What are the early signs of perimenopause, what age does it happen, how long does it last, is there a test for it and how do you know when you've reached menopause?
Perimenopause is the time leading up to menopause, when your levels of reproductive hormones like oestrogen and progesterone start to fluctuate.
The earliest signs of perimenopause are usually changes to your menstrual cycle, but you may also experience hot flushes, brain fog and anxiety, among other symptoms.
The age when you enter perimenopause can vary hugely but it’s most common after 45 and generally lasts for 4–8 years.
Below we’ll delve into all of this in more detail, as well as looking at the signs that you may be in the later stages of perimenopause, how to tell if you’ve reached menopause and how your doctor might test for this.
We’ll also consider some of the lifestyle changes you can make to help manage your symptoms if you are in perimenopause.
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What are the first signs and symptoms of perimenopause?
Most perimenopause symptoms are caused by fluctuating levels of reproductive hormones like oestrogen and progesterone – and the first sign most women experience is changes to their menstrual cycle.
When oestrogen is high in comparison with progesterone, the lining of your uterus thickens, leading to heavier periods when the lining is shed. When oestrogen levels are lower, your periods may be lighter and shorter.
Your menstrual cycle can also become irregular during perimenopause, and you may even skip a period. You might also notice light ‘spotting’ between periods.
Other common symptoms of perimenopause include:
- Hot flushes and night sweats: The sudden feeling of heat on your face, neck or chest can be accompanied by sweating and sometimes dizziness.
- Poor sleep: This can be partly due to night sweats but you may also have unrelated trouble getting to sleep, or find you wake up too early or during the night.
- Mood swings and anxiety: Feeling unusually irritable, anxious or depressed, or experiencing mood swings or low self-esteem, can all be symptoms of perimenopause.
- Brain fog: Difficulty concentrating or thinking, and problems with your short-term memory, are common during perimenopause.
- Urinary issues: You may have recurring urinary tract infections or feel the urge to pee more often.
- Vaginal dryness: Changes to vaginal tissues during perimenopause can lead to dryness, itching, and pain or discomfort during sex.
- Reduced libido: Fluctuating hormones can reduce your sex drive, which can be exacerbated by vaginal dryness or a negative body image.
There are many other perimenopause symptoms that are less common but still experienced by a significant number of women.
To find out whether your symptoms could be a sign of perimenopause, use our symptom checker, which lists 49 possible symptoms.
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What is the average age for perimenopause?
Everyone’s experience of perimenopause is different and there’s a wide range of ages when it can begin.
On average, the transition to menopause starts between 45 and 55, but in some cases it can begin as early as your mid-30s.
You’re more likely to experience an early menopause if you started your periods before the age of 8, are a smoker or are underweight. Treatment for other heath conditions – including chemotherapy, some hormone therapies or surgery to remove your ovaries – can also increase your risk of an early menopause.
How long does perimenopause last?
For most women, perimenopause lasts between 4 and 8 years – and it’s generally towards the earlier end of that range. But, again, it can vary widely.
Less commonly, perimenopause can last for as long as 14 years or for less than a year.
It’s also worth remembering that some women can have relatively minor symptoms so may not know for sure when their perimenopause began.
Is there a test for perimenopause?
There’s no single test for whether you have started perimenopause. Because hormones including oestrogen fluctuate a lot during this time, testing your hormone levels is not particularly helpful.
To decide whether you’ve started perimenopause, a doctor will generally look at a range of factors. These include any symptoms you’re experiencing, such as changes to your menstrual cycle or hot flashes, as well as your medical history.
Although there isn’t a test to show whether you’ve started perimenopause, testing your levels of a hormone called follicle-stimulating hormone (FSH) is sometimes used to decide whether you are in the later stages of perimenopause or have passed menopause. We’ll look at this in more detail later in the article.
Can you be in perimenopause and not know?
It’s certainly possible to have begun perimenopause and not be aware of it.
Some women have very few symptoms, others have none at all.
Even if there are signs, you may not immediately link them to perimenopause. It’s easy to think that symptoms like brain fog, putting on weight, tiredness, aching joints and muscles, and problems sleeping are just because you’re getting older.
And if you’re towards the younger age range for the start of perimenopause, you may not initially make the connection.
Health professionals say that women who are experiencing certain perimenopause symptoms often worry that they are signs of a more serious health condition.
If you think you might be in perimenopause, or that you could have an illness, you should see your doctor.
What are the signs that perimenopause is ending?
Experts often divide perimenopause into two stages, the early and late menopausal transition.
In the early stage, your periods can be erratic, with the time between them varying by a week or more. As perimenopause progresses, your periods become further apart. As you get close to menopause – when your menstrual cycle ends – there will tend to be 60 days or more between your periods.
Although this is a sign that you’ve reached the later stage of perimenopause, it could still continue for another 1 to 3 years before your final period.
At this stage, it’s possible your doctor will test your hormone levels. While doctors don’t generally do tests for perimenopause in the earlier stages when hormones are fluctuating, as you get close to menopause your levels stabilise. At this point, high levels of FSH – over 25 milli-international units per millilitre (mIU/mL) / 150 picomoles per litre (pmol/L) – can indicate that you are in the later stages of perimenopause.
