Maybe you’re still having regular periods, so menopause hasn’t crossed your mind. But lately you’re waking in the night, feeling unusually anxious, getting aches & pains, forgetting words or finding that things you used to manage now feel overwhelming.
Perimenopause can begin long before your periods become irregular. You don’t have to wait for a hot flush, either. The changes can show up in your sleep, mood, energy and concentration first.
Perimenopause, menopause and postmenopause: what’s the difference?
Perimenopause is the transition towards menopause. Your ovaries are still working, but ovulation and hormone levels become less predictable. Your periods may stay regular for a time, then become shorter, longer, heavier, lighter or more widely spaced.
Menopause is the point reached after 12 consecutive months without a period, when there is no other reason for periods to have stopped.
Postmenopause is the time after that. Some symptoms improve, but others can continue and still deserve attention.
When can it begin?
For many women, perimenopause begins in their 40s and lasts several years. There is no exact birthday when it starts, and no single pattern that every woman follows.
If you think you may be experiencing menopause symptoms before 40, speak with a doctor. Menopause before 45 is considered early; before 40, it needs particular medical assessment and support.
It isn’t just one hormone
Oestrogen does not simply decline in a straight line during perimenopause. It can fluctuate, sometimes considerably, before settling at a lower level after menopause. Changing oestrogen levels can play a part in hot flushes, night sweats, migraines, vaginal dryness and changes in sleep.
Progesterone is made after ovulation. As ovulation becomes less predictable, progesterone levels may vary too. This is part of the changing hormone picture, although symptoms alone cannot tell you exactly what your progesterone level is.
Testosterone is present in women as well and can contribute to sexual desire. Low libido, however, can also be connected to tiredness, stress, poor sleep, discomfort during sex or other health concerns. It deserves a proper conversation, rather than a quick assumption that one hormone is to blame.
These hormones interact with the rest of your health. That is why two women can experience perimenopause very differently.
What might you notice?
You may have just a few symptoms, or several that change over time:
- Sleep: difficulty falling asleep, waking at 3 a.m., night sweats or waking up exhausted.
- Mood: new anxiety, irritability, low mood or feeling less able to cope.
- Thinking: brain fog, forgetfulness, losing your train of thought or struggling to concentrate.
- Periods: cycles getting shorter or longer, missed periods, heavier bleeding or a different premenstrual pattern.
- Temperature: hot flushes or sudden episodes of sweating, during the day or at night.
- Body and energy: fatigue, headaches or migraines, joint and muscle aches, palpitations, changes in weight or body shape, dry skin or hair thinning.
- Sexual and urinary health: less interest in sex, vaginal dryness or discomfort, needing to pass urine more often, or recurrent urinary symptoms.
You do not need to tick every box. Equally, these symptoms can have other causes. If something is new, persistent or affecting your life, it is worth getting it assessed.
Will a blood test give me the answer?
During perimenopause, hormone levels can vary from day to day. One “normal” hormone result does not necessarily explain how you have been feeling. A clinician will often learn more from your age, symptoms, menstrual history and wider health picture. Tests can still be helpful when there is a reason to check for other conditions or when symptoms start unusually early.
Where do I begin?
Start by writing down what has changed. Track your periods alongside sleep, mood, energy, headaches and any symptoms that feel unfamiliar. You deserve to be taken seriously, even if your periods have not stopped.
Support can include a discussion with your health provider about menopause hormone therapy or other treatments, alongside practical attention to food, movement, strength, sleep and stress management. The right choices depend on your health history and what is troubling you most.
At Evolve Female Wellness, we can take time to look at the whole picture together. My aim is to help you understand the changes you’re experiencing, find realistic ways to support yourself and know when to seek medical care.
Please arrange a medical assessment for very heavy or unusual bleeding, bleeding after sex, symptoms suggestive of menopause before 40, or any bleeding after 12 months without a period.
Would you like more individual support?
I offer a comprehensive, individualised programme shaped around your needs and circumstances. We can explore food, lifestyle, supplements and herbs, and I can recommend testing when appropriate. Email lisa@evolvefemalewellness.com to enquire about working together.