Perimenopause (commonly referred to as the menopausal transition) is the period of time prior to menopause. During perimenopause, estrogen production starts to decrease causing menopausal symptoms – women experience changing menstrual cycles, hot flashes, sleep problems, vaginal dryness and mood swings.

Perimenopause symptoms can last for years and women can experience symptoms either all at once or one after the other. Once a woman has gone a year without a menstrual period, it’s likely that menopause has begun.


During perimenopause, your ovaries begin to produce fewer hormones causing a change to your menstrual periods. The average age for perimenopause is as early as the mid-30s for some women however is more common as females reach the mid-40s.

What hormonal changes occur during the menopausal transition?

Hormones work together to keep a balance. As hormone levels fluctuate, they trigger the ovaries or the pituitary glands to make other hormones, causing a change to the hormone balance.

Inhibin levels decrease

The first hormone level to decrease is Inhibin. When Inhibin decreases, it tells the pituitary gland to make less follicle-stimulating hormone (FSH).

FSH levels fluctuate

FSH levels often fluctuate depending on the stage the woman is at in the menopause transition. Levels can be high one minute and low the next. When levels are high, the ovaries produce estrogen and when they are low, levels drop.

Progesterone levels decrease

Progesterone is made by the ovaries after a menstrual period. As a woman ovulates less frequently, progesterone levels decrease and cause irregular menstrual periods.


Risk factors

Menopause is an ordinary part of a woman’s life, but it occasionally happens earlier in some women than others. Evidence suggests that the below factors make it more likely to reach menopause earlier.


Early perimenopause occurs more commonly in women that smoke than those who do not.

Family history

Women with a family history of early menopause may experience natural menopause early themselves.

Cancer treatments

Chemotherapy treatment has been linked to early menopause.


A hysterectomy that removes your uterus, but not your ovaries, usually doesn’t cause menopause. Although you no longer have periods, your ovaries still produce estrogen. But such surgery may cause menopause to occur earlier than average. Also, if you have one ovary removed, the remaining ovary might stop working sooner than expected.

Perimenopausal symptoms

Symptoms of perimenopause are different for every woman. Many women experience mild symptoms that can be treated by a few lifestyle changes like avoiding caffeine whereas some women never require treatment at all.

Below are the most common symptoms you might notice.

Changes to your menstrual period

This is what most women notice first. You may notice that you experience irregular periods – they may become shorter or longer than usual and you may bleed much more or much less.

These symptoms are incredibly normal but if you experience any of the following you should consider getting checked out by a healthcare professional:

  • Extremely heavy bleeding
  • Spotting between periods
  • Periods that last longer than a week
  • Menstrual bleeding that resumes after a year or more of no bleeding

Hot flashes

Hot flashes are the most common symptom of menopause. They are often related to changing estrogen levels and involve a sudden flash of heat in the upper part or all of your body.

Your face and neck may become warm and red and these may be accompanied by sweating, cold shivering and a rapid heartbeat. They usually last up to 5 minutes.

Night sweats

Night sweats are similar to hot flashes, except they occur at night and interfere with sleep.

You may sweat so much that your bed sheets and pyjamas are wet, and this may be accompanied by a rapid heartbeat.

Sleep problems

During perimenopause, some women also have problems with sleeping, forgetfulness, and depression/anxiety. A decrease in sex drive (libido) is also quite common. While many of these symptoms can be a result of dropping estrogen levels, they may also be a sign of other medical conditions. If you experience any of these symptoms, please talk to your doctor to get the proper care.

Mood swings

Mood swings and irritability are extremely common around menopause, and scientists aren’t exactly sure why this happens however studies suggest that mood changes may be linked to sleep problems associated with night sweats.

Vaginal atrophy

Declining estrogen levels around menopause lead to vaginal dryness. This can make sexual intercourse uncomfortable for many women as it can cause a feeling of tightness, burning, or soreness.

Perimenopause diet

Treatments for perimenopausal symptoms

Deciding how to treat menopausal symptoms can be complicated and personal. Some women seek treatment from medical professionals for symptoms of perimenopause such as vaginal dryness and hot flashes.

The main treatment for symptoms of menopause is hormone therapy. It replaces the hormones that are missing in the body such as estrogen and is extremely effective at relieving many of the menopause-like symptoms.

There are a variety of non-invasive treatments and lifestyle changes available to make you feel better including:

  • Yoga
  • Regular exercise
  • Meditation
  • Losing weight
  • Cognitive behavioural therapy (CBT)
  • Wearing light clothing

Complimentary and alternative therapies such as herbal treatments are also available, however, these are not typically recommended as it’s unclear how safe or effective they are.

If you are struggling with the symptoms or the menopause, make an appointment with your doctor or gynaecologist to develop a treatment plan as they should be able to help you alleviate symptoms such as:

  • Abnormal bleeding – hormone therapy can help to establish create a regular menstrual cycle.
  • Depression – medicine such as anti-depressants can help to improve low mood as well as other treatments such as cognitive behavioural therapy (CBT).
  • Reduced sexual desire – testosterone gel can be offered to help restore sex drive.

Some women will continue to feel the symptoms of perimenopause for many years and it is common to have hot flashes, night sweats and mood swings as you age. If you are suffering from symptoms, know that you aren’t alone. It’s important to speak to your doctor if you feel overwhelmed or have any questions as they can ensure you get the help and support you need.