Perimenopause marks a significant transition in a woman’s life that often comes with questions, concerns, and sometimes confusion. As many as one-third of the female population in the UK are currently experiencing perimenopause or menopause.
At Summerhill Health, we understand this journey can feel overwhelming, which is why we’ve created this comprehensive guide to help you navigate this important life stage with confidence.
What Exactly Is Perimenopause?
Perimenopause means “around menopause” and refers to the transitional period before menopause when your body begins to undergo hormonal changes. During this time, your ovaries gradually produce less oestrogen, which can lead to various physical and emotional symptoms.
When does perimenopause typically begin?
Most women enter perimenopause in their 40s, but some experience it as early as their mid-30s. This phase can last anywhere from a few months to 10 years, with the average duration being about four years.
What happens to oestrogen during perimenopause?
As you enter perimenopause, your ovaries, i.e. the organs responsible for producing most of your body’s oestrogen, begin to slow down. This means they release less oestrogen, and the amount produced can fluctuate unpredictably from month to month.
Over time, these levels generally trend downward, but it’s the erratic ups and downs that often trigger many of the symptoms women notice during this phase.
Why does lower oestrogen cause symptoms?
Oestrogen is a key hormone that affects many systems in your body, not just your reproductive organs. As levels decline, the body’s usual balance is disrupted, which can lead to a wide range of symptoms, both physical and emotional.
Common Symptoms of Perimenopause
Every woman’s experience is different. Some may only notice mild changes, while others have perimenopause symptoms that significantly affect their daily life. The timing, severity, and combination of symptoms can vary widely, partly because oestrogen levels don’t just fall steadily; they can swing up and down unpredictably before finally settling at a lower level after menopause.
Here are common perimenopause symptoms you should be aware of:
- Irregular periods
Your menstrual cycle may become unpredictable, i.e. shorter, longer, heavier, or lighter as hormone levels fluctuate. - Hot flushes and night sweats
Sudden feelings of warmth spreading throughout your body, often accompanied by sweating and sometimes followed by chills. - Sleep problems
Night sweats and general hormonal changes can disrupt sleep, which can lead to you feeling more tired during the day. - Mood swings
Oestrogen influences neurotransmitters in the brain, such as serotonin, which help regulate mood. As oestrogen levels drop, you may feel more irritable, anxious, or low in mood. - Vaginal dryness
Oestrogen helps keep the lining of the vagina healthy and lubricated, so lower levels can cause dryness, discomfort during sex, and even an increased risk of urinary tract infections. - Decreased fertility
While you can still get pregnant during perimenopause, fertility naturally declines. - Changes in sex drive
Your libido may fluctuate during this time. - Cognitive changes
Some women report “brain fog”, i.e. problems with memory, mental clarity or difficulty concentrating. - Low self-esteem and confidence
Emotional changes can affect how you feel about yourself and your relationships - Increased risk of depression and anxiety
The risk of developing depression or anxiety is higher during perimenopause, particularly if you have a history of these conditions. - Joint and muscle pain
Many women notice new aches or stiffness, which is partly due to hormonal changes. - Changes in cholesterol levels
Decreased oestrogen can affect your heart health. - Headaches
Fluctuating oestrogen can make headaches or migraines worse for some women. - Bone Health
Over the long term, lower oestrogen levels increase the risk of osteoporosis, as bones lose density more quickly.
Are these symptoms normal, or should I be concerned?
While these symptoms are typically normal aspects of perimenopause, they can sometimes mirror signs of other health conditions. That’s why it’s important to discuss any new or concerning symptoms with a healthcare provider like Summerhill Health, who specialises in women’s health.
How is Perimenopause Diagnosed?
There’s no single definitive test for perimenopause, but several approaches can help confirm what’s happening:
- Clinical assessment: Your GP will discuss your symptoms, medical history, and menstrual cycle changes.
- Hormone testing: While hormone levels fluctuate significantly during perimenopause (making single tests less reliable), certain patterns in blood tests can help support a diagnosis. These may include measuring the following:
- Follicle-stimulating hormone (FSH)
- Oestradiol (a form of oestrogen)
- Anti-Müllerian hormone (AMH)
- Exclusion of other conditions: Some conditions have symptoms that overlap with perimenopause, including thyroid disorders, depression, and certain autoimmune diseases. Your GP may recommend tests to rule these out.
How Can You Manage Your Perimenopause Symptoms?
The good news is that there are many approaches to managing perimenopause symptoms:
Lifestyle Modifications
- Regular exercise because physical activity can help manage weight, improve mood, promote better sleep, and strengthen bones; all particularly important during perimenopause.
- Balanced nutrition, especially incorporating whole foods, calcium, vitamin D, and phytoestrogens (plant compounds that can mimic oestrogen) may help manage symptoms.
