Perimenopause: the facts

Symptoms can start up to 10 years before your last period. So what can you do to make perimenopause better?  

What does the term “perimenopause” mean to you? Many of us confuse it with menopause itself, but in fact it’s the transitional phase that comes before our periods cease. Here’s what you need to know. 

What happens to your hormones during perimenopause? 

First, let’s define what perimenopause actually is. It begins, medically speaking, on average four years before menopause, and lasts until menopause itself.  

Technically, menopause is just one day: precisely a year since the start of your last period. The day before, you are perimenopausal; the day after, you are in post-menopause (but confusingly, we usually say we’re in menopause).  

Perimenopause is the period when your body is gradually beginning to produce less and less oestrogen. But it’s a time of fluctuation: one day the level can be normal, the next very low. Many menopausal symptoms – fatigue, hot flushes, loss of libido, trouble sleeping – which are also common during perimenopause, are caused by this fluctuation. And that’s what does the damage. If it were simply a progressive decline, your body would adapt to the new (lower) hormone levels. It’s the continuous rollercoaster of hormones that creates the havoc. Your body and your brain are confused.  

For some, perimenopause can be a relatively painless transition into menopause. But for others, it severely affects the body and mind – as well as lives and relationships. 

For all these reasons, it’s important to be aware of perimenopausal symptoms – not to alarm yourself, but to make sure you’re prepared for whatever might come. Knowing is better than wondering – and surely it’s better to understand what’s going on if you find yourself with a plethora of new symptoms and are unsure about where they came from.  

Perimenopause can be a difficult time, particularly because it’s the first step into menopause and is often ill defined. It might leave you asking, why? Why do we have to go through all of this? Perhaps, like ageing, menopause is the price we women have to pay for our biology. 

Hormone levels and HRT 

Perimenopause represents the first of many changes for women. It can be difficult to accept – and to diagnose. Blood tests can sometimes confirm if you’re approaching menopause by analysing your hormone levels. When a woman’s FSH (follicle-stimulating hormone) level is consistently elevated to approximately 30 mIU/mL or higher, and she has not had a menstrual period for a year, she can be said to have reached menopause.  

However, FSH levels can be high one day and low the next, particularly in the first few years of perimenopause. If your hormones are fluctuating, a blood test might not immediately provide you with an answer if the window in which it’s taken is one of “normal” levels. Difficulty of diagnosis is one reason many perimenopausal women aren’t put on HRT (hormone replacement therapy) right away, or given the appropriate treatment for their symptoms, which only makes the transition worse.  

Perimenopause can start up to 10 years before your last period 

Don’t suffer years of misdiagnoses, or assume your symptoms are indicative of a more serious physical or mental condition. Go to your GP and say that you want to see a menopause specialist. GPs get little or no training on menopause, which means you need to be well informed. Don’t delay the start of treatment if your symptoms are severe – it can really make a huge difference to your life.  

Perimenopause by numbers 

There are currently 13 million perimenopausal and menopausal women in the UK, with an estimated 1.5 million women starting to experience symptoms each year.  

Hot flushes are reported by up to 85% of menopausal women – but they’re present in 55% of women even before the onset of the menstrual irregularity that usually defines our entry into menopausal transition. Their incidence and severity increase as women go through the varying phases of menopause, peaking in the late part of transition and tapering off over the next few years.  

A meta-analysis of 35,445 women taken from different studies showed that the average duration of hot flushes is four years (for some women it can be 10, while others don’t experience them at all), with the most troublesome symptoms beginning about a year before the final menstrual period and declining thereafter.  

Perimenopause is having a huge impact in the workplace: 73% of women reported having hot flushes, while 63% said they regularly felt tired or drowsy. Forty-eight percent suffered with low mood, 47% struggled to concentrate and 43% had memory trouble. As a result, 34% of women said they had developed depression and anxiety, with 29% having a major loss of self-confidence. Only 6% of the sample group said that they did not experience any symptoms at work.  

Perimenopause has a huge impact on women’s lives. Make sure you’re fully informed.