It is important to note the difference between the two: perimenopause is when oestrogen production in the ovaries begins to slow (often in our 40s), while menopause sees the ovaries stop releasing eggs (usually in our early 50s).
But the symptoms of the two are often the same (think hot flushes, brain fog and mood swings) – and a woman's menopause transition is wholly individual in terms of age and symptoms – so it can be difficult to work out which of the two stages you are in.
We asked two women's health doctors and menopause experts to explain what perimenopause is, the symptoms to keep an eye on and the signs that it is ending. Find out more below.
What is perimenopause?
"Perimenopause refers to the period of time when a woman's body begins to transition into menopause, which is when she stops menstruating permanently," says Dr Shahzadi Harper, founder of The Harper Clinic and author of The Perimenopause Solution.
"It is characterised by irregular menstrual cycles and hormonal fluctuations and can start in the 30s or 40s, although the average age for the onset of perimenopause is 47. The duration can vary greatly, but it typically lasts for several years, with the average being four years.
"Perimenopause ends when a woman has gone through 12 consecutive months without a menstrual period, at which point she is considered to have entered menopause."
What are the symptoms of perimenopause?
There are a number of signs and symptoms to look out for, but it is worth noting that they will vary from woman to woman and won't be experienced by all of them.
"With each cycle, hormone levels vary and this is why symptoms in perimenopause can often be unpredictable."
Irregular periods are the first sign of perimenopause. "Menstrual cycles may become shorter or longer, and periods may be lighter or heavier than usual," says Dr Harper. "For those women with a Mirena coil or progesterone only form of contraception, they may not experience this as often they may already not be having a period."
Other non-menstrual symptoms include:
- Hot flushes and night sweats
- Mood changes including tearfulness, irritability and/or short-temperedness
- Sleep disturbances
- Vaginal dryness and discomfort
- Decreased fertility
- Changes in sexual function, including changes in libido, arousal, and sexual satisfaction
- Bladder leaks due to weakened pelvic floor and a more frequent/urgent need to urinate
- Itchy skin, including "formication", where patients experience the sensation of insects beneath the skin
- Dry eyes
- Dental issues including gum disease
- Dizziness, tinnitus, vertigo
- Changes in skin and hair including skin dryness, thinning hair, and changes in skin tone
What are the signs perimenopause is ending?
Perimenopause is considered to have ended once a woman has gone through 12 consecutive months without a menstrual period, but it's not always as clear cut as that.
"Often periods become more spaced out and less frequent but it can be difficult to know for sure that perimenopause has ended, especially if a woman is experiencing irregular periods," explains Dr Harper.
"Some women may have several months without a period and then have one again. It's important to remember that menopause is a gradual process, and symptoms can continue for several years after the last menstrual period."
For women using hormonal contraception, hormone replacement therapy or who have had treatments for heavy periods, natural periods might not be a reliable marker. Dr Barton recommends tracking the intensity and consistency of the non-menstrual symptoms instead.
"If there is ambiguity, measuring the FSH (follicle-stimulating hormone) levels can also provide additional information to determine if a women remains perimenopausal or has reached menopause," she says. "FSH tends to increase as ovarian reserve declines so higher levels can indicate late perimenopause or menopause."
Where can women find support with perimenopause?
Speaking to your GP or a menopause specialist is a good place to start, particularly when it comes to discussing future treatment like HRT or making positive lifestyle changes to help with symptoms. But finding support from the community can also have huge benefits.
"There is some evidence to suggest that women tend to feel better and truly thrive when sharing and learning from one another," says Dr Barton. "The 'menopause cafe' movement is a great place for women and many workplaces are now adopting 'menopause champions' to help women struggling with symptoms."
There are valuable online resources offering helpful information and support, including Women's Health Concern, Rock My Menopause and The Daisy Network. And as the taboo around menopause and perimenopause continues to lift, there are now more books, TV shows and podcasts on the subject than every before.
Dr Barton recommends the online community Her Spirit and The Balance App, while many women have found Davina McCall's Channel 4 documentary Sex, Myths and the Menopause and her best-selling book Menopausing indispensable.
Support can also be found on social media, where leaders in the field such as Dr Harper share their knowledge with thousands of followers. "I do a weekly women’s power hour discussing topics around menopause and perimenopause, covering everything from weight loss to sleep and anxiety," she says.
There's still a long way to go but thankfully, the conversation around perimenopause is only getting louder.
Find the most common signs of perimenopause here, along with the signs of menopause a GP sees most. We've rounded up all the information you need to know around menopause here.
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