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

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). Menopause is a retroactive diagnosis – 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. 

When can I expect to go through Perimenopause?

The timing of perimenopause/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 mid-40s.

Is there a test I can do to determine if I’m in Perimenopause?

I get asked to “test” if a patient is in perimenopause all the time, usually after a patient has seen their GP and been refused. This is one time I have to agree with the GPs: there is no point trying to test for perimenopause because it’s a time of extreme hormonal volatility, and whether or not you happen to catch the hormones at the right time is complete luck. If you’re absolutely desperate you can check something called FSH (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. Please do bear this in mind before asking your GP to 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 following 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.

Stress and Perimenopause

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 (or have been told so by their healthcare practitioner, as per above comment). They then just accept it without making any changes to their lifestyles. While it is completely possible that you’re in the earlier stages of peri at this age (where progesterone is starting to drop because egg quality is diminishing), it’s also very possible stress is causing these symptoms. These may include direct symptoms such as insomnia and weight gain and indirect symptoms 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 assume it couldn’t be stress driving (or at least significantly contributing to) your symptoms because you used to be able to handle this much in your 20s (didn’t we all!!).

Either way, managing stress (and thyroid hormones) is an important part of peri-support.

To explore perimenopause and how to manage symptoms further, book online via our website.

Thanks for reading!

Ali Berecry | Naturopath