What is menopause and when do you reach it?
The word menopause is often used as a blanket term for perimenopause, the time after it or a combination of the two. But strictly speaking, menopause is defined as a single point in time – 12 months since you last had a period. After that you are in post-menopause.
For most women, menopause takes place between the ages of 40 and 58, with the average at around 51. As mentioned earlier, the time between perimenopause and menopause is generally 4–8 years, but for some women it can be significantly longer or shorter.
Lifestyle choices can have an impact on when you start perimenopause. Studies have shown that smokers have a significantly higher risk of an earlier perimenopause than non-smokers. The good news is that if you stop smoking soon enough it can reduce that risk.
How do you know if you’ve passed menopause?
For some women, certain symptoms are at their most severe during perimenopause, so you may find that they ease or stop after menopause. However, that’s not the case for everyone.
If you think it’s been a year since your last period, your doctor may test the levels of FSH in your blood to help decide whether you have passed menopause. A consistent level of 30 mIU/mL / 180 pmol/L or higher, along with other symptoms, will generally confirm this.
How do hormone levels change during perimenopause and menopause?
Changing hormone levels are behind most of the symptoms you’ll experience during perimenopause and after menopause.
Oestrogen is the most significant, being involved in a range of important functions around your body and particularly in reproductive, vaginal and breast health.
However, each of the following hormones plays its part:
- Oestrogen: During perimenopause, oestrogen levels in your bloodstream fluctuate unpredictably, going up as well as down. High and low levels of oestrogen are each responsible for different perimenopause symptoms. In the later stages of perimenopause, oestrogen levels become consistently lower, and stay there after menopause.
- Progesterone: Like oestrogen, progesterone fluctuates during perimenopause, and your body stops producing it after menopause. Progesterone is involved in particular in changes to your menstrual cycle. Progesterone and oestrogen also interact, and in some cases progesterone’s effects on perimenopause symptoms depend on its levels relative to oestrogen.
- Follicle-stimulating hormone (FSH): FSH is responsible for triggering the production of oestrogen in your ovaries. As oestrogen levels go down, FSH goes up, which is why FSH levels are sometimes used to help determine whether a women is at the later stages of perimenopause or has reached menopause.
- Testosterone: You may think of testosterone as a male reproductive hormone, but it also contributes to women’s sex drive, as well as playing an important role in the production of oestrogen. Women’s testosterone production starts to fall after their 20s, but even though it’s not caused by perimenopause it can still contribute to some of the symptoms.
Ways to manage and treat your perimenopause symptoms
There are lifestyle changes that can help with a range of perimenopause symptoms, as well as improving your overall health.
If you have continuing symptoms that are impacting your quality of life, your doctor may prescribe hormone replacement therapy.
- Eat more plants: Studies have found that switching to a plant-based diet can significantly improve menopause issues including hot flashes, low mood, joint pain and vaginal health. Try to include a wide range of vegetables, fruit, wholegrains, nuts and seeds, and especially legumes like beans and pulses.
- Exercise regularly: Adding moderate aerobic exercise like brisk walking to your routine several times a week has been shown to reduce perimenopause symptoms including tingling skin, insomnia, irritable mood, joint and muscle pain, tiredness, headaches and vaginal health issues. It’s also a good idea to include regular resistance training to help to reduce muscle loss.
- Optimise your sleep routine: As well as being a common symptom of perimenopause, poor sleep is also linked to depression, brain fog, low energy and stress. By sticking to a regular bedtime routine – and incorporating these other tips – you can increase your chances of getting a good night’s sleep.
- Take a probiotic supplement: Probiotics are beneficial bacteria that can improve your overall health by boosting the health of your gut. The Better Gut is the first probiotic blend created specifically for perimenopause and menopause and has been shown in studies to help with a range of symptoms including hot flashes, brain fog, anxiety, vaginal dryness and digestive issues.
- Hormone replacement therapy (HRT): HRT is a prescription treatment that may reduce many of the more common symptoms of perimenopause and menopause. It involves taking tablets, or using a gel or skin patches, to boost your levels of hormones like oestrogen and progesterone.
To find out more about probiotic supplements for perimenopause and menopause, visit The Better Gut. And join our newsletter community for 10% off your first order.
When to see a doctor about your symptoms
Health care professionals are there to help so you should talk to them if you have perimenopause or menopause symptoms that are troubling you, especially if you’re younger than 45.
Your doctor will generally be able to tell you whether you are menopausal based on your symptoms but they may test your FSH levels to help make a diagnosis.
Summary
The first signs of perimenopause are usually changes to your menstrual cycle, including shorter, longer, lighter or heavier periods.
You may also experience hot flashes, brain fog, anxiety and vaginal health issues, among many other possible symptoms.
The transition to menopause usually starts between the ages of 45 and 55 and lasts for 4 to 8 years, but for some women this can vary significantly. As you approach menopause, your periods will start to get further apart.
Exercising regularly, getting better quality sleep and eating a balanced diet, including a wide variety of plants, could all help to manage your health during perimenopause and menopause.
Taking a specially designed probiotic supplement like The Better Gut can improve a whole range of symptoms, including many of the most common signs of perimenopause.
To find out more, visit The Better Gut – and get 10% off your first order here.