Perimenopause happens a few months or years before menopause starts — it’s completely normal, and the symptoms vary from person to person. Understand what perimenopause is, the most common symptoms to look out for, and how to manage your symptoms.
- What’s perimenopause?
- When does perimenopause start?
- Perimenopause symptoms
- What are the stages of perimenopause?
- Is there a perimenopause test?
- Is there treatment for perimenopause?
- Are there supplements for perimenopause?
Perimenopause refers to the reproductive and hormonal changes you experience before reaching menopause (when you stop having periods).
It happens when your ovaries start to produce lower levels of a sex hormone called oestrogen — plays a key role in reproductive and bone health. This drop in oestrogen can cause a wide range of symptoms.
Find out more about how oestrogen affects your health.
Perimenopause means “around menopause”. Typically, people enter perimenopause in their late 30s or early 40s. Perimenopause can last anywhere from a few months before your period stops up to 5-7 years.
Most people transition into menopause between 45 and 55 (the UK average is 51). Around 1 in 100 people reach menopause before the age of 40 — known as premature menopause.
If you haven’t had a period for more than 12 months, you’re no longer perimenopausal.
The most common perimenopause symptoms include:
- irregular periods and menstrual pattern changes — they might become shorter or longer, with a lighter or heavier flow
- hot flushes and night sweats
- muscle and joint pain
- vaginal dryness — due to falling oestrogen levels
- reduced libido
- trouble sleeping
- poor concentration
- mood swings
The stages of perimenopause can vary from person to person. Usually, the different stages of perimenopause correlate with fluctuating hormone levels.
Typically, there are two stages of perimenopause:
- starting with an irregular menstrual cycle — during this time your periods may be longer, shorter, lighter, or heavier
- followed by your periods stopping completely
Perimenopause typically ends one year after your periods have stopped — you’ve reached menopause.
Blood tests aren’t usually necessary to diagnose perimenopause. Your GP will consider your age, menstrual history, and symptoms.
But you might like to see a GP or specialist if:
- your symptoms are bad
- your periods become irregular early, especially if this is before the age of 40
You can measure your hormone levels at home with a women’s hormones blood test. However these can fluctuate a lot in perimenopause, which might make them harder to interpret.
While there’s nothing you can do to stop the physical symptoms of perimenopause naturally occurring, you can help manage them by:
- wearing layers – so you can remove them if you get too hot
- keeping your bedroom cool at night
- avoiding caffeine, smoking, alcohol and spicy foods – these can trigger perimenopause symptoms
- taking a cool shower or using a fan
- exercising regularly — like weight-bearing exercises to improve your bone strength
- practising mindfulness to reduce your stress levels
- getting enough sleep
- losing any excess weight
- looking after your mental health
- hormone replacement therapy (HRT) — medication available as gels, patches and tablets that keep female hormone levels steady as you transition through menopause
- cognitive behavioural therapy (CBT) — a type of talking therapy that can help you manage anxiety and depression by changing the way you think and behave
If your symptoms are really affecting your day-to-day life and mental health, you should see your GP to discuss what other options might be available for you.
Cognitive behavioural therapy (CBT) in particular can help to improve sleep in perimenopausal and postmenopausal people with insomnia and hot flushes. Your doctor might also recommend selective serotonin reuptake inhibitors (SSRIs) — a common antidepressant that’s often used in combination with CBT.
Eating a balanced diet full of a wide range of foods is the best way to support your overall health.
There’s not a lot of evidence to support taking supplements to directly treat perimenopausal symptoms. But there are certain nutrients you should focus on getting enough of.
Vitamin D acts on areas of your brain linked to mental wellbeing. And good levels are linked to a reduced risk of low mood, anxiety, and depression. Oily fish, egg yolks, fortified foods, and supplements (from October to April) help to support healthy levels.
Vitamin D is also essential for your bone health — as lowering oestrogen levels increases your risk of osteoporosis.
Vitamin B12 is essential for a healthy brain and nervous system. Not getting enough vitamin B12 is linked with changes in the way you feel and think. These changes might make you more irritable, and lead to feelings of anxiety and depression, which could heighten your perimenopausal symptoms. Meat, dairy, and fortified plant-based sources are good sources of vitamin B12.
Once you’re over the age of 50 years, you’re more at risk of vitamin B12 deficiency. This is because you might stop producing enough hydrochloric acid in your stomach — which is needed for the absorption of vitamin B12. Monitoring your levels with a home blood test can help you understand if you might need a supplement.
Calcium also helps to protect your bones and reduce the risk of osteoporosis. Dairy, green leafy vegetables, fortified alternative milk, and bread made with fortified flour are good sources.
Some research suggests omega-3 fats might help to reduce night sweats and improve mood. They might also help to reduce the risk of breast cancer — but currently, the evidence is unclear. Because these fats are so important for many areas of your health, getting enough will be beneficial for your overall wellbeing.
Oily fish is one of the best sources of omega-3s. It’s recommended that you aim to eat 1-2 portions a week. There are some plant sources, like flaxseed and chia seeds but your body finds it harder to use this type of omega-3 (ALA). If you’re vegan, vegetarian or don’t eat a lot of fish you might need to think about taking a supplement.
Some people also like to include phytoestrogen-rich foods in their diet. Phytoestrogens are substances found in certain plants that have oestrogen-like effects. There is some evidence that they might help to reduce hot flushes.
Foods high in phytoestrogens include soybeans, tofu, tempeh, and sesame seeds.
Find out more about what you can do to support your mood and the role of vitamins and minerals.
Recommended listening for you
Dording, C. M., & Sangermano, L. (2018). Female sexual dysfunction: Natural and complementary treatments. Focus, 16(1), 19-23.
Fabian, C. J., Kimler, B. F., & Hursting, S. D. (2015). Omega-3 fatty acids for breast cancer prevention and survivorship. Breast cancer research, 17(1), 1-11.
Freeman, M. P., Hibbeln, J. R., Silver, M., Hirschberg, A. M., Wang, B., Yule, A. M., ... & Cohen, L. S. (2011). Omega-3 fatty acids for major depressive disorder associated with the menopausal transition: a preliminary open trial. Menopause (New York, NY), 18(3), 279.
Jaeger, M. D. B., Miná, C. S., Alves, S., Schuh, G. J., Wender, M. C., & Manfro, G. G. (2020). Negative affect symptoms, anxiety sensitivity, and vasomotor symptoms during perimenopause. Brazilian Journal of Psychiatry.
Mohammady, M., Janani, L., Jahanfar, S., & Mousavi, M. S. (2018). Effect of omega-3 supplements on vasomotor symptoms in menopausal women: A systematic review and meta-analysis. European Journal of Obstetrics & Gynecology and Reproductive Biology, 228, 295-302.
National Health Services. Menopause treatment. Retrieved 14 September 2021 from https://www.nhs.uk/conditions/menopause/treatment/.
National Institute for Health and Care Excellence. (2019). Menopause: diagnosis and management [NICE Guideline No. 23]. Retrieved 29 September from https://www.nice.org.uk/guidance/ng23.
Santoro, N. (2016). Perimenopause: from research to practice. Journal of women's health, 25(4), 332-339.