Perimenopause, explained
The years before menopause, when hormones change and symptoms begin. Often earlier, longer and more varied than women expect.
What perimenopause is
Perimenopause is the time when your ovaries gradually make less oestrogen and progesterone, and hormone levels start to rise and fall unpredictably. It ends at menopause, which is when you have not had a period for 12 months.
When it starts
Most women notice changes in their mid-40s, but it can begin earlier. Perimenopause commonly lasts four to eight years, and the average age of menopause in the UK is around 52.
Signs and symptoms
Changes to your periods are common, but many women first notice something else, such as poor sleep, anxiety, low mood or brain fog. Symptoms can come and go from month to month.
- Hot flushes
- Night sweats
- Brain fog
- Low mood
- Anxiety
- Sleep problems
- Low libido
- Joint pain
- Vaginal dryness
- Low energy
Getting diagnosed
Over 45: NICE guidance says perimenopause and menopause can be diagnosed from your symptoms alone, without a blood test. Hormone levels swing so much during perimenopause that a single result is often more misleading than helpful.
Between 40 and 45: a blood test measuring FSH can help support the diagnosis, alongside your symptoms.
Under 40: your periods stopping early needs proper investigation for premature ovarian insufficiency, which affects around one in a hundred women. FSH should be checked twice, four to six weeks apart. This needs a gynaecology or endocrinology assessment rather than a menopause prescription, because of what it means for your bones, heart and fertility, and we will refer you rather than treat you.
Thyroid problems, low iron and low vitamin B12 produce very similar symptoms and are worth checking whatever your age.
Treatment
HRT is the most effective treatment for many perimenopause symptoms. In perimenopause, the progestogen part of HRT is often taken for part of each month. CBT, non-hormonal medicines and lifestyle changes can also help.
Contraception
HRT is not a contraceptive. You can still get pregnant in perimenopause, so you should use contraception until you have had no periods for two years if you are under 50, or one year if you are over 50. A hormonal coil can provide both contraception and the progestogen part of HRT.
