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What is perimenopause and how do you know you are going through it?

The menopause is a natural part of a woman’s life – yet so many people still don’t know that a transitory period comes first.

Last year, one study surveyed 1,039 women aged 40 to 65 and found that nearly half (45%) didn’t know the difference between perimenopause – the transitional period leading up to menopause – and menopause itself, the biological process that marks the end of a woman’s menstrual cycles.

Other research shows that it takes around 14 months for women to realise it is perimenopause.

That’s a long time to be dealing with irritating symptoms without knowing what is going on. 

In 2022, menopause ‘has gone mainstream’, the British Menopause Society says: ‘After the deafening silence surrounding it for so long, that change is very welcome.’

‘Yet the flood of information can be overwhelming and confusing since there is no “one size fits all” solution.’

They said this as part of World Menopause Day, which has ran every October 18 since 2009.

The day, organised by the International Menopause Society (IMS) and the World Health Organization (WHO) has gone some way in raising awareness of menopause.  

There’s still so far to go, and education is a big part of that.

Here’s everything you need to know, so you can take control of what’s going on. 

Firstly, what is perimenopause?

When we talk about women enterting ‘the menopause’, we actually mean the perimenopause. 

Perimenopause is the time before menopause, Dr Alice McGee, a clinical content advisor for eco-friendly pregnancy test company Hoopsy’s, tells 

In this transitory period, your oestrogen levels are dropping (as they natural do in your 40s) but you still ovulate and have periods. 

They will just become more irregular and unpredictable, Dr Alice says. 

Perimenopause ends 12 months after the last menstrual period. At this point, women would be in menopause.

How do I know if I’m in perimenopause?

Women’s health is still whofully underresearched.

It is unsurprising, then, that 90% of women fail to recognise the symptoms as perimenopause – instead blaming symptoms to ageing, stress, anxiety and depression.  

Fluctuating hormone levels can cause a whole bunch of physical, emotional and mental symptoms. 

This is because, when we start to run out of eggs during perimenopause, says Dr Clare Spencer is a registered menopause specialist and GP. 

She says: ‘Our ovaries begin to produce fewer hormones, particularly oestrogen, and the levels can fluctuate wildly. 

‘Our brains make more FSH to try to balance things out when oestrogen levels are low. The changing levels of hormones from the ovaries give many of us symptoms – some of which are well known (hot flushes) and some less so (joint pains).’

Typically, women experience five symptoms during the early stages of perimenopause. Most common symptoms include period changes, sleeping problems, hot flushes, anxiety, weight gain, low mood and night sweats.  

You can also experience: 

● Irregular periods

● Sleep problems

● Hot flushes

● Decreased sex drive

● Mood changes – including depression and irritability

● Vaginal dryness

● Increased number of urinary tract infections 

Perimenopause symptoms vary from person to person. Most women will experience perimenopause symptoms in their 30s or 40s. 

However, perimenopause and menopause can happen earlier than this, Dr Alice says. 

‘So if you are experiencing any of these symptoms in your 30s or early 40s it is important to speak to your doctor straight away,’ she adds. 

But it seems people don’t yet do this – as research conducted on behalf of Health & Her found 37% of women haven’t sought any kind of help. 

It’s important that people do, as perimenopause can affect how you function at work, while 1 in 10 have had suicidal thoughts. 

What do these symptoms mean?

Simone Thomas, founder of Simone Thomas Wellness, went into more detail of what to expect. 

Concentration issues, memory lag and forgetfulness – You may find it less easy to concentrate on the task at hand, find your mind wandering more often, or have trouble recalling information.

Mood changes – During perimenopause you may find your mood changes and tolerance can decrease. You may get irritable more quickly, experience waves of anxiety, or suddenly need a really good cry.

Changes in libido – During perimenopause many women become less ‘in the mood’ as oestrogen production decreases, however some experience a hefty increase related to testosterone production.

Heart palpitations – It is not uncommon for heart palpitations to emerge as an early sign of perimenopause. This is a symptom best checked by a doctor in case there is something else going on. 

Irregular periods – Ovulation may become less regular, and you may not always ovulate. Periods may become lighter or heavier, and PMS and discomfort may worsen.

Hot flashes – Hot flashes can come on suddenly at any time, causing body temperature to increase. Sweating and redness in the face and upper chest are symptomatic of hot flashes associated with perimenopause.

Issues sleeping – You may find you find it less easy to get to sleep, or to stay asleep. Sleep may also be punctuated by the aforementioned hot flashes, reducing time asleep.

Hair thinning and hair loss – While not one of the most common early signs, hair loss suffered during perimenopause and during menopause is one of the most visible and for some, one of the most upsetting. We’ll talk more about this in the next section.

Bladder issues – Some women suffer from diminished bladder control during perimenopause, thanks to hormonal changes which can increase the need to urinate, and less bladder control when coughing or sneezing. Perimenopause is also linked to an increase in urinary tract infections.

Fatigue and tiredness – Women experiencing perimenopause may tire more easily and suffer regular fatigue for spans of time

Decreased bone density – During menopause is it common for women to be at higher risk of osteoporosis, the thinning of the bone as it becomes more porous. It is not uncommon for perimenopausal women to begin experiencing this condition too.  

Vaginal dryness and discomfort during sex – Hormonal changes and the reduction in oestrogen in the body can lead to vaginal dryness and pain or discomfort during sex due to thinning of the vaginal tissue or atrophy. It may also numb feeling in sensitive areas, adding to the decreased libido symptom noted earlier.

Cholesterol changes – A reduction in oestrogen production is linked in an increase in the bad kind of cholesterol (LDL) and a decrease in the good kind (HDL) which can contribute to other health issues if it goes unchecked.

If you are unsure if you’re in perimenopause or have any concerns at all, the easiest things to do is go to your GP, family doctor or fertility specialist. 

In the meantime, there are plenty of online resources. 

Dr Claire Mann was fobbed off by her GP until she was given HRT on her 45th birthday. She’s just launched a new menopause tracking app where you can monitor all of your symptoms, rate the quality of your sleep, any brain fog, mood or hot flushes. 

It also directs you to various online support groups.

Do you have a story to share?

Get in touch by emailing [email protected].

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