By the time we hit 35, many of us women have figured out how our bodies function. We have a handle on our cycles, know our skin and hair better, and understand what works for us in terms of nutrition and well-being. We’re in control. Then suddenly, we begin to see changes again, and the uncertainty returns with a new question: am I perimenopausal? With a number of signs and symptoms, it can be difficult to understand whether these changes are an early sign of the menopause — or something completely unrelated. To help you navigate this somewhat confusing transition, we’ve put together this helpful guide breaking down the signs of the perimenopause.

What is the perimenopause?

The perimenopause is the time during which your body makes the natural transition to menopause. It's the ‘before’ stages of the menopause, when a woman’s ovaries gradually begin to make less estrogen, causing a range of early symptoms. As such, it’s also called the menopausal transition, as the perimenopause can intensify in the last year or two before the menopause, and start to present more menopause-like symptoms.[1]

Women begin their perimenopause at different ages. It is thought to begin around the early forties, and the process itself has been known to last anywhere from a few months to 10 years, however the average perimenopause goes on for about 4 years, ending when the ovaries stop releasing eggs, and the menopause begins.

It’s difficult to predict precisely how it will be for each individual the perimenopause happens differently to everyone, from the kinds of symptoms you may experience to their frequency and intensity. Below, we’ll discuss some of the most common symptoms to give you a better understanding of whether you might be perimenopausal.

What are the first signs of perimenopause?

The signs of perimenopause are not all the same as the signs of the menopause and may often go unnoticed by some women. But if you are consistently seeing the signs we’re about to discuss, or if any of them are persistently troubling you, we definitely recommend talking to your doctor to get to the bottom of it. 

Menstrual irregularity

During the perimenopause, it’s normal for your periods to become irregular. This can understandably cause some anxiety, especially if your period arrives unexpectedly at work or when you’re out. Usually, you will find that your cycle becomes longer, and you bleed less frequently. If, however, you find that your periods are happening more often than usual, becoming heavier or more clotted, or lasting longer than usual, you should see a doctor and rule out the possibility of underlying problems such as fibroids.[2]

Hot flushes

As your oestrogen levels fluctuate, they may begin to affect your body’s thermoregulation, resulting in one of the most common symptoms of the perimenopause and menopause — hot flushes. Also known as hot flashes, hot flushes can come on suddenly and leave you feeling sweaty and uncomfortable. Often, birth control may be prescribed to help you beat the heat as they can regulate your hormone levels, but this is something you will need to discuss with your doctor.[3] You can also turn to more natural ways to combat hot flushes, such as try altering your diet and habits or giving up smoking. They can, however, occur due to reasons other than the perimenopause, such as stress, illness, (or even too much spicy food), so be sure to rule these out in any case.

Breast pain

Many women experience breast pain during their menstrual cycle, usually in the form of a dull ache in both breasts just before their period. During the perimenopause, however, you may experience different pain, unlike what you may have felt before.

Perimenopausal breast pain is often described as a burning or throbbing soreness, or sharp stabbing pain felt in one or both breasts. This pain is caused by the fluctuating levels of oestrogen and progesterone in your body that can affect your breast tissue. It usually improves once your periods stop, however hormone replacement therapy (HRT) may cause it to continue.[4] If your breast pain is very intense or frequent, or if you see or feel any changes in your breasts, you should consult your doctor to rule out the possibility of any other conditions. Your doctor may also be able to recommend ways to deal with the pain or prescribe medication to help ease it.

Lower libido

Dropping oestrogen levels may also lead to women experiencing a lower sex drive during the perimenopause. While a part of this may just be down to not feeling aroused, another factor to consider is that during this time, you may also experience vaginal dryness (medically known as vaginal atrophy), which is a common symptom of falling oestrogen levels. This dryness may cause intercourse to be uncomfortable or painful and contribute to your lack of enthusiasm for sex. You may find that over-the-counter lubricants help, but if the symptoms persist, you should consult a medical professional to find a solution that helps you feel more comfortable.

Insomnia

During the perimenopause, having trouble sleeping (also known as insomnia) is a fairly common thing for women to experience. Insomnia is often caused by hormonal changes. It can lead to tiredness during the daytime and a lack of productivity, which in turn causes anxiety that leads back into the inability to sleep, and so the cycle continues. While over-the-counter sleeping aids and other medications may help, you may find that home remedies, mindful practices, and healthier changes to your bedtime routine may help settle your insomnia. If, however, it persists, you might consider medication or behavioural treatment based on your doctor’s recommendations.

Fatigue

During this transitional period, fatigue is a common issue many women encounter as their hormone levels fluctuate. It can have a significant impact on your day-to-day life, as well as contributing to other symptoms such as anxiety, insomnia, and lower mood and libido. There are, however, many steps you can take to combat fatigue, such as a better daily exercise routine, changes to your diet, meditation, and other energizing practices.

Mood swings

If you’re a woman, you’ve probably heard of PMS or premenstrual syndrome — it’s a set of symptoms that 90% of women experience due to the dramatic fluctuation of oestrogen levels just before their period hits. This hormone imbalance is the same reason for the mood swings or low moods you may experience during the perimenopause. To fight these feelings, you may find that working out and giving up smoking and excessive drinking can make a big difference, as well as changing your diet to keep your blood sugar levels as consistent as possible. Research shows that calcium supplements can be beneficial for perimenopausal women with PMS symptoms, as they not only help to keep your mood level but also help protect your bones from the deteriorating effects of the menopausal and postmenopausal years.[5]

Urinary incontinence

Another perimenopause symptom is urinary incontinence or the loss of bladder control. This is a symptom that many women experience at various stages of their lives, and it may be a very minor loss of control, resulting in a few drops of urine leaking when you laugh, sneeze, exercise or bend over to lift something heavy. In some cases, you may be rushing to the bathroom and aren’t quite able to hold it in until you get there. The frequency of urinary incontinence generally worsens as you get older, and is a result of decreasing muscle strength in the pelvic muscles due to hormonal changes can also affect your muscle strength in the pelvic region. However, urinary tract infections, being overweight, and excessive drinking and smoking can also cause incontinence. If it happens too frequently, you may need to consult your doctor for a solution. In addition to medication, your doctor may also recommend that you routinely do Kegel exercises to strengthen your pelvic muscles. 

The positive outlook

We’ve covered a number of bases when it comes to decoding your perimenopause symptoms, it’s important to remember that every woman’s journey is unique. You may not experience some of the symptoms we’ve discussed, or perhaps you’ll experience them all, but the important thing is to accurately identify your symptoms, determine if they are in fact signs of perimenopause, and find the solutions that work for you.

To discover more great advice on the perimenopause, visit our Menopause Guide and learn more about what to expect during the perimenopausal years.

1. Medical News Today, Comparing Premenopause and Perimenopause (2017). Available at: https://www.medicalnewstoday.com/articles/318660.php#What-are-the-stages-of-menopause
2. WebMd, Perimenopause (2019). Available at: https://www.webmd.com/menopause/guide/guide-perimenopause
3. Healthline, Hot Flashes: Causes, symptoms and treatment (2018). Available at: https://www.healthline.com/health/menopause/hot-flash-causes
4. Healthline, Sore Breasts (2018). Available at: https://www.healthline.com/health/menopause/sore-breasts-menopause
5. Fatemeh Shobeiri et al, “Effect of calcium on premenstrual syndrome: A double-blind randomized clinical trial”, in Obstet Gynecol Science. 2017 Jan; 60(1): 100–105. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5313351/