Demystifying Perimenopause: When and Why Does it Occur?

Perimenopause, which is often colloquially referred to as the ‘menopause transition’, can be a time that catches women by surprise. This is a crucial phase in a woman’s biological life, marking the beginning of changes that will continue into menopause. 

While menopause is understood on a general level, perimenopause can have a significant amount of confusion and uncertainty around it. By learning about the timeline, symptoms and causes of perimenopause, you’ll be more prepared for what’s ahead (or what may have already begun for you).

What is perimenopause?

Perimenopause marks the period leading up to menopause, characterised by both hormonal fluctuations and noticeable changes in an individual’s menstrual cycle.

It first begins when the ovaries start to produce less oestrogen, resulting in symptoms and irregular periods. This is a transitional phase, denoting the commencement of a time that will end with menopause. 

Perimenopause continues until menopause begins, which is officially reached when a woman has been without a period for 12 consecutive months. 

There’s not a certain time when perimenopause will occur. For many women, it’s likely to begin in their 40s, although some women can experience it from as early as their mid-30s. Its duration also varies from person to person, with some women experiencing perimenopause for a few years and others for over a decade. These individual experiences can be influenced by factors such as genetics, health and lifestyle choices.

Perimenopause symptoms

As with menopause, there’s no singular perimenopausal set of symptoms. Each woman’s experience with perimenopause is unique, with some symptoms occurring more frequently and intensely, and other symptoms never eventuating at all. Perimenopause likes to keep you on your toes!

Common symptoms that can occur during perimenopause include:

• Irregular periods – this is one of the clearest signs of perimenopause for many women, with irregular periods indicating the beginning of changes in hormone production.
• Hot flushes and night sweats – sudden, intense sensations of heat or sweating can also mark perimenopause’s beginning, with these symptoms often continuing through menopause.
• Mood swings – changes in hormonal production can lead to irregularities in moods and emotions.
• Vaginal dryness – decreasing oestrogen levels can reduce natural vaginal lubrication, pointing to perimenopause’s arrival. 
• Weight gain – many women find that they begin to gain weight during perimenopause, with connections between weight gain and hormone production bringing changes in this area.

Alongside these more common symptoms, a wide range of lesser-known symptoms may also point to the onset of perimenopause. These include:

• Urinary incontinence – the commencement of fluctuating hormones can weaken the pelvic floor muscles, causing urinary incontinence or an increase in the need to urinate.
• Tender breasts – for some women, this symptom can mirror what they may have experienced before or after their period.
• Hair loss or thinning – changing hormone levels can also result in hair loss or thinning, which can be of particular distress to some women.
• Joint pain – as oestrogen plays an anti-inflammatory role in the body, declining oestrogen levels during perimenopause can result in joint pain or stiffness. 

How to manage perimenopause’s symptoms

While navigating perimenopause can be difficult, there are a number of steps you can take to help manage your symptoms and maintain your overall physical, mental and emotional wellbeing.

The following lifestyle changes can play a key role in minimising the disruption of perimenopause symptoms:

• Follow a healthy diet. By eating a balanced diet that’s rich in fruits, vegetables, whole grains, lean proteins, and healthy fats, you can support your natural hormonal balance and overall physical wellbeing throughout perimenopause. By staying away from artificial and highly processed foods, you can fuel your body with the nutrients it needs to meet its daily demands in the midst of fluctuating hormones.
• Maintain a regular exercise schedule. Not only does regular physical activity help to combat weight gain, but it also has a direct impact on our moods, as well as promoting better sleep. Building an exercise routine that has a minimum of 30 minutes of moderate activity a day can be a key ingredient in navigating each change perimenopause brings.
• Monitor and manage your stress levels. High stress levels can make perimenopausal symptoms even more intense, adding pressure on your internal systems and your body’s ability to regulate itself. Perimenopause is a great time to practise even more stress management than usual. Opt for stress management techniques such as deep breathing, meditation, yoga or mindfulness to reduce stress levels and contribute to a more positive sense of emotional wellbeing.
• Keep up a strong sleep routine. As sleep can regularly be disturbed during perimenopause, it’s important to give yourself the best chance for a restful night as possible. A consistent sleep schedule with a relaxing bedtime routine is one way you can get into the rhythm of supporting your sleep throughout the changes perimenopause and menopause will continue to bring.
• Raise your hydration levels. Drinking more water can be a simple way to reduce hot flushes and help to maintain healthy skin during perimenopause. It’s also key to avoid too much caffeine and alcohol, both of which can contribute to dehydration. 

How body-identical hormone therapy can help

Alongside these lifestyle management tools, body-identical hormone therapy can play a significant role in reducing the impact of perimenopause on your daily experience. This is a form of perimenopause and menopause treatment that uses approved body-identical hormones to help regulate the body’s response to reduced levels of natural hormone production.

Shifts in menopause research have identified body-identical hormone treatments as a pathway that can alleviate perimenopause and menopause symptoms. The Australian Menopause Centre offers best-practice menopause treatment that’s patient-centred and specific to the individual’s needs, with treatment options, dosing and length of treatments all based on symptoms, circumstances and expectations for each patient. 

There’s no need to suffer in silence through the onset of perimenopause. Find proactive, expert medical support with the Australian Menopause Centre – navigate this changing season with tools, insights and resources.