First signs of menopause: perimenopause explained

You’ve probably heard of menopause. But what is perimenopause?

Most people have heard of the menopause and have at least a basic understanding of what it is. Approximately 50% of the population experience it, and the rest experience it second hand. Very often, what people call menopause is in fact perimenopause. This is the time leading up to menopause and is when a woman might start to notice symptoms.

There are so many myths and assumptions around the menopause that it’s hardly surprising many people get confused. Really, this is just terminology. It won’t make any difference to what you experience.

However, it’s good to arm yourself with the facts so that you can understand more about what is happening – or could happen – to your body. Forewarned is forearmed…

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Stages of the menopause transition

Menopause is a transition. This means it has phases as it moves us from one stage to another. These can be different for everyone, as your balance of hormones changes. Some women have a very short transition, for others it may take many years.

Perimenopause: the time leading up to menopause – ‘peri’ simply meaning around. It is important to know that symptoms can appear during this time, often when you’re in your early 40s.

Menopause: this means the natural cessation of periods, often known as ‘the change’. A woman achieves menopause when she hasn’t had periods for 12 consecutive months. The following day is classed as the menopause.

Post menopause: this is the time after menopause and for the rest of a woman’s life.

When we talk about a menopausal woman, it’s a woman at any point of this transition.

The average age for a woman to reach menopause is 51, and is usually between 45-55. It can be later but that’s less usual.

For some women, menopause can happen much earlier. This could be due to surgery such as oopherectomy (having your ovaries removed), or Premature Ovarian Insufficiency (POI). Every woman’s experience of menopause is different and personal to her. It is a journey and can change over time.

What symptoms can perimenopause bring?

The infamous hot flushes are often what spring to mind when we talk about the menopause. However, there is a very wide range of symptoms. You could experience a few of these then find they change to others. You might not notice any, if you’re lucky, or you could find yourself blindsided by some unexpected ones.

Symptoms can be physical, or psychological, or both. In my experience, it is the psychological ones that women say can really sneak up on them and catch them unawares. In many cases, women don’t know these symptoms are caused by perimenopause. Often, many women are still having regular periods and in some cases they may be diagnosed as having depression and anxiety and may even be prescribed antidepressants. Knowing what causes it can actually be a big relief for some women, who are worried they’re ‘going crazy’. Some women are so worried they think they are developing dementia.

Physical symptoms can include:

  • Hot flushes, experienced during the day or night (night sweats)
  • Changes to your periods, increased or decreased flow, increase or decrease in frequency
  • Insomnia or fatigue
  • Headaches or migraines
  • Vaginal dryness
  • Urinary tract infections (UTIs)
  • Aching joints
  • Itching

Psychological symptoms include:

  • Increased anxiety or worry
  • Lack of confidence and self esteem
  • Low or changing moods
  • Problems with memory recall
  • Heightened emotions
  • Decreased sex drive

This is by no means an exhaustive list of symptoms. I certainly don’t want anyone to be alarmed into thinking they’re going to be suddenly hit by a whole raft of symptoms all in one go. That would be very unlucky. It is really helpful to understand that changes to your body and emotions could be caused by perimenopause, and it can be reassuring to know this.

For context, let’s look at a survey conducted by the TUC, Henpicked Menopause in the Workplace and the Government Research Team. The survey aimed to discover more about menopause in the workplace and attracted over 5,000 responses.

The five most frequently ticked symptoms that respondents had experienced were hot flushes, fatigue, night sweats, insomnia and change in periods.

When asked which symptoms had affected their work negatively, the ‘top five’ symptoms were fatigue, hot flushes, difficulty focusing or concentrating, anxiety and worry, insomnia.

When does perimenopause end?

Lots of women want to know when their menopause will end. As I’ve explained earlier, this isn’t really the right question to be asking. Usually, this question is from women wanting to know when their symptoms will stop. It’s such a tricky question to answer, as each woman is unique and experiences menopause differently. Symptoms commonly last between 4-8 years, but it really is variable.

How to manage your perimenopause

I wish I could say ‘do this and all your symptoms will disappear’ but real life doesn’t work like that. However, there are lots of things you can do to keep your symptoms under control. How you do this is largely up to you.

Some prefer to look at a medical approach, which could include Hormone Replacement Therapy (HRT). other women prefer to take a  look at their nutrition and exercise regimes, as well as natural remedies and Cognitive Behavioural Therapy (CBT). Of course you don’t have to pick one or the other, you could choose to mix and match your approaches.

If your symptoms are getting in the way of you enjoying your life or your work I’d strongly recommend you speak to your GP or a menopause expert. You could also see if your company has any menopause support in place at work.

The symptoms of menopause can be complex and often confusing. Not everything you experience will be due to menopause, so do always talk to your doctor about any concerns.

Dr Joanne Hobson is a guest speaker at our next Menopause Roadshow on 16th October in Birmingham.

Join us at our next Menopause Roadshow in Birmingham

Places are limited: book now – click here


Joanne Hobson

About Joanne Hobson

I've worked in Nottingham as a GP for over 30 years and have always had an interest in women's sexual health and psychosexual medicine. Although I am now retired as a partner in general practice I still undertake locum surgeries in primary care. I am a menopause specialist and have run a menopause clinic with a colleague for the last 15 years in Nottingham. I work in a Nottingham community gynaecology clinic and see all aspects of gynaecology, including patients with psychosexual problems. I have Membership of the Institute of Psychosexual Medicine and regularly give talks to local groups. I contribute to local radio programmes on general health as well as menopausal topics. Please visit my website to find out more, or do get in touch. I also have a private practice at Spire Hospital.