline. 

Eventually, your periods stop. Twelve months after your last period is when you’ve gone through menopause. 

An early sign of perimenopause is often a change in your menstrual cycle. For instance, you may notice longer or shorter periods, and sometimes you might skip an entire month. 

Many experts believe that genetic factors can largely influence the age you will begin perimenopause. 

Studies have shown that your mother’s age at menopause can indicate the age you begin menopause yourself. So, if your mother had early or late perimenopause, you will likely begin the transition at a similar age. 

Keep reading to learn about perimenopause and what to expect during this significant transition. We also answer your top questions related to all things perimenopause.

What is perimenopause?

Perimenopause translates to “around menopause.” During this stage, the body prepares itself to enter menopause. 

Women start perimenopause at different ages. It can begin as early as your 30s or as late as your mid-50s. In rare cases, some women can even enter perimenopause in their late 20s.

Perimenopause is marked by fluctuations in and a gradual decline in reproductive hormone levels, namely estrogen and progesterone. 

During your menstrual cycle, reproductive hormones ebb and flow predictably. Estrogen levels rise before ovulation, and this triggers your ovaries to release an egg. 

Shortly after ovulation, progesterone levels also begin to rise to prepare the body for pregnancy. If the egg isn’t fertilized, the hormones dip and the lining of the uterus sheds during your period. Then the cycle begins again.     

As you age, the number of eggs in your ovaries declines. During perimenopause, the amount of progesterone and estrogen the ovaries make begins to fluctuate. 

As a result, estrogen levels can rise and fall more randomly than in a typical cycle, leading to less predictable and irregular periods. 

During the later stages of perimenopause, your body produces less and less estrogen and, eventually, your periods stop. Then, after you’ve missed 12 consecutive cycles, you’ve been through menopause.

Perimenopause begins and ends on its own schedule. The average length women spend in perimenopause is about 4 years. But for some, it may last between a few months and a decade.  

What are the symptoms of perimenopause?

Sometimes, especially early on, the symptoms of perimenopause are subtle or come so gradually that they can be hard to recognize. But as you progress through perimenopause, your symptoms may become increasingly noticeable.

Most women experience at least one of the following symptoms:

Period changes

One of the key symptoms of perimenopause is a change in your periods. You may find that you have irregular periods or spotting between cycles. 

Your periods might be heavier and longer or lighter and shorter. And sometimes, you might skip a cycle altogether. 

Hot flashes

A hot flash is a sudden feeling of intense heat spreading through your body that seems to come from nowhere. 

They’re mostly caused by the hormonal changes that occur in perimenopause and can continue long after menopause. 

Breast tenderness or swelling

Hormonal spikes during perimenopause can cause breast pain to start or increase. 

Breast pain can range from mild tenderness to an intense throbbing sensation and usually resolves after menopause. 

Vaginal dryness

As your estrogen levels fall, the tissue of your vulva and the lining of your vagina become thinner. 

This means that during sex, you may produce less discharge, leaving you feeling dry and uncomfortable. 

Night sweats and insomnia

Night sweats happen when hot flashes occur at night time. They are periods of heavy sweating that can cause sleep disruption and, in some cases, insomnia.

Mood changes

It’s common to experience mood changes, such as irritability, aggression, and mood swings during perimenopause. 

These mood changes can cause a woman’s emotions to fluctuate across the spectrum, from high to low and back again. Some women describe their mood changes as like being in a constant state of premenstrual syndrome (PMS).    

Perimenopausal symptoms vary greatly from person to person. In addition, individuals can experience a different combination of symptoms to varying degrees of severity. 

Unpublished ZOE research found that there was a link between weight and the extent of symptoms during perimenopause. Our scientists found that women with obesity were more likely to experience symptoms. 

You can read more about perimenopausal symptoms here.

Treatment for perimenopause

Perimenopause is not a disease or disorder. It’s a natural stage in the female reproductive cycle. 

There aren’t any treatments to stop perimenopause, but there are treatments available to help you manage your symptoms. 

Menopausal hormone therapy (MHT)

MHT (also known as hormone replacement therapy or HRT) is a form of treatment that doctors prescribe to help balance out levels of estrogen and progesterone. 

The main benefit of MHT is that it can help relieve symptoms such as night sweats, hot flashes, and vaginal dryness. MHT is available as pills, skin patches, implants, sprays, and gels.

