How do I know if I'm in perimenopause?

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When you're talking, thinking and learning about menopause, you're going to come across the phrase 'perimenopause' very quickly. In fact, they're often used interchangeably - incorrectly, because they are defined differently.

With this post, we're going to help you understand what those differences are by taking a deep dive on perimenopause. We'll look at what perimenopause is, when you might experience it and how you will know when you are. We'll also offer some advice on how to make this life stage a little easier. 

What is perimenopause?

The perimenopause is the time leading up to menopause. During this time you will start to notice changes in your menstrual cycle as your hormone production changes and you ovulate less frequently.

Your progesterone and oestrogen levels start to fluctuate then decline - this can cause a wide range of symptoms. The experience is different for every woman and starts at different ages and lasts different durations. Some people will have severe symptoms, others will barely notice the change. The average time spent in perimenopause is around 4 years but can last 10 years.

What is the typical age for perimenopause? 

Research shows the median age for perimenopause is 47. Experience suggests that the earlier perimenopause begins, the longer it lasts but there are a lot of other factors involved too. Race and body weight may also play a role.

How do I know if I am perimenopausal?

As there is no single test to confirm if you're perimenopausal, it comes down to your doctor considering your symptoms, age and medical history. If these all indicate perimenopause, this will likely be your diagnosis.

It is unusual to perform a blood or urine test for hormones to confirm perimenopause because your hormones fluctuate so much during this time.

What are 4 stages of perimenopause?

Perimenopause is a gradual change in your body chemistry. As with all hormonal changes, symptoms may fluctuate but it is a progressive decline and some people break this down into 4 stages.

These stages are not medically defined, and in some cases, the differences are so subtle you may miss them. The only way to know for sure is by testing hormone levels in your blood which (as we mentioned above) is rarely done.

For those who like to think of it in stages, they can be defined as:

• Very early - your cycle is still relatively regular though you notice some changes, these are brought on by your progesterone levels starting to lower.
• Early perimenopause - when your periods become noticeably irregular, stretching over longer than your previous cycles, sometimes by up to a week. During this time you are likely to experience both low levels of progesterone and higher (though fluctuating) oestrogen which can make a range of symptoms more severe.
• Late perimenopause - once you start missing periods (going through two lengths of your cycle without menstruating) you are in late perimenopause. During this time your oestrogen levels lower overall - though they may fluctuate. This means some of your perimenopause symptoms linked to oestrogen levels could ease (such as breast pain) while others (like night sweats or hot flushes) could become worse.
• Very late - when your periods seem to have stopped completely. Menopause itself does not start until you have been 12 months without menstruating, so very late perimenopause is when you stop ovulating but that full year has not passed. During this time, oestrogen levels are far lower, so some symptoms may ease.

What are common perimenopausal symptoms?

The symptoms of perimenopause are essentially the same as menopausal ones. And like menopausal symptoms, they can be different for every person and can vary in severity. You reach menopause after your periods have stopped for 12 months. 

Heavier or irregular periods

This is probably the most easily identifiable symptom. Your shifting hormone levels will alter the length of your menstrual cycle and the heaviness of your flow. As time passes you will start to skip periods occasionally before they stop completely. You might also see spotting between periods.

Hot flushes

Around 80% of women experience hot flushes, an intense feeling of heat flooding the body, often accompanied by heavy sweating and redness lasting for usually a few minutes. Though the exact causes haven't been verified, it may be that they  are caused by changing hormones telling your brain that your body is too hot. As a result your blood vessels dilate in an attempt to cool it down. This causes a hot flush.

Brain fog

Reduced concentration, memory and focus are often reported during perimenopause. This 'brain fog' is because oestrogen, progesterone and testosterone all play a role in cognitive function and your levels of each change throughout perimenopause.

Unfortunately, many of the other symptoms of perimenopause (sleep problems, mood swings and hot flushes) can also increase brain fog too.

Sleep problems

Studies have shown that your sleeping patterns and quality can be affected by menopause. Lower progesterone can make it harder to fall and stay asleep. However, it is also down to the other symptoms such as night sweats and mental health issues which can lead to frequent waking or lower sleep quality.

Weight gain

Hormonal changes affect your metabolism and can lead to weight gain (the menopause belly), as well as lead to changes in your cholesterol levels, increasing bad cholesterol (LDL) and lowering the good (HDL). This puts you at higher risk of type 2 diabetes and heart disease.

Mood Swings

Hormonal changes can cause mood swings or changes in your mood. If you already struggle with mental health issues, your condition may worsen but you can also develop new symptoms for the first time. These include anxiety, depression, and panic disorders alongside irritability or feelings of low self-esteem.

Vaginal dryness

Some women experience vaginal dryness or even infections during perimenopause. This is because your dropping oestrogen levels mean your vagina produces less natural lubrication while the tissue often becomes thinner.

How can I thrive in perimenopause?

Perimenopausal changes can make a heavy impact on your life. However, there are some simple well known steps you can take to make a dramatic improvement to your health.

The NHS recommends making the following changes to support your perimenopausal and menopausal symptoms:

• eat a healthy, balanced diet, high in calcium (plenty of milk, yoghurt and leafy green vegetables), magnesium and zinc (plenty of nuts of and seeds)
• exercise regularly, even if it's just regular walks 
• take time to relax with yoga, tai chi, mindfulness or other forms of meditation
• keep a regular sleep routine to help minimise sleep problems
• find support from others experiencing the same transition

Do try and build these changes into your life as early and completely as possible but they won't always be easy. Taking a menopausal food supplement can help make symptoms feel more manageable too.

Should I speak to my doctor during perimenopause?

If you are struggling with perimenopausal symptoms you should speak to your GP. Your doctor will be able to offer reassurance, guidance and support for you. This support can come in many forms, especially information - even if you don't want hormone replacement therapy, they will be able to help.

Supplements to support your health

If perimenopause symptoms are hitting you hard, taking food supplements can help ease some of your symptoms. Our Multi Meno is also effective as a perimenopause supplement, helping to ease the symptoms that many women experience. 

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