Whether you’re in the midst of perimenopause or worried about what’s to come, it’s best to keep informed. Writer Alyssa Jaffer speaks to an array of experts and reveals everything you need to know and what to expect from the menopause and beyond.
Due to a historical lack of funding for research on women’s health — what’s known as the gender health gap — there’s a lot we still don’t know or understand about how the menopause affects women when it comes to ageing and age-related diseases, as well as treatment and support such as hormone replacement therapy (HRT).
That’s why we asked medically certified experts on the menopause Dr Elizabeth A. Poynor, Dr Maria Knöbel, Miss Smita Sinha and Dr Anna Cantlay to break down all the commonly asked questions when it comes to the menopause and perimenopause.
What are perimenopause and menopause?
Perimenopause refers to the transitional stage that leads up to the menopause, which is technically just one day — a day that marks 12 months without periods.
“This time is characterised by significant hormonal fluctuations and changes in menstrual patterns. Perimenopause is associated with a decline in ovarian function, leading to fluctuating levels of oestrogen, ultimately resulting in decreased levels of oestrogen and progesterone,” says Dr Poynor, a gynaecological oncologist and women’s health specialist.
“Menopause is defined as the permanent cessation of menstruation, diagnosed after 12 consecutive months of no menses, resulting from the loss of ovarian activity,” she explains.
Read more: Perimenopause vs menopause and everything you need to know about ‘the change’
At what age does perimenopause start?
Unfortunately, there’s no simple answer as it varies for each woman.
“Perimenopause typically starts in the early to mid-forties and lasts for several years. Most women in the UK become menopausal around the age of 51,” says GP and British Menopause Society accredited advanced menopause specialist Dr Cantlay. “Some women may go through an early menopause under the age of 45, or have premature ovarian insufficiency where their ovaries stop working properly before they turn 40.”
How long do perimenopause and the menopause last?
Again, it depends — how long these phases last vary from one woman to the next.
“Perimenopause can last anywhere from a few months to several years, typically ranging from four to eight years and a variety of symptoms may occur in this time, with or without changes to periods,” says Miss Sinha, a consultant gynaecologist and founder of Serenity Women’s Clinic.
“Menopause itself is a single point in time — one year after the last period — after which a woman is considered postmenopausal,” she adds.
Read more: Menopause treatments to discuss with your doctor (from HRT to non-hormonal options)
What are the 34 symptoms of perimenopause?
If you’re going through the menopause yourself, you’ll know there are lots of symptoms — literally dozens of them. Not everyone experiences perimenopause and menopause, and their symptoms, the same way, but there are telltale signs that your hormones are changing. The list is long, and you might be surprised at how your body responds to the menopause.
“The 34 symptoms of perimenopause list is a popular concept that aims to highlight the wide range of symptoms women may experience during perimenopause and menopause, due to the widespread affect across the body from hormonal changes,” says Miss Sinha.
The 34 symptoms of perimenopause are:
- Hot flushes
- Night sweats
- Irregular periods
- Mood swings
- Sleep disturbances
- Vaginal dryness
- Reduced libido
- Memory problems
- Difficulty concentrating
- Fatigue
- Weight gain
- Hair loss or thinning
- Joint pain
- Muscle aches
- Breast tenderness
- Headaches
- Heart palpitations
- Anxiety
- Irritability
- Depression
- Dizziness
- Bloating
- Changes in body odour
- Dry or itchy skin
- Tingling extremities
- Urinary issues
- Digestive problems
- Brittle nails
- Allergies
- Osteoporosis risk
- Gum problems
- Changes in taste
- Electric shock sensations
- Burning mouth syndrome
What are the worst symptoms?
The answer will vary depending on who you ask. Some women can experience disruptive hot flashes throughout the day and night, others might find brain fog particularly frustrating, while others may point to mood swings, headaches or weight gain as the most intense symptoms of perimenopause and some report changes in libido due to low testosterone impacts relationships.
It can be unpredictable and different for each person experiencing the menopause.
What are the first signs of perimenopause?
“The early signs of perimenopause often don’t include changes in the menstrual cycle or hot flushes,” says Miss Sinha. “More often, women experience mood swings, sleep disturbance and increased anxiety or irritability. Some women may also experience fatigue, changes in sexual experience and reduced libido. These symptoms occur due to fluctuating hormone levels, particularly oestrogen.”
How do you diagnose perimenopause? Is there a test?
There isn’t a definitive test to diagnose perimenopause, but a blood test to check hormone levels such as follicle-stimulating hormone (FSH) and oestrogen can help — especially in younger women. Instead, perimenopause is diagnosed based on symptoms, changes in menstrual patterns and age.
“If a woman in her 40s begins to experience irregular periods, mood changes or hot flashes, these are strong indicators of perimenopause,” explains GP and menopause care specialist Dr Knöbel.
Can you get pregnant during perimenopause?
“Yes,” says Dr Poynor definitively. Although fertility declines significantly as you approach the menopause and ovulation becomes less predictable, it doesn’t stop entirely.
“Contraception is needed if you don’t want to get pregnant during perimenopause,” she recommends.
Can periods stop suddenly in perimenopause?
“Yes, for some women periods can stop suddenly during menopause. However, it’s more common for periods to become irregular before they cease entirely. This irregularity is due to fluctuating hormone levels, particularly oestrogen and progesterone, which control the menstrual cycle,” says Dr Knöbel.
How long is too long for a period during perimenopause?
When you’re going through perimenopause, you may notice changes to your menstrual period as your body begins to prepare for the menopause. As periods become either shorter or longer or wholly unpredictable, a commonly asked question is how long is too long for a period during perimenopause?
“If a period lasts more than seven days or is excessively heavy, requiring you to change your sanitary protection every hour, you should immediately consult a doctor,” advises Dr Knöbel. “Excessively prolonged or intense bleeding could indicate other underlying issues such as fibroids or hormonal imbalances, which should be evaluated.”
How long do perimenopause symptoms last and what are the signs of coming to the end of menopause?
“A common misconception is that menopause ‘ends’ after a period of time. If only that were so!” says Dr Cantlay.
“Once your periods have stopped you spend the rest of your life postmenopausal and your level of
female hormones remain low. Some symptoms related to the hormonal chaos of perimenopause may settle with time.
“But for some women, they may remain troubled by bothersome symptoms — speak to your GP or menopause specialist if that’s the case and don’t suffer in silence,” she advises.
What happens after the menopause?
“After menopause, women enter a phase known as postmenopause. During this time, the body’s levels of hormones, particularly oestrogen, stabilise at lower levels,” says Miss Sinha. “Some women may find that menopause symptoms such as hot flushes and night sweats gradually decrease or resolve, while others may continue to experience symptoms for several years.”
“The decrease in oestrogen increases the risk of osteoporosis, as bone density tends to decrease more rapidly,” adds Dr Knöbel. “Cardiovascular health also becomes more of a focus, as oestrogen plays a protective role in heart health. Many women also experience vaginal dryness or discomfort during intercourse due to the lack of natural lubrication, but treatments like hormone replacement therapy or non-hormonal options can help manage these symptoms,” she says.
If you’re experiencing perimenopause or menopausal symptoms, it’s important to speak to your GP or an expert to support you during this significant life stage.
