Perimenopause

What is perimenopause?

Perimenopause is a natural part of a woman’s life. It’s the stage before your final period (menopause) when your body is transitioning to the end of its reproductive years. You can still get pregnant during this time.

When does perimenopause happen?

In Australia, the average age for women to reach menopause is 51 to 52. Perimenopause usually starts in a woman’s 40s. On average it lasts four to six years, but it can last from one to 10 years.

If you are at the expected age and have some symptoms (e.g. irregular periods), it’s likely you’re approaching menopause.

What happens at perimenopause?

During perimenopause, your ovaries start to run out of eggs. This causes hormone levels, particularly oestrogen, to go up and down. Your menstrual cycle changes during perimenopause. Your periods may become irregular, heavier, lighter, shorter or longer. Some months your period may not come at all. You may not ovulate every month or you could ovulate twice in a cycle.

Symptoms

Many women have physical and emotional symptoms during perimenopause. Every woman will experience symptoms differently. About 20% have no symptoms, while 60% experience mild to moderate symptoms. The remaining 20% have severe symptoms that interfere with daily life.

Your symptoms may be due to low levels of oestrogen (e.g. hot flushes) or high levels of oestrogen (e.g. sore breasts and migraines).

Common physical symptoms include:

• hot flushes and night sweats
• sleep problems and tiredness
• headaches
• aches and pains
• dry vagina
• sore breasts.

Common emotional symptoms include:

• mood changes
• forgetfulness
• brain fog
• anxiety or depression.

Managing your symptoms

Symptom management will depend on your individual experience (i.e. what is bothering you and how it is affecting your life).

For example, if you are experiencing hot flushes, night sweats or period symptoms, your doctor may recommend menopausal hormone therapy (MHT) or non-hormonal medicines. They may also recommend practical things you can do, such as using a fan or water spray, dressing in layers and drinking lots of water.

Fertility and contraception

Even though fertility is much lower in your 40s and 50s, you can still get pregnant. This is because if you still have periods, you are still ovulating. Note that MHT is not a contraceptive. If you don’t want to get pregnant, you should use contraception until you’ve had:

• one year without a period (if you’re older than 50)
• two years without a period (if you’re under 50).

Support through perimenopause

Perimenopause may affect your mood and feelings, which can also affect your relationships. It’s important to seek support if you need it. You can see a counsellor or psychologist to help with your feelings.

If you have a partner, they might not understand what you’re going through or the impact of menopause symptoms. You can explain how you’re feeling and ask them to read information about perimenopause for partners.

When to see your doctor

See your doctor if you are worried about your periods or if symptoms affect your normal routine (e.g. eating, sleeping and daily activities).

Depending on your symptoms, your doctor may refer you to a specialist, such as a gynaecologist, psychologist, endocrinologist or dietitian.

For more information, resources and references, visit the Jean Hailes menopause web page.