What is the perimenopause?

The majority of us have heard of the menopause and understand it’s a time in a woman’s life where hormones change — where periods have stopped and levels of oestrogen and progesterone are lower.

While this is true, there is also a timeframe before this called the perimenopause which is often misunderstood as the menopause starting.

Nikki Porges, registered nurses in AXA Health’s 24/7 health support line, for members, explores what the perimenopause is, what can happen during this phase of a woman’s life and what can be done to help the symptoms.

When does the perimenopause start?

This period of time in the lead up to the menopause, sometimes starts before the age of 40 which is considered an early perimenopause. But, typically, the average age for perimenopause to begin is in the mid-forties, and can last from several months to up to ten years.¹

It’s worth noting, that the average age for the menopause to start in the UK is 51; so, it’s helpful to remember the age in which either the perimenopause or menopause begins is not set in stone, and every journey is different.

What’s the difference between the menopause and the perimenopause?

The menopause is when there has been an absence of periods for 12 months, after this period of time a woman is considered post-menopausal for the rest of her life.

The perimenopause, however, is the time before this. Physiological changes in the body and rapidly changing and fluctuating hormone levels occur in the run up to the menopause.

Fewer eggs are produced overall during this time and hormone levels will begin to cycle and fluctuate rapidly up and down, (periods still occur but may change in frequency and can also become heavier and/or longer lasting).

Overall, during the perimenopause, symptoms commonly associated with the menopause start to appear even though periods may remain normal.

Equally, not every woman will have symptoms, but most will, and these can occur before, during and after the perimenopause and menopause, and can also vary in type and intensity.

How is the perimenopause diagnosed?

If a woman is having symptoms and is over the age of 45, they could be perimenopausal and the diagnosis is generally made based on symptoms alone.

However, for anyone under the age of 45, confirmation may be sought through a blood test to exclude any other cause and to confirm if the perimenopause or menopause is happening.

Two blood tests are usually needed, taken six weeks apart. These will be looking at the level of a specific female hormone known as the follicle stimulating hormone, (this is expected to be raised during menopause and the perimenopause transition).

It’s important to remember however, that due to the widely fluctuating levels of hormones in the body, (which will swing from normal to low to high during perimenopause), that even with two blood tests six weeks apart, it is still possible for both readings to be normal while the perimenopause is happening.

This is why symptoms tend to be much more indicative in themselves. For this reason, it’s a good idea for women to keep a symptom diary as it can provide a very helpful guide and insight that can be used when consulting with their medical practitioners.

Common symptoms of the perimenopause

As every experience will be unique, there isn’t a set list of symptoms that every woman will experience. However, here are some of the more common ones which could be experienced in varying levels of severity and duration:

Physical symptoms

• hot flushes and night sweats,
• headaches,
• dizziness,
• vaginal dryness,
• incontinence and bladder issues,
• reduced sex drive,
• joint and muscle pain,
• difficulty sleeping,
• weight gain.

Mental health symptoms

• low mood or mood swings,
• anxiety,
• problems with memory or concentration (brain fog).²

What can help the symptoms?

A healthy lifestyle can help to minimise the effects of the perimenopause and improve overall health.

Diet and nutrition – with hormones changing during this time and oestrogen levels dropping, there is an increased risk of heart disease and osteoporosis. So, a healthy diet is essential at this stage:

• try to keep salt and saturated fat intake low (below 20 mg a day for saturated fat), making sure to include healthy fats such as olive oil, fatty fish and sources of Omega 3, this can help to reduce blood pressure and maintain healthy cholesterol levels.
• a diet rich in calcium and vitamin D can help to strengthen bones.

Some women take dietary supplements to help get the balance right. Our article on women’s vitamins, minerals and supplements may help you decide is this is something for you to consider.

Stay active – exercising regularly not only can help keep hearts healthy and bone mass maintained, it can also help to reduce anxiety. Some women experience increased anxiety during this time, so regular, moderate intensity, exercise can help to convert this stress into positive energy and has been found to be the most beneficial in maintaining overall fitness during perimenopause.

Look after your head too – try to maintain regular sleep and get plenty of rest. With mood swings potentially happening, relaxation techniques such as mindfulness can help keep you in good mental health; as well as yoga or meditation.

Talking – it might sound obvious but talking to others going through the same process can really help eliminate the loneliness. There might be support groups at work, in the local area, or online, where experiences can be shared. Friends and family too can help support or just be there to listen.

Treatment

Hormone replacement therapy (HRT) is the most effective and widely used treatment for those going through the perimenopause. It’s simply a way of replacing the hormone oestrogen that’s lost during the perimenopause.

Cognitive behavioural therapy (CBT) can also help some of the symptoms or can be an alternative for those women who can’t take HRT. This talking therapy can help with:

• low mood and anxiety caused by menopause and perimenopause
• some physical symptoms like hot flushes and joint pain.³

There are also some non-hormone medicines that can help treat some of the more severe symptoms, as well as some herbal remedies (although there is no strong evidence these work).

Treatment, however, is on an individual basis, and a GP would discuss the benefits and side effects of each when assessing any symptoms.

Whether you’re currently going through the perimenopause, concerned about if it’s started for you, or you’ve come through the other side – remember not to be afraid to talk about what is happening to you.

It might be your partner, your sister, your GP, employer, or a friend, but asking for support can be a powerful step in managing your symptoms and helping you to feel like you’re in control of your body and what it’s currently going through.

Further reading

• Our ultimate guide to the menopause
• Menopause Matters
• The British Menopause Society (BMS)

References

1. When does the perimenopause start? — Patient
2. Menopause symptoms — NHS
3. Treatment — NHS