What is perimenopause?

Perimenopause is the stage of life leading up to your last menstrual period. During this stage you may have some of the symptoms of menopause.

Perimenopause ends one year after your last period — this is known as menopause. The next life stage is known as post-menopause.

Perimenopause usually starts in your 40s. On average, perimenopause lasts 4 to 6 years. However, it can last from 1 to 10 years.

What are the symptoms of perimenopause?

A common symptom of perimenopause is irregular periods.

Your periods may:

• come more or less often
• be longer or shorter than usual
• be lighter or heavier than usual

Some months you might not get a period. It can change from month to month.

What other perimenopause symptoms may I get?

Most females will have some physical or emotional symptoms of menopause.

About:

• 3 in 5 females will have mild to moderate symptoms
• 1 in 5 females will have symptoms severe enough to affect their daily activities
• 1 in 5 females won’t have any symptoms at all

Physical symptoms of perimenopause may include:

• hot flushes and night sweats
• disturbed sleep and tiredness
• headaches
• sore muscles and joints
• vaginal dryness
• sore breasts

Emotional and mental symptoms of perimenopause may include:

• mood swings
• brain fog
• anxiety or depression

You may also have weight gain despite not changing your diet or exercise.

What causes perimenopause?

Perimenopause takes place as your ovaries start to run out of eggs.

The levels of hormones in your body, such as oestrogen, change during this time. Changes in your hormone levels can cause perimenopausal symptoms like hot flushes.

Some people experience sudden menopause because of surgery or cancer treatment.

When should I see my doctor?

You should speak with your doctor if you are having trouble with perimenopause symptoms.

Even though changes in your periods are normal in perimenopause, you should see your doctor if:

• your bleeding is very heavy or continues for a long time
• you have bleeding after not having your period for a year
• bleeding happens after you’ve had sex
• you have polycystic ovarian syndrome (PCOS)
• you are obese

Your doctor may refer you to a:

• gynaecologist (specialist in female health)
• psychologist
• endocrinologist (hormone doctor)
• dietitian

How is perimenopause diagnosed?

Your doctor will talk to you about your symptoms.

If you’re under 45 years, your doctor may arrange a blood test to check your level of follicle stimulating hormone (FSH). This test can help to rule out other causes for your symptoms.

Your doctor will talk about treatment options with you.

They may also discuss:

• stopping smoking
• healthy eating
• regular exercise
• reducing your alcohol intake

Your doctor will also talk to you about contraception.

How is perimenopause treated?

Your treatment will depend on the symptoms that are bothering you.

There are 3 treatment categories:

1. menopausal hormone therapy (MHT), also called hormone replacement therapy (HRT)
2. non-hormonal prescription treatments
3. complementary therapies

Menopausal hormone therapy

The use of menopausal hormone therapy is considered safe when started before 60 years.

However, treatment is not advised if:

• you have or have had a hormone-dependent cancer (for example, breast cancer or endometrial cancer)
• unexplained vaginal bleeding

Non-hormonal prescription treatments

There are some non-hormonal treatments that can help with hot flushes and night sweats.

Can I take herbal medicines?

Traditionally, medicinal plants and herbs have been used to help manage menopausal symptoms. However, more research is needed about their effectiveness and safety.

There is some evidence that St John's wort may reduce hot flushes and improve your mood. This happens when it’s taken with black cohosh or passionflower.

It’s best to get advice from a health professional with training in herbal medicine use. Always check with your doctor before taking any herbal medicines.

Lifestyle changes

You might find the symptoms ease if you:

• get enough sleep
• lower stress where possible
• lose weight, if you are overweight

Hot flushes may be eased by:

• cutting back on tea, coffee and other drinks with caffeine
• avoiding alcohol and spicy foods
• eating foods that have phytoestrogens, such as tofu, whole grains, beans and lentils
• using fans or air conditioning
• drinking cool drinks
• dressing in layers, so that you can take off some clothing when you feel hot

If you suffer from vaginal dryness, you can use lubricants to feel more comfortable.

Can perimenopause be prevented?

Perimenopause is the life-stage before menopause and cannot be prevented.

Complications of perimenopause

Females with a history of major depressive disorder and hormone-related mood conditions are at risk of depression.

Pregnancy

You can still become pregnant before you reach menopause.

A missing period may mean you are pregnant. It’s important to take a pregnancy test if you miss a period.

You should use contraception during perimenopause if you don’t want to be pregnant.

Resources and support

NSW Health has a list of perimenopause symptoms to help you have conversations with your doctor. The list is available in English and other languages. There is also a checklist for Aboriginal women and an easy-read checklist.

Partners and families of people experiencing perimenopause can learn more at:

• Jean Hailes — information for partners
• NSW Health — understanding menopause for partners and families

You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with 24 hours a day, 7 days a week.