Our Guide to the First Signs of Perimenopause - Stella
Your body
6 mins

What are the signs of perimenopause?

byTanaaz Khan

If you don’t know the signs of perimenopause, don’t worry. We’ve got everything you need to know in our handy guide. Find out more about how long it lasts, symptoms, treatment options and how you know it is ending.

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What is perimenopause?

Your body has a natural life stage called perimenopause, which is when your ovaries gradually stop producing eggs and your periods become irregular before they stop. It can happen up to 10 years before menopause, which is when your periods have stopped for more than 12 months 

During perimenopause, your body produces less of the hormone oestrogen and levels can fluctuate during your cycle. Erratic changes in hormone levels and gradual reduction in oestrogen can cause menopause symptoms and your periods can become irregular, heavier or lighter. 

Be aware that certain medications (including hormonal contraceptives like the pill) can cause your periods to become less frequent or even stop, making it difficult to tell when you have reached menopause itself. If this is the case, speak to your doctor for further advice.

What happens during perimenopause?

You may spot some of the four main changes to your body, which are signs of perimenopause:

  • Gradual loss of oocytes (your eggs)
  • Fluctuations in hormone levels, 
  • Irregular periods
  • Reduced fertility

Pregnancy is still a possibility and contraception is important – find out more.

Perimenopause phases

Perimenopause has two phases:

  1. Early transition. You might see a delay of more than 7 days in your period or notice a skipped period. Your bleeding flow may also change. 
  2. Late transition. Your period cycle may be as long as 60 days and become more irregular. Your oestrogen levels are still fluctuating but more consistently low.

Perimenopause ends when you reach menopause, at which point your ovaries are no longer producing eggs and your periods stop. The average age for menopause is 51 years old. Read more about the stages of menopause.

At what age does perimenopause start?

Perimenopause usually occurs between the ages of 45 and 55. Early menopause occurs when women under 45 experience menopause naturally or for specific reasons, such as chemotherapy, surgery or genetics.

Find out more about early menopause.

How long can perimenopause last?

Perimenopause starts up to 10 years before your menopause and lasts for four to eight years on average. Your menopause journey is unique to you and perimenopause can last just a few months or much longer for some women.

Perimenopause symptoms and their duration differ from one woman to another for many reasons, including:

  • Medical history and family history
  • The type of symptoms experienced
  • Age
  • Lifestyle (exercise, smoking, drinking)
  • Cultural factors

What are the first signs of perimenopause?

One of the key signs of perimenopause is that your period changes and can become heavier, lighter or irregular, even all of these but at different times! If your period is generally 28 days on the dot, but suddenly becomes all over the place – 25 days, 20 days, 35 days – it might be perimenopause. You might notice you feel mentally and emotionally off-kilter too.

When it comes to signs of perimenopause, there are around 34 symptoms. This isn’t an exhaustive list but some of the most commonly reported, including:

Perimenopause symptoms

Every perimenopause is different in terms of the number, combination, duration and severity of symptoms. Research has found:

  • At least one-third of women experience hot flushes (Journal of Women’s Health)
  • Women were two to four times more likely to experience a major depressive episode when they were perimenopausal or early postmenopausal, according to one study of American women (Study of Women’s Health Across the Nation)
  • Of 3890 peri- to postmenopausal women screened, 67% experienced symptoms and 54% sought either medical input or some treatment concerning their symptoms. The decision to seek treatment was influenced by age, number, and severity of symptoms (source)

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How is perimenopause diagnosed?

The most reliable way to be assessed for perimenopause is for your doctor to review your symptoms. They may want to examine you or do some other tests to exclude other causes for your symptoms.

Hormone blood tests are not generally recommended if you are over 45. This is because hormone levels fluctuate throughout menopause, and can be dramatically different from one day to the next. Blood tests taken in perimenopause do not give us an accurate picture of where you are in your menopause journey and are therefore not particularly useful in most cases.

Current recommendations are for doctors to assess your menopause status based on your age, menstrual cycle and symptoms. Despite being seemingly lower-tech, this is the most accurate way of diagnosing perimenopause.

There are, however, certain exceptions to this. Blood tests may be useful if your symptoms are not typical, if you are under 45 or if you are using certain contraceptives. 

Find out more about menopause tests.

How do you manage perimenopause symptoms?

The good news is there are practical things you can do to manage many menopause symptoms with simple lifestyle changes. It helps to:

  • Manage stress with relaxation techniques, such as yoga and meditation
  • Get quality sleep and practise proper sleep hygiene
  • Managing weight and focus on menopause-friendly nutrition
  • Be active with a mix of cardio exercise, stretching and strength training

Can HRT help with perimenopause?

If you are struggling with perimenopause symptoms, talk to your doctor and find out what support or treatment is right for you. Hormone replacement therapy (HRT) is an effective treatment for many perimenopause symptoms and your doctor can explain the risks and benefits for you.

Read our advice on how to talk to your doctor about menopause.

What are the signs that perimenopause is ending?

Perimenopause ends when you reach menopause – the moment when you haven’t had a period for a year and are not on hormonal contraception.

Many women find that their symptoms ease around this time, although others may continue to struggle even after their periods have stopped.

What kind of complications should I expect?

Talk to your doctor if you have:

  • Severe hot flushes that make day-to-day life difficult
  • Vaginal dryness and irritation
  • Heavy bleeding and/or blood clots and/or pain
  • Bleeding after sex or outside your period
  • Period lasting longer than usual
  • Any other symptoms that are worrying or troublesome

Find out more about red flag symptoms or heavy bleeding.

Final word

Knowing that perimenopause or menopause looks different for each woman is essential. 

If you’re feeling different – physically, emotionally or mentally – make an appointment to see your doctor for advice about treatment. Many women hesitate to ask for support but talking to friends and family, even your colleagues and employer can really help. Here is some inspiration to get those conversations going:

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