Key facts
- Perimenopause is the phase leading up to and just after menopause. Perimenopause ends 12 months after your final period (menopause).
- Perimenopause commonly begins when you are in your 40s.
- Perimenopause lasts between 2 and 10 years, with an average around 4 to 6 years.
- Hormone levels fluctuate in perimenopause, which can cause physical, emotional and mental symptoms.
- Diagnosis is usually based on your age, symptoms and period history (menstrual pattern).
- There are lifestyle changes and medical treatments that can help you manage symptoms and look after your health and wellbeing.
What is perimenopause?
Perimenopause is the phase leading up to your final period (menopause) and for 12 months after menopause. This is the time it takes for you to be sure you have reached menopause.
Perimenopause usually starts during your 40s, although it can be earlier or later. On average, perimenopause will last for 4 to 6 years. However, everyone is different and it can last between 2 and 10 years.
In perimenopause, the hormones oestrogen and progesterone, which are produced in your ovaries, fluctuate until menopause. This causes your periods to change (become irregular, heavier or lighter), and many women start experiencing symptoms. After menopause, the levels of oestrogen and progesterone in your blood are low.
After 12 months in a row without a period, you know you have reached menopause, and perimenopause ends.
In Australia, menopause usually occurs between the ages of 45 and 55 and the average age of menopause is 51. Some might go through the menopause transition earlier or later.
You might hear people talk about ‘premenopause’, which is different to perimenopause. Premenopause refers to the years starting from when you first get your period, to when you reach perimenopause.
Find out more about menopause and postmenopause.
Menstrual changes
Changes in oestrogen and progesterone cause irregular periods, which are often one of the first signs of perimenopause. You might notice:
- your periods occur more, or less, often
- you have heavier or lighter bleeding
- your menstrual cycles vary in length
- you miss periods in some months.
Common menopause-related symptoms
Many women experience a range of symptoms during perimenopause that are related to hormone changes throughout the menopause transition. You might experience a combination of physical, emotional or mental health symptoms, or no symptoms at all.
About 1 in 2 women report mild to moderate symptoms. Around 1 in 4 women have symptoms severe enough to affect daily activities. And around 1 in 4 women have no symptoms.
You don’t have to push through symptoms or manage alone. Information, support and treatment options are available if you need them.
A few of the commonly reported symptoms include:
- hot flushes and night sweats
- brain fog
- trouble sleeping
- joint and muscle pain
- low mood and mood changes
- anxiety
- dry or itchy skin
- vaginal dryness and irritation
- urinary (wee/bladder) problems
- loss of interest in sex
- increased belly fat.
Not all health issues and symptoms experienced at this time of life are due directly to the menopause transition.
It is important that you seek advice from a doctor to rule out other causes for your symptoms, get an accurate diagnosis and receive appropriate care.
Find out more about symptoms and managing your symptoms.
Diagnosis
A doctor will be able to determine if you are in perimenopause based on your age, symptoms and period history (menstrual pattern).
If you are in the typical age range for menopause (45 to 55 years), doctors don’t usually measure your hormone levels to check if you are in perimenopause. This is because hormone levels fluctuate during perimenopause so blood testing might not show any changes.
Your doctor does not need a blood test to discuss management and treatment options with you.
If you are younger than 45 years and your periods are irregular or have stopped, your doctor should measure your hormone levels to understand what’s causing the change.
At any age, your doctor might suggest health checks and blood tests to rule out other causes for the symptoms you are experiencing, like problems with your thyroid or low iron. Your doctor might also recommend tests and checks for conditions like osteoporosis or heart disease as part of a general health check.
Fertility and contraception
Pregnancy is still possible during perimenopause. Even if your periods are irregular, your ovaries still occasionally release eggs. If you don’t want to become pregnant, it is important to consider contraception at least until the end of perimenopause (12 months after your final period).
The Jean Hailes for Women’s Health website has information for women at all stages of life, including information on contraception.
Management and treatment options
If you have menopause-related symptoms that are affecting your quality of life, there are many management and treatment options you can consider. Talk to a doctor about options that might be suitable for you.
Your doctor might discuss:
- lifestyle and behavioural strategies
- physical therapy and interventions for some bladder problems
- Menopausal Hormone Therapy (MHT) (sometimes called Hormone Replacement Therapy or HRT)
- hormonal contraceptives
- non‑hormonal prescription medicines
- non-prescription medicines for treatment or management of symptoms.
Find out more about managing your symptoms and treatment options.
Keeping healthy and ageing well
Looking after your health is important leading up to and during the menopause transition.
The reduction in hormones at menopause, and changes in your body as you age, can have significant health impacts. This can increase your risk of:
- bone loss, which increases the risk of osteoporosis and fractures
- vaginal dryness, irritation and painful sex
- bladder irritability and urinary tract infections
- muscle loss, which makes it harder to do everyday activities
- heart disease
- insulin resistance (increased risk of diabetes).
There are lots of things you can do now that will help you feel healthier and stronger later in life and reduce your risk of developing disease. Some of these things can also help manage menopause-related symptoms. They include:
- eating a healthy diet with lots of fruit, vegetables, lean protein, dairy or alternatives, and whole grains
- limiting alcohol and caffeine intake
- stopping and avoiding smoking and vaping
- being active, including weight bearing, resistance and aerobic exercise
- looking after your bone health
- maintaining a healthy body weight
- having a good sleep routine
- looking after your mental health and emotional wellbeing, including staying socially connected and mentally engaged.
Don’t forget to also keep up to date with recommended health checks, including:
- breast screening
- cervical screening
- bowel cancer screening
- lung cancer screening for eligible people
- blood pressure and cholesterol checks
- bone density assessments for those at risk of bone loss or osteoporosis.
The Jean Hailes for Women’s Health website has lots of tips and information to help keep you healthy, including:
- Staying healthy
- Health checks for your age
- Looking after yourself around the time of menopause
- Health after menopause.
Healthy Bones Australia also has information on exercise and maintaining bone health.
When to see a doctor
If you have menopause-related symptoms that are impacting your life or worrying you, it is important to talk to a doctor. There are treatment and support options that can help.
Not all health issues and concerns experienced in your midlife are due directly to the menopause transition. Some symptoms can also be due to other health conditions or issues. For example, low iron (caused by heavy periods) is a common cause of fatigue.
It is important that you talk to a doctor to get an accurate diagnosis and appropriate care.