Perimenopause - fact sheet

This project was funded by the Victorian Government.

What is perimenopause?

Perimenopause is the lead-up to a woman’s final menstrual period, the menopause. Perimenopause can cause symptoms similar to, or even more intense, than those of menopause.

When does perimenopause occur?

Perimenopause usually happens in a woman’s 40s and on average lasts 4-6 years, but can be as short as one year, or as long as 10. When you have had no period, spotting or staining for 12 months, you have reached menopause and are then considered postmenopausal. However, symptoms may continue for months or years after menopause – every woman is different.

What happens at perimenopause?

At perimenopause, your ovaries are starting to run out of eggs and wind down. This causes fluctuations in the female hormones oestrogen and progesterone, which in turn can affect your periods. They can become irregular, heavier, lighter, shorter or longer, or some months may not come at all. This also means that some
months you may ovulate, other months you may not, and sometimes you may ovulate twice in a cycle. Changes to your periods are often the first sign of perimenopause, but other common symptoms include hot flushes and mood swings. Symptoms may come in waves and often get worse before your period, when oestrogen levels drop.

Symptoms

Perimenopause can bring a range of physical and emotional symptoms. However, not all women experience symptoms; in fact, 20% will have none at all, while 60% experience mild to moderate symptoms and 20% have symptoms so severe that they significantly interfere with daily life. Symptoms can include any of the following:

• hot flushes
• night sweats
• irregular periods
• problems with falling asleep, staying asleep and sleep quality
• breast tenderness
• itchy/crawly/dry skin
• exhaustion
• trouble concentrating
• vaginal dryness
• loss of libido (sex drive – talk to your doctor about sexual function if this concerns you)
• migraines
• more pronounced premenstrual tension
• mood changes, such as feeling more teary and irritable. Anxiety may also occur
• weight gain, despite no changes to diet or exercise, due to the metabolism slowing down.

When will menopause occur?

During perimenopause, hormone levels may be low one day and within the normal range or high the next. So, there is currently no test that can determine when menopause will occur for you. The best way to tell if you are close to menopause is to pay attention to the symptoms you have. Keep a record of your menstrual cycle to see if your periods are irregular or have stopped for some time. If you’re experiencing typical menopausal symptoms such as hot flushes and erratic periods, it’s likely you are going through perimenopause, and menopause is approaching.

What you can do

You can make lifestyle changes to help minimise the effects of the symptoms of perimenopause. Eat healthily. Be physically active. Don’t smoke. Drink alcohol if you wish, but not too much. Take care of your emotional wellbeing.

Treatment options

Know that you don’t need to put up with bothersome symptoms.

For healthy women without any medical history of cancer, who have bothersome symptoms such as hot flushes, the most effective treatment is menopausal hormone therapy (MHT – formerly called hormone replacement therapy, or HRT). In general, for women under the age of 60 when starting MHT, the benefits far outweigh any risks.
There are many different therapies available. One type may suit better than another. There are a number of other strategies including natural therapies and prescribed medications – such as the Pill – for women who have bothersome symptoms and do not wish to, or cannot take, MHT. It is recommended that women discuss all their options with a health practitioner who has expertise in women’s health. Treatments may help some symptoms, but the changes that menopause brings will still occur.

Contraception

Perimenopausal women can ovulate twice within one cycle, and can still ovulate up to three months before their final period. Though fertility is much lower in your 40s and 50s, you can still become pregnant until you have had:

• one year without your period, or
• two years without a period if you are under 50.

Therefore, you need to keep using contraception and protection for safe sex. The chance of pregnancy in women aged 45-49 years is estimated to be 2-3% per year. After the age of 50, it is less than 1%. While this is low, every woman’s fertility is different. MHT is not a contraceptive.

Supporting your partner through perimenopause

During perimenopause, your partner goes through hormonal changes that can have a significant impact on her body, health, energy levels and mood. Coming to the end of her reproductive years may also affect how she feels about herself. Knowing about perimenopause and menopause can help you, your partner and your relationship. Tips that can help both of you include:

• reading up about menopause. Ask her which symptoms are affecting her the most and show her more understanding
• engaging in non-sexual ‘no strings attached’ physical contact, such as hugs and back rubs. Hormonal changes can make a woman’s vagina dry and sex uncomfortable, which may mean she does not feel like having sex as much, or at all. If engaging in penetrative sex, make sure you use a good-quality lubricant designed for women
• sleeping alone when necessary – some women prefer this due to the hot flushes and associated discomfort that can accompany menopause, so that both she and her partner can sleep more comfortably
• listening and asking questions. Instead of suggesting how to ‘fix’ things, listen and ask her how she is feeling
• making comments that show empathy (“that sounds really hard”) and support (“let me know if I can do anything to help”)
• not making jokes about her symptoms
• reminding your partner you find her attractive and how much you love and value her.
  

For more information go to jeanhailes.org.au/health-a-z/menopause