Perimenopause 101 - early signs, duration, and natural ways to manage symptoms

Perimenopause is the phase leading up to menopause, a time when the body's reproductive hormones, like oestrogen and progesterone, begin to fluctuate. These shifts can create a variety of physical and emotional changes that vary from woman to woman. Often, the earliest signs are changes to the menstrual cycle - some women may experience heavier or lighter periods, longer cycles, or spotting. But there are also other indicators to watch for, such as hot flashes, mood swings, and brain fog.

When does perimenopause typically start?

The onset of perimenopause can vary widely, but it usually begins between the ages of 45 and 55. Some women, however, may start perimenopause as early as their mid-30s, especially if influenced by factors like early menstruation, smoking, or certain medical treatments. Lifestyle and genetic factors can also play a role, so while most experience it in their 40s or early 50s, it’s essential to know that this phase can look different for everyone.

Recognising common perimenopause symptoms

In addition to changes in the menstrual cycle, many women experience a variety of other symptoms:

• Hot flashes and night sweats: Sudden waves of warmth, often followed by sweating and, sometimes, dizziness.
• Sleep disturbances: Trouble falling asleep or staying asleep is common, as are early morning awakenings.
• Mood swings and anxiety: Irritability, anxiety, and a sense of low mood can intensify during this time.
• Brain fog: Memory issues, especially with short-term memory, and difficulty focusing are frequent complaints.
• Urinary and vaginal health: Symptoms such as recurring urinary tract infections, frequent urination, vaginal dryness, itching, and discomfort during sex are related to hormonal changes.
• Reduced libido: Fluctuating hormones can impact sexual drive, which may be compounded by physical symptoms or shifts in body image.

How long does perimenopause last?

Most women experience perimenopause for an average of 4–8 years. However, some may find the transition lasts longer, extending up to 14 years, while others may go through a shorter phase. Due to these wide variations, there’s no “typical” experience, and each woman’s journey through perimenopause will be unique.

Is there a test for perimenopause?

Because hormone levels fluctuate greatly during perimenopause, there’s no definitive test to determine if you've entered this phase. However, if symptoms like irregular menstrual cycles, hot flashes, and mood changes arise, a doctor may evaluate these signs along with your medical history to help diagnose perimenopause. For those in later stages, a follicle-stimulating hormone (FSH) test can be useful; consistently elevated FSH levels may indicate the transition to menopause.

Knowing when perimenopause is ending

Perimenopause often progresses in two stages: early and late. During the early stage, menstrual cycles may fluctuate slightly, with timing varying by a week or more. In the late stage, periods may become more widely spaced. As menopause approaches, the gaps between cycles can extend to 60 days or more. Once 12 consecutive months have passed without a period, menopause is considered to have occurred, marking the transition to post-menopause.

Lifestyle tips and menopause supplements for symptom relief

Managing symptoms during perimenopause involves a holistic approach that includes lifestyle changes and possibly using menopause supplements to support the body. Here are some effective ways to find relief:

• Diet: A plant-based diet that includes a wide range of vegetables, fruits, whole grains, nuts, seeds, and legumes can improve symptoms like hot flashes, joint pain, and low mood. Certain plant compounds, like phytoestrogens in soy, may also provide natural support for hormonal balance.
• Exercise: Regular physical activity, including aerobic and resistance training, has been shown to reduce a variety of symptoms, from mood swings to muscle aches. Exercise can also help improve sleep quality and combat fatigue.
• Sleep hygiene: Establishing a regular bedtime routine and creating a calming environment can be key to getting quality sleep, which may alleviate brain fog, low energy, and stress.
• Menopause supplements: Specially formulated supplements can offer additional support. For example, probiotics may aid in managing symptoms like hot flashes, brain fog, and anxiety. Supplements rich in magnesium, B-vitamins, and adaptogenic herbs like ashwagandha are popular choices for women seeking natural ways to support mood, sleep, and energy levels during this transition.

Some women also find relief with hormone therapy. Hormone Replacement Therapy (HRT) involves taking hormones like oestrogen and progesterone, either orally, through a patch, or as a gel. Discussing options with a healthcare professional can help you decide if HRT is right for you, as well as exploring natural or supplemental options if preferred.

When to consult a healthcare provider

If your symptoms are severe or affecting your quality of life, it’s a good idea to consult with a healthcare provider. They can assess your symptoms, possibly test your FSH levels, and discuss treatment options like menopause supplements, hormone therapy, or other approaches to help you navigate this phase comfortably.

The early signs of perimenopause often include changes in the menstrual cycle, accompanied by a variety of symptoms such as hot flashes, sleep disturbances, and mood swings. This transition typically starts between 45 and 55, lasting from 4 to 8 years on average. Adopting a balanced approach that includes regular exercise, a nutrient-rich diet, quality sleep, and menopause supplements can support your body through perimenopause and help you feel more in control of your health during this phase.