What is perimenopause, and how do I know if I’m in it?

Menopause is a retroactive diagnosis (although we shouldn’t use the term diagnosis, because it’s not a disease, just a normal life phase) – it can only be confirmed when you’ve gone 12 months without a period (assuming a natural menopause). And yes, if you have a period after an 11-month break I’m afraid the clock starts over again.

Perimenopause takes place anywhere between 2-10 years prior to menopause and includes the first year after menopause (i.e. before the official menopause transition). When exactly you go through (peri)menopause is often dictated by genetics, but environmental influences are playing an increasing role in this (think diet, lifestyle, stress, even light exposure…).

Since it’s common to have your final period anywhere from 45 to 55, and peri can last as long as 10 years, you technically could start having perimenopause symptoms as early as your mid-30s IF you had the longest peri transition AND the earliest menopause onset. Personally, I feel like the media and health influencers have grabbed on to this to sell products or programs, because with the average age of menopause around 51, you’re more likely start experiencing symptoms around your early- to mid-40s.

I get asked to “test” if a patient is in perimenopause all the time, usually after they’ve seen their GP and been refused. This is one time I have to agree with the GPs: there is no point trying to test your hormones in perimenopause because they’re extremely volatile- they’re oscillating wildly hour-by-hour. If you’re absolutely desperate you can check something called FSH around day 2/3/4/5 (it tends to rise slowly throughout peri before it peaks at about 15x premenopausal levels), but I’ve also seen plenty of women in early perimenopause with absolutely perfect FSH levels. So please do bear this in mind before getting upset your GP won’t test this.

A far more accurate way of gauging if you’re in peri is to confirm if you’re having at least 3 of the 9 changes –

🌙 New onset of heavy/longer flow

🌙 Increased cramps

🌙 Shorter cycles (moving to less than 26 days)

🌙 Anovulatory cycles OR skipping periods (i.e. cycles lasting over 60 days)

🌙 New sore/swollen/lumpy breasts

🌙 New sleep maintenance insomnia (unable to stay asleep/fall back asleep easily when waking in the night)

🌙 Onset of night sweats, especially pre-menstrual

🌙 New/increased PMS mood swings

🌙 Unexplained weight gain

However, it’s important to rule out thyroid issues if you’re experiencing these symptoms, which can present similarly.

I would add to this to check in on stress – I see lots of women experiencing hormonal symptoms at 36/37/38 and they write it off as peri and just accept it without making any changes to their lifestyles (or jump straight to HRT). And while it is completely possible that you’re in the earlier stages of peri at this age (because progesterone is starting to drop with diminishing egg quality), it’s also very possible stress is causing these symptoms directly (insomnia and weight gain) and indirectly (impacting ovulation, which is already less-than-optimal because of your life stage). So, if you're 37 and struggling with 2 small kids, a full time job, running a household in challenging financial times and ageing parents, please don't rule out stress as a driver of (or at the very least significantly contributing to) your symptoms just because you used to be able to handle this much in your 20s (didn't we all!!).

And either way, managing stress (and thyroid hormones) is an important part of peri-support, regardless of whether you opt for HRT or not (PS, I’m actually a big advocate of the appropriate use of HRT! But I do believe diet and lifestyle still need to be addressed when these medications are employed).

If you’d like to discuss how Naturopathy can support the menopausal transition you can book in with me here