What is perimenopause and just how early can it start?

Written by
Eleni Stefanou

Medically reviewed by
Dr Georgina Leslie, Clinical Lead at Bloomful

Updated on
10 Apr 2024

Quick facts

As you head towards menopause (which is when your menstrual cycles stop), your hormone levels begin to fluctuate. This phase is called perimenopause and can introduce new hurdles in your life (emphasis on can).
Often, women notice symptoms in their 40s, but they can also make an earlier appearance.
On average, perimenopause lasts 3-4 years. In some cases, it can last 10 years.

Why should I start thinking about it now?

While most of us are aware of the hormone headliner that is menopause, perimenopause is the lesser known supporting act. This means you could be experiencing symptoms and not link it to perimenopause, especially if you’re younger and have put thinking about the menopause off until much later in life.

Symptoms aside, knowing you’re in perimenopause can help you plan for Big Life Changes. For example, you might want to speak to a doctor about your fertility plans (more on this below) and start building healthy routines to protect your body from the possible long-term effects of hormone decline, such as loss of bone density (strength), heart disease and osteoporosis.

What happens to my body during perimenopause?

Ovaries are responsible for producing most of our oestrogen, progesterone and testosterone. As we age, our ovarian function slowly declines and, with it, so do these important hormones. Before our ovaries officially retire, some of our hormones actually step things up with the goal of helping our ovaries perform like they used to. This hormone fluctuation is characteristic of perimenopause.

While common menopause symptoms include hot flushes, night sweats and mood swings, perimenopause symptoms can be more subtle. Here are some signs to look out for:

Irregular periods
Brain fog
Loss of confidence
Flat mood, anxiety and depression
Low stamina and fatigue
Poor sleep
Migraines
Irritable bowel symptoms (eg bloating, diarrhoea)
Bladder problems
Vaginal dryness
Reduced muscle strength
Muscle and joint aches, stiffness and swelling
Pins and needles
Weight gain

Talk to a health coach

Is oestrogen decline a big deal?

In short, yes. Oestrogen plays an active role in functions such as maintaining bone strength and cholesterol levels and, of course, facilitating fertility.

We’re holistic beings with hormone receptors throughout our body. This means all our systems can be affected by the drop in hormones during perimenopause and menopause. Research shows it can increase the risk of heart disease, type 2 diabetes, autoimmune and inflammatory conditions, depression and dementia.

How can perimenopause symptoms be treated?

The good news is there are lots of ways to improve your symptoms and positively impact your long-term health. Most important is embracing healthy lifestyle habits, but there are also effective medical treatments such as hormone replacement therapy (HRT).

HRT comes in many forms and doses and the relief can be pretty quick after starting treatment. Speak to a menopause specialist or your GP to find the right HRT solution for you.

When it comes to lifestyle changes, research findings support:

Sticking to a Mediterranean-style diet to protect against conditions such as heart disease, which you’re more at risk of developing when your hormone levels decline.

Reducing alcohol and smoking, which has a similar effect to healthy eating.

Regular physical activity, which helps maintain a healthy heart and build muscle strength. Weight training in particular can help to preserve bone density and offset bone loss by applying resistance to the muscles.

Minimising stress achieves overall goodness. It makes it easier to get good sleep, manage your emotions and reduce fatigue and migraines. Stress increases cortisol levels, which has a knock-on effect on your sex hormones.

Getting good sleep helps regulate your circadian rhythm, a set of natural processes that occur over a 24-hour cycle. It also helps with stress, fatigue, brain fog, and mood. A cool, dark room will help to ease sleep disturbances such as night sweats.

Pacing yourself and avoiding exertion. By pushing through with your symptoms, there’s a good chance you’ll make them worse. Spreading your activities out and balancing work with rest is key.

When should I expect to experience the first signs?

Most women will experience the first symptoms of perimenopause in their 40s. Some enter the perimenopause and menopause in their 30s and even 20s. This is known as premature ovarian insufficiency (POI) or premature menopause (if your periods cease altogether). This is rare and occurs in 1 in 100 women under 40 and 1 in 1,000 women under 30.

The result of these conditions is low oestrogen for a longer period of time compared to women who experience menopause in middle age. This means the effects of hormone decline can impact you even more.

Do I need to speak to a doctor if I notice symptoms?

Yes. Especially if you’re experiencing heavier or prolonged periods or bleeding outside of your normal period (this can be a sign of cancer).

The right treatment will depend on the symptoms you’re experiencing and how they’re impacting your life. Hormone-related symptoms can overlap with other conditions, but if you’re struggling to get to the root of a problem, get an accurate diagnosis or helpful treatment, then don’t be afraid to raise the flag that this could be perimenopause.

Will perimenopause affect my fertility?

No easy way to say this, but ultimately, yes. Because our ovarian function declines in the lead up to menopause, this can mean fewer periods, which in turn can narrow the opportunities to conceive. Having said that, it is possible to get pregnant when you’re in perimenopause.

It's important to be aware of any signs of perimenopause before starting in vitro fertilisation (IVF). Don’t let it put you off IVF, but be aware that your symptoms may worsen with the hormone fluctuations you experience after giving birth.