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Understanding Perimenopause: What Happens and When?

Perimenopause is the stage of hormonal change that leads up to menopause. It can begin several years before periods stop completely, and for many women it is a time when changes in both body and mind can feel unexpected or difficult to understand.

For some women, the changes are subtle. For others, symptoms can have a significant impact on work, relationships, sleep, confidence and everyday life.

What is perimenopause?

Perimenopause happens as ovarian hormone production becomes more variable and, over time, begins to decline.

One of the earliest signs can be a change in your menstrual cycle. Periods may become closer together, further apart, heavier, lighter or less predictable.

But hormonal changes can affect much more than your periods.

Women may experience symptoms including:

Not every woman experiences the same symptoms, and symptoms can change over time.

When does perimenopause start?

There is no single age at which perimenopause begins.

For many women, the transition occurs during their 40s, although it can happen earlier or later. The timing and experience can vary considerably between individuals.

Importantly, you do not need to wait until your periods have stopped before discussing your symptoms with a healthcare professional.

For women aged 45 and over, perimenopause and menopause can often be identified from symptoms and changes in the menstrual cycle rather than relying on routine hormone blood tests. Your individual history and symptoms remain an important part of the assessment.

Why can it feel so confusing?

Perimenopause does not always announce itself clearly.

A woman may notice that she is sleeping badly, feeling more anxious, struggling to concentrate or experiencing changes in her body without immediately connecting these symptoms with hormonal changes.

This can be particularly difