The ‘perimenopause’- what is it and why does it happen…

Perimenopause is a term we hear a lot these days, but when does it happen, what should we be looking out for, and what can be done? 

Mr Paul Simpson, Consultant Gynaecologist and Menopause Lead at the Norfolk & Norwich University Hospital, Norfolk Menopause co-founder and member of the British Menopause Society, medical advisory council has a huge amount of experiencing in helping women navigate this difficult time.  He provides a comprehensive insight into this time of life to help you understand what is happening to you and your body.

The perimenopause is the natural transition from the reproductive phase of your life into the time after your periods stop.  It is typically spread over several years and is associated with both physical and psychological symptoms.  The range and severity of symptoms varies between women, but they are all driven by hormonal changes, particularly the significant reduction of oestrogen levels in the body.

The menopause is defined as the last menstrual period and is confirmed once you have missed your period for twelve months in a row.  The average age when this happens is 51 but it can occur between 40 and 60.  It is difficult to predict when this will happen for someone, but genetics seem to play a role and environmental influences, such a smoking can cause it to happen up to two years earlier.  The age of your mother can give some idea, particularly if this was early but it can be difficult to be certain about timings. 

As the number of eggs in the ovaries reduce, ovulation becomes less predictable, and this leads to changes to your menstrual cycle.  You may notice that the length of your bleed time changes or the time between one period at the next becomes more uncertain.  This is the beginning of the perimenopause and can start many years before your periods stop- sometimes as many 4-8 years before.  The continued reduction of eggs eventually reaches a level where ovulation does not occur every month and can lead to missed periods and reduced oestrogen levels in the blood stream.  It is this reduction in hormone levels that typically leads to physical symptoms, such as hot flushes.

The symptoms of the perimenopause can be very variable.  Some women will experience extreme symptoms of hot flushes, night sweats, mood swings, sleep disturbance and anxiety, whilst some women will experience very few symptoms.  The onset of symptoms can occur before any changes to periods have been noticed and in these circumstances the symptoms can often be more psychological type symptoms, such as an increase in mood swings, anxiety and a loss of confidence.  These symptoms often follow the menstrual cycle, in a similar way to pre-menstrual syndrome (PMS).

Unfortunately, doctors find it very difficult to predict who will get symptoms, how severe they might be and how long they might last.  The most bothersome symptoms tend to be around the perimenopause and typically last two to seven years, although the severity of the symptoms tends to reduce over this timescale.  This can be frustrating, as the duration and severity of symptoms is often key to whether a person decides to seek help and whether treatment is advised.

The good news is that there is help available- whether it is period irregularity, physical symptoms such as hot flushes, or psychological symptoms such as mood swings and anxiety, treatments can provide a significant relief from symptoms.  A combination of hormonal medications, non-hormonal medications, lifestyle modifications and dietary changes, can all provide valuable support for those that need it.  

If you would like to know more, please do visit the Norfolk Menopause website ( for further information and consider booking an appointment with one of the Norfolk Menopause team.  We are here to support you on your menopause journey. 

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