Perimenopause explained

Key takeaways

Menopause = last period. Perimenopause is the transition leading up to it.
Early perimenopause is often about low progesterone, with PMS-like symptoms and heavier periods.
Late perimenopause brings declining oestrogen, hot flushes, night sweats, and cycle changes.
Diagnosis is based mainly on symptoms and age; hormone tests can be unreliable in late perimenopause.
Pregnancy is still possible until menopause is confirmed.

What is menopause?

Menopause has become a hot topic lately. From workplace awareness events to magazine covers, it can almost feel intimidating - like a giant milestone looming in your 40s. If you’re wondering what all the buzz is about, this article is for you. Let’s break it down gently, so you know what’s ahead and how to navigate it with confidence.

Menopause vs perimenopause: What’s the difference?

The term “menopause” refers to your very last menstrual period. You only know you’ve reached it in hindsight, when 12 months have passed without a period.

The wider transition, sometimes called “the menopause change,” usually spans 7–10 years. It has three stages:

Perimenopause: the years leading up to menopause, when hormones start fluctuating.
Menopause: the final period.
Post-menopause: life after your periods stop.

Most of the symptoms women talk about, like hot flushes, brain fog, mood shifts, actually begin in perimenopause. More well-known symptoms like hot flashes often start closer to actual menopause, and unfortunately, for some women they can continue well into postmenopause.

Did you know that the average age of menopause is 52? Still, 1 in 10 women reaches it before the age of 45, which means symptoms can already start between 35–38. Around 1% experience menopause even before 40. This is called premature ovarian insufficiency (POI). If you suspect you may have POI, ALWAYS seek medical help. Women with POI have a higher risk of health problems later in life, which is why hormone therapy is recommended in this case.

What happens in early perimenopause?

In your late 30s or early 40s, your ovaries start preparing to wind down. Ovulation doesn’t happen every month anymore, leading to “anovulatory cycles.” That means less progesterone is produced, while oestrogen can remain high or even spike.

This imbalance is why many early perimenopause symptoms are actually linked to low progesterone rather than low oestrogen.

First signs and symptoms

Early perimenopause can feel a lot like intense PMS. Some common experiences include:

Headaches or migraines
Anxiety, restlessness, or mood swings
Heavier, longer periods
Low libido
Skin or hair changes, brittle nails

The later phase: when oestrogen starts to drop

After several years of fluctuating cycles, oestrogen levels begin to decline too. This stage - late perimenopause - is when the classic menopause symptoms show up:

Hot flushes and night sweats
Irregular (often longer) cycles
Vaginal dryness
Brain fog and poor sleep
Aching joints or tingling skin

🥵 Fact check: There are at least 33 recognised menopause symptoms, and some sources count up to 49. Not everyone gets hot flushes - around 40% never do.

Periods at this stage can still be heavy. If you’re soaking through pads or tampons hourly, passing large clots, or feeling weak and tired, it’s worth speaking with a doctor. Anaemia is common but treatable.

How do you know if it’s perimenopause?

There isn’t a single test that confirms perimenopause. Doctors usually rely on your age, cycle patterns, and symptoms. Blood tests (like FSH or LH) can help in early perimenopause, but later on hormone levels fluctuate so much that results may look “normal” even if you’re experiencing strong symptoms. That’s why the tests don’t always tell you much and are, to some extent, pointless.

What can be useful is checking your vitamin and mineral levels, since deficiencies in iron, vitamin D, or B-vitamins can worsen how you feel.

Can you still get pregnant during perimenopause?

Yes. Even with irregular periods, ovulation can still happen. Natural conception is rare but possible into your early 50s. That means contraception is still important if you don’t want to become pregnant.

On the flip side, if you are hoping for a baby, time matters. Fertility declines significantly during this stage, so seeking medical advice early can make a difference. Do you have questions about this or are you looking for support? Book an intake - we’ll be happy to help you.

Final thoughts

Perimenopause is a natural stage of life, but it can feel unsettling when your body starts changing in ways you didn’t expect. Remember: you’re not alone, and support is out there - from lifestyle strategies to medical options. At Flouria, we’re here to help you make sense of it all, so you can step into this new chapter feeling informed and empowered.

References:

Depypere, H., & Comhaire, F. (2020). The peri-menopause in a woman’s life: A systemic inflammatory phase that enables later neurodegenerative disease. Journal of Neuroinflammation, 17, 317. https://doi.org/10.1186/s12974-020-01998-9

Kim, C., Slaughter, J. C., Wang, E. T., Appiah, D., Schreiner, P. J., & Tepper, P. G. (2023). Associations of LH and FSH with reproductive hormones depending on each stage of the menopausal transition. Journal of Clinical Endocrinology & Metabolism, 108(6). https://doi.org/10.1210/clinem/dgad238

Kim, C., Slaughter, J. C., Wang, E. T., Appiah, D., Schreiner, P. J., & Tepper, P. G. (2023). Associations of follicle-stimulating hormone and luteinizing hormone with metabolic syndrome during the menopausal transition from the National Health and Nutrition Examination Survey. Frontiers in Endocrinology, 14. https://doi.org/10.3389/fendo.2023.1034934

Santoro, N., Epperson, C. N., & Mathews, S. B. (2015). Perimenopause: From research to practice. Journal of Women’s Health, 24(3), 228–236. https://doi.org/10.1089/jwh.2014.5005

Santoro, N., & Randolph, J. F. (2021). The menopause transition: Signs, symptoms, and management options. Journal of Clinical Endocrinology & Metabolism, 106(1), 1–13. https://doi.org/10.1210/clinem/dgaa764