- Stress management including practices like mindfulness meditation, yoga, or other relaxation techniques can help mitigate the effects of stress on perimenopausal symptoms.
- Sleep hygiene meaning a consistent sleep routine and a cool, comfortable sleep environment that can help address sleep disturbances.
Medical Treatments
- Hormone replacement therapy (HRT): For many women, low-dose hormonal treatments can effectively manage symptoms. These come in various forms, including tablets, patches, gels, and vaginal preparations. At our menopause clinic, we offer personalised HRT options tailored to your specific needs.
- Non-hormonal medications: For women who cannot or prefer not to use HRT, several alternatives can help with specific symptoms, such as certain antidepressants for hot flushes or mood changes.
- Vaginal moisturisers and lubricants: These can help address vaginal dryness and related discomfort.
Complementary Approaches
Some women find relief through complementary therapies such as:
- Acupuncture
- Herbal supplements (like black cohosh or evening primrose oil)
- Cognitive behavioural therapy
Which approach is right for me?
The best approach is highly individual and depends on your symptoms, medical history, preferences, and lifestyle. Working with a healthcare provider who specialises in women’s health can help you develop a personalised plan.
When to Seek Professional Help
While perimenopause is a natural transition, certain situations warrant professional attention:
- Very heavy or prolonged bleeding
- Periods that occur significantly more frequently than every 21 days
- Spotting between periods or after intercourse
- Severe symptoms that interfere with your quality of life
- Symptoms of depression or anxiety that are difficult to manage
As women’s health specialists, we can help you determine whether your symptoms are related to perimenopause or indicate another condition that requires attention.
How to Prepare for Menopause
Perimenopause is a transition to menopause; the point when you haven’t had a period for 12 consecutive months.
You can help prepare by understanding what to expect:
- Bone health: Declining oestrogen affects bone density. Weight-bearing exercise, adequate calcium and vitamin D, and sometimes medication can help protect your bones.
- Heart health: Your risk of cardiovascular disease increases after menopause. Regular check-ups, a heart-healthy diet, exercise, and not smoking are important protective measures.
- Emotional wellbeing: The psychological aspects of this transition shouldn’t be overlooked. Many women find this a time of reflection and reassessment, sometimes leading to positive life changes.
Why We Care About Women and Perimenopause
Perimenopause represents a significant transition in a woman’s life, but with the right knowledge and support, it can be navigated with grace and even embraced as a new chapter. At Summerhill Health, we’re dedicated to providing compassionate, evidence-based care to women during all life stages.
If you’re experiencing perimenopausal symptoms and would like personalised advice, please don’t hesitate to book an appointment or take our free menopause quiz.
Remember, you don’t have to navigate this journey alone.
References
- British Gynaecological Cancer Society & British Menopause Society. (2024). BGCS-BMS Guidelines on Management of Menopausal Symptoms after Gynaecological Cancer. https://www.bgcs.org.uk/wp-content/uploads/2024/08/BGCS-BMS-Guidelines-on-Management-of-Menopausal-Symptoms-after-Gynaecological-Cancer.pdf
- British Menopause Society. (2024). NICE Guideline. https://thebms.org.uk/publications/nice-guideline/
- Cui, J., Shen, Y., & Li, R. (2023). Menopause is more than just loss of fertility. Frontiers in Endocrinology, 14, 10751372. https://pmc.ncbi.nlm.nih.gov/articles/PMC10751372/
- Davis, S. R., Lambrinoudaki, I., Lumsden, M., Mishra, G. D., Pal, L., Rees, M., Santoro, N., & Simoncini, T. (2015). Menopause. Nature Reviews Disease Primers, 1, 15004. https://doi.org/10.1038/nrdp.2015.4
- Monteleone, P., Mascagni, G., Giannini, A., Genazzani, A. R., & Simoncini, T. (2018). Symptoms of menopause – global prevalence, physiology and implications. Nature Reviews Endocrinology, 14(4), 199–215. https://doi.org/10.1038/nrendo.2017.180
- Muka, T., Oliver-Williams, C., Kunutsor, S., Laven, J. S., Fauser, B. C., Chowdhury, R., Kavousi, M., & Franco, O. H. (2018). Symptoms of menopause – global prevalence, physiology and implications. Nature Reviews Endocrinology, 14(4), 199–215. https://www.nature.com/articles/nrendo.2017.180
- National Institute for Health and Care Excellence. (2024). Menopause: identification and management (NICE Guideline NG23). https://www.nice.org.uk/guidance/ng23
- Takahashi, T. A., & Johnson, K. M. (2021). Menopause preparedness: perspectives for patient, provider, and policy. Medical Clinics of North America, 99(3), 521–534. https://pmc.ncbi.nlm.nih.gov/articles/PMC8462440/