Talk to your doctor about your symptoms and whether MHT is right for you. 

Vaginal creams

Vaginal estrogen creams are applied directly inside the vagina. The cream exclusively treats vaginal symptoms of perimenopause, such as vaginal dryness and any discomfort. 

Get support

Changes in mood, including depression, are common during perimenopause. Research suggests that women are two to four times more likely to experience depressive symptoms during this time compared with the years before they entered perimenopause. 

If you're not feeling like your usual self, talk to a healthcare professional about your options. 

Your doctor may recommend an antidepressant or suggest working with a therapist to try a talking therapy.

Adjustments to your diet and lifestyle may also help improve perimenopausal symptoms and smooth the transition through menopause.

A healthy diet

Choose a whole-food diet low in saturated fats and rich in fresh produce, such as fruits, vegetables, legumes, whole grains, nuts, and seeds. 

Whole foods are full of fiber, which can help maintain your energy levels, mood, the right levels of nutrients, and a healthy weight through perimenopause and beyond. 

Eat a variety of healthy fats

There is some evidence that healthy fats, such as omega-3 fatty acids, might help reduce the severity of hot flashes and night sweats. However, more research is needed.

To help increase your omega-3 intake, consider adding oily fish, chia seeds, flax seeds, and walnuts to your diet. 

Get regular exercise

Engaging in moderate-intensity exercises, such as cycling or running, is good for overall health at any age.

Research also shows that exercise might help reduce some of the symptoms of perimenopause, such as mood and insomnia. 

However, there is no good evidence that it helps reduce hot flashes.

Slow down and breathe

Some research suggests that mindfulness meditation may help manage stress, anxiety, and hot flashes. 

If you want to try mindful meditation, you could listen to a guided meditation or follow a simple sitting meditation where you focus on the flow of your breathing and your thoughts while sitting upright.

You can find more information on ways to manage perimenopausal symptoms here.

Your questions answered

What age does perimenopause start?

All women start perimenopause at different ages. Perimenopause begins around 8 to 10 years before menopause and usually occurs in your mid-to-late 40s. However, it can start earlier. 

What’s the difference between perimenopause and menopause?

Perimenopause is the phase before menopause. Perimenopause occurs when your menstrual cycle becomes irregular but doesn't stop entirely. 

Once you’ve gone through 12 consecutive months without a period, you have passed through menopause. 

Can I get pregnant during perimenopause?

Although the chances of getting pregnant during perimenopause are lower, it is still possible to get pregnant. 

So, if you don't wish to become pregnant at this stage, carry on using contraception until your healthcare practitioner tells you it’s safe to stop. 

Do you still ovulate during perimenopause?

Yes, as long as you’re still getting your period, even if it’s irregular, you are still ovulating. And as long as you’re ovulating, there is the potential to get pregnant.

What causes early perimenopause?

Early or premature perimenopause can occur:

• if you’ve had your ovaries or uterus removed

• if you have a family history of early menopause

• due to lifestyle factors such as smoking

• if you have a low body mass index (BMI)

• if you have certain medical conditions, including rheumatoid arthritis, HIV, and thyroid disease

• if you’re undergoing treatments that stop your ovaries from functioning, such as radiotherapy or chemotherapy

What effects will perimenopause have on my sex life?

As a result of lower estrogen levels, you may notice that you’re not as interested in having sex or you’re not as easily aroused. 

Lower hormone levels also contribute to vaginal dryness, which can affect vaginal lubrication. 

If changes in your libido and sexual health are bothering you, you may wish to talk to your healthcare provider about ways to help.  

How is perimenopause diagnosed?

Perimenopause is a natural part of life, and doctors don’t try to diagnose it unless the symptoms cause significant discomfort or interfere with your daily activities. 

Your healthcare provider can often confirm that you’re going through perimenopause based on your symptoms. In some cases, they may run a blood test to check your hormone levels to see if you're nearing or are in menopause. 

Summary

Perimenopause is a transitional phase that is marked by a drop in estrogen levels.

All people who menstruate will pass through perimenopause at some point, and it usually occurs in their 40s but can happen much earlier or later. 

The symptoms are different for everyone, but it’s common to experience hot flashes, night sweats, irregular menses, mood swings, vaginal dryness, and a lowered sex drive. 

MHT, alongside lifestyle or dietary changes, can help some people manage their symptoms.