To better understand perimenopause and what it means for you, it's helpful to explore the symptoms you may experience and the strategies for successfully managing this natural but often challenging phase of a woman's life.

What is perimenopause?

Peri-menopause (or ‘around' menopause) is a significant transitional stage of life that commences with the onset of irregular periods and concludes when 12 consecutive months have passed since your last period, at which point menopause is reached.

The perimenopause stage typically begins in your early to mid-40s and ends at around age 51, though the length of time spent in perimenopause will vary from woman to woman. It's also commonly accompanied by a range of physical and emotional symptoms.

What's going on with your body, including irregular periods?

Biologically, perimenopause represents the natural winding-down of a woman’s reproductive cycle. Perimenopause is characterized by hormonal fluctuations and declining estrogen levels, which play a central role in the transition toward menopause.

During this time, your levels of estrogen, progesterone and testosterone will fluctuate (often significantly) as the ovaries begin to slow down before they eventually stop producing eggs altogether. Estrogen levels decline, and the ovaries gradually produce estrogen less efficiently.

With progesterone and estrogen controlling your monthly cycle, these shifting hormone levels commonly result in menstrual periods that vary in length, flow and duration. Changes in cycle length, including longer or irregular cycles, are common as the menstrual cycle becomes less predictable.

As with puberty in your younger years, this hormonal transition is not without its challenges. Physical changes, such as hot flashes and night sweats, can result from these hormonal shifts.

Many women find their bodies, once so familiar, feel unrecognisable as they start behaving and reacting differently. You may feel the effects mentally and emotionally as well, with hormonal changes and the associated symptoms impacting your mood and your daily life, work and relationships.

What are the symptoms of perimenopause?

The list of perimenopause symptoms is long, and while everyone’s experience is different, the symptoms commonly encountered by perimenopausal women include hot flushes (or flashes), night sweats, sleep disruptions, mood swings, anxiety, mood changes, and fatigue. Hot flushes and night sweats are examples of vasomotor symptoms, which are among the most common and recognizable indicators of perimenopause. During this time, mood changes can increase the risk of developing a mood disorder.

You may also experience weight gain, libido changes, body aches and joint pain, breast tenderness, hair loss, a need to pee more often, heavy sweating, difficulty concentrating and brain fog, vaginal dryness, irregular bleeding, and heavy bleeding. Learn more about symptoms in our factsheet here.

Bothersome symptoms or moderate symptoms may require medical attention or treatment. Certain medications, such as chemotherapy drugs, and cancer treatment can trigger hot flashes or other menopause symptoms, and sudden menopause can occur after such interventions. Early menopause can occur before age 40 and may present with similar symptoms. Bone loss is a long-term risk associated with perimenopausal symptoms.

Navigating this new reality can be confusing - and confronting at times. However, these symptoms are a normal part of the perimenopausal experience.

How can I be sure it's perimenopause?

With hormone levels fluctuating day to day, perimenopause can be difficult to test for and diagnose. Perimenopause is diagnosed by evaluating your symptoms and, in some cases, through blood tests such as measuring FSH levels, especially in women under 45. It can feel like a guessing game deciphering whether symptoms are related to perimenopause or not. There is not enough evidence to support the use of some tests or alternative methods for diagnosing perimenopause.

Tracking your period and potential symptoms can be helpful, as can finding a qualified and compassionate doctor who can support you through this time and discuss management options. Women using hormonal contraception may find it harder to track symptoms, as hormonal contraception can mask typical changes and complicate diagnosis.

If symptoms are impacting your overall health or disrupting your daily life, it’s important to explore these more thoroughly with your GP. See your doctor if your symptoms are severe, unusual, or concerning.

Fertility and contraception during perimenopause

While fertility naturally declines during perimenopause, it’s important to remember that pregnancy is still possible as long as menstrual cycles continue, even if they become irregular. Because ovulation can still occur unpredictably, women who wish to avoid pregnancy should continue using contraception until menopause is confirmed, which is defined as 12 consecutive months without a menstrual period. It’s also important to note that hormone therapy, such as menopausal hormone therapy (MHT), is not a reliable form of birth control. Instead, options like birth control pills, intrauterine devices (IUDs), or barrier methods should be considered. Every woman’s needs are unique, so discussing fertility and contraception options with your healthcare provider is essential to ensure you’re protected and making the best choices for your health during this transitional time.

Complications and prevention: what to watch for

Perimenopause is more than just a shift in your menstrual cycles—it can also bring an increased risk of certain health complications. Women may be more susceptible to osteoporosis and cardiovascular disease as hormone levels change. Additionally, those with a history of major depressive disorder or hormone-related mood symptoms may notice a return or worsening of mood symptoms during this time. To help prevent or manage these complications, it’s important to maintain a healthy lifestyle: regular exercise, a balanced diet, and ensuring adequate calcium and vitamin D intake can all make a difference. Keep an eye on your menstrual cycles and be alert for abnormal bleeding or severe symptoms, as these could signal underlying health issues that need prompt attention. Don’t hesitate to reach out to your healthcare provider if you notice any changes or have concerns—early intervention is key to staying healthy during perimenopause.

When does perimenopause end?

Once 12 months have passed since your last period, you officially enter menopause. At this stage, your ovaries have stopped producing hormones and are no longer releasing eggs.

What options are available for managing perimenopause?

We are fortunate to live in a time when trusted evidenced-based information is readily available, allowing you to take charge of your own health and navigate this period with your eyes wide open.

Developing an understanding of the hormonal changes your body is going through, exploring the broad range of medical and non-medical treatment options on offer, and having the language to speak about what you're experiencing to those around you, can be life changing.

In fact, with the right support many women find this time of life deeply empowering as they reconnect with their bodies and take proactive steps to improve their physical and mental health – whether through lifestyle changes, nutritional modifications, dietary supplements, stress reduction techniques, or medical therapies.

With an estimated 47 million women entering menopause each year, accessing the support available and finding out what works for you is undoubtedly the best way to deal with this natural mid-life transition.

Explore our range of symptom-specific supplements, developed to support your body and your needs before, during and after this transitionary life stage.

Staying healthy through perimenopause

Taking care of your health during perimenopause means adopting a holistic approach that addresses both body and mind. Regular exercise, such as walking, swimming, or yoga, can help reduce the risk of osteoporosis and heart disease, while also easing menopausal symptoms like hot flashes and night sweats. Eating a balanced diet rich in fruits, vegetables, and whole grains can support your overall well-being and help manage symptoms such as hot flashes. Managing stress is equally important, techniques like meditation, deep breathing, or mindfulness can help relieve emotional symptoms, including mood swings and anxiety. Staying on top of recommended health screenings, such as mammograms, Pap tests, and bone density scans, ensures that any potential issues are caught early. By making these healthy choices, you can better manage symptoms and support your body through the menopausal transition.

Support and resources for your perimenopause journey

Navigating perimenopause can feel overwhelming, but you don’t have to do it alone. Your healthcare provider is a valuable resource for managing menopausal symptoms, discussing fertility and contraception, and connecting you with specialists if needed. In addition to professional support, there are many online resources, educational materials, and support groups where you can find information and connect with others experiencing similar symptoms. Sharing your experiences with friends or family members can also provide comfort and encouragement. Remember, seeking support is a sign of strength, and reaching out can make a significant difference in how you manage the physical and emotional changes of perimenopause.

Embracing the transition

Perimenopause is a natural part of life’s journey, and with the right approach, it can be managed effectively. By understanding the changes your body is going through and staying informed about proactive steps to ease symptoms and protect your health, you can take proactive steps to ease symptoms and protect your health. Prioritizing self-care, seeking support, and staying up-to-date with the latest research empowers you to navigate this transition with confidence. Embrace perimenopause as an opportunity for personal growth and renewal, by taking charge of your health and well-being, you’ll emerge from this phase stronger, wiser, and ready for the next chapter.

This article has been reviewed by our expert advisory team.