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What is Perimenopause, and What are the Symptoms?

Like many things in the field of women’s health, there was once a time when the only mention of perimenopause happened in hushed tones in quiet corners.

God forbid that the seismic transition from menstrual years to menopause was talked about out loud in public where men might hear.

Thankfully, the pearl-clutching around ‘women’s problems’ is changing, and we’re actively encouraging conversation about this stage of female life.

So, let’s look at what perimenopause is and the symptoms many women experience when they go through it.

We’ll be deep diving into:

  • The definition of perimenopause and how it differs from menopause
  • How the menstrual cycle is affected by the perimenopause
  • The physical symptoms to look out for
  • How perimenopause impacts your emotional health

How is Perimenopause Defined?

Perimenopause is when the body begins transitioning from its reproductive years to menopause.

The hormone levels in the body start to fluctuate, which impacts the regularity of ovulation and the frequency of your periods.

For many women, the first inkling that perimenopause is happening comes when the menstrual cycle begins to change.

According to the Menopause Charity, most women will experience some perimenopausal symptoms in their 40s, although they can happen much earlier.

When you reach the point where it’s been 12 months since your last period, you are in menopause.

What’s the Deal with My Hormones?

Oestrogen is the female hormone that takes centre stage during perimenopause and its shenanigans.

During our reproductive years, it’s oestrogen that is vital to the growth and health of our reproductive organs.

When the body hits perimenopause, oestrogen levels will begin to fluctuate – sometimes you’ll produce more, sometimes less.

If your oestrogen levels shoot up, you will likely experience the symptoms generally associated with PMT.


Good to Know:

When oestrogen production decreases, you might have vaginal dryness, night sweats and hot flushes.

What are the Symptoms of Perimenopause?

There are several symptoms commonly associated with perimenopause – but you might not experience all of them, or indeed any.

In their guide to perimenopause and its symptoms, the NHS clearly states that this time can feel “different for everyone”.

But as more research and discourse into perimenopause and menopause happens, more tools are at our disposal to manage unpleasant symptoms.

Symptom #1: Irregular Periods

Let’s start by acknowledging that for some women, there’s no such thing as a regular menstrual cycle.

However, research tells us that the average cycle lasts around 28 days, during which the body prepares for ovulation and later sheds its uterine lining if pregnancy does not occur.

During perimenopause, hormonal fluctuations disrupt ovulation and make it far less predictable.

Therefore, the length of time between your periods may change dramatically.

What the researchers say

In their paper ‘Management of the Perimenopause’, Dr Lara Delamater and Dr Nanette Santoro caution that “bleeding patterns among women in the perimenopause vary, thus distinguishing between ‘normal’ and ‘abnormal’ can be difficult.”

They explain that in the early stages of perimenopause, it’s more common for women’s cycles to become shorter.

However, as the body reaches late perimenopause and heads towards menopause, the time between periods becomes longer.

They also point out that “during the menopausal transition, women were more likely to experience an increased number of days of bleeding, with 77% reporting at least three episodes of 10+ days of bleeding.”

You may wish to wear period underwear or pads more regularly in case you bleed unexpectedly.

Symptom #2: Hot Flushes and Night Sweats

You’ve probably heard a lot about the body temperature ‘big dipper’ ride that many women experience during perimenopause and menopause.

Hot flushes and night sweats are among the most common symptoms because changing levels of oestrogen, progesterone and testosterone impact the hypothalamus.

For the uninitiated, the hypothalamus is the part of the brain in charge of regulating body temperature.

During the transition to menopause, it can go haywire and result in sudden bursts of heat in the body.


What the researchers say

The Menopause Charity says that one in three women will experience hot flushes during perimenopause.

They describe the sensation as “a sudden feeling of heat which spreads through your face, neck, chest and body.”

According to their experts, you may also experience intense sweating, heart palpitations, dizziness, and feeling flushed.

They tell us that for women who have night sweats, there’s the added issue of chills afterwards as the body temperature cools down.

Make sure you wear light clothing, keep your bedroom cool, use cold showers and drinks to bring your temperature down, keep a fan on you and try to reduce your stress levels.

Symptom #3: Mood Changes

It should come as a surprise to no-one that enduring a several-years-long festival of hormone fluctuation is going to result in mood changes.

It’s hard to be sunny 24/7 when you don’t know what spontaneous symptom your body will serve up next.

You may get angry faster, experience anxiety and depression, have increased irritability, get tearful more often, become frustrated or generally feel flat.

All these feelings are normal during this part of your life but can be scary and worrying when you are going through them.

What the researchers say

In Medical News Today, they explain that these mood swings are linked to the drop in oestrogen during perimenopause.

Researchers believe that low oestrogen levels could have an impact on how the body produces serotonin, the natural mood booster.

In addition, low oestrogen is linked to the emotional challenges we’ve listed above, plus forgetfulness and lack of concentration.

Unfortunately, fluctuating hormone levels don’t just cause all these unpleasant feelings, they can also intensify them.

That’s why many women choose a combination of Hormone Replacement Therapy (HRT), talking therapies and relaxation exercises to support them.

Symptom #4: Vaginal Dryness

In news nobody wants to hear – perimenopause goes hand-in-hand with vaginal dryness.

That’s right, you may well feel like it’s awful arid down there suddenly, and sex can become painful as a result.

Of course, if you are feeling dry and sore in the vagina, you are unlikely to be super cheerful about it.

Therefore, vaginal dryness is a physical symptom, but it can impact your mental health too.

What the researchers say

Bupa’s Dr Samantha Wild explains that, once again, oestrogen depletion is to blame for vaginal dryness.

She explains, “When your oestrogen levels drop, the walls of your vagina become thinner, drier and less flexible. They’re also more easily irritated.

“As part of this process, your body also produces fewer vaginal secretions, so your vagina is less well lubricated.”

For many women, sex is more painful; therefore, using vaginal moisturisers, lubricant before intercourse, and topical hormonal creams may help.

Symptom #5: Bone Loss

Up until the age of 50, most people will have levels of bone breakdown and bone formation that stay stable.

However, from 50 onwards, this changes; therefore, bone loss starts to impact the body and can lead to osteoporosis.

For women, perimenopause and menopause accelerate bone loss as the oestrogen levels drop in every cell in the body.

What the researchers say

In their paper Bone and the Perimenopause, Dr Joan Lo et al. cite the final year of perimenopause as significant in the drop in bone mineral density (BMD).

They write: “The greatest reduction in BMD occurs in the year before the final menstrual period and the first two years after the final menstrual period, with lower rates of loss during the ensuing 1–7 years.”

While they advise making sure your calcium and vitamin D intake is sufficient, the NHS also says it’s essential to exercise regularly.

Their advice is to do weight-bearing exercises like walking, running or dancing and also include resistance workouts using weights.

Work with Nature

Perimenopause might not be the easiest time to navigate, but it’s a natural part of female life.

It’s the right time for your body to transition from its reproductive state to the next chapter.

The best way to prepare for any physical transition is to live as healthily as possible – both in your body and mind.

Remember, women have been going through perimenopause for centuries and having fulfilling, happy lives.

You’ll get through it too.

Evidence Based
This article has been reviewed by our Kari Health Experts and Editorial Board to ensure accuracy and reliability of the information presented. However, please note that the content provided is for informational purposes only and should not replace advice from your medical professional.

Did you find this article helpful this article? 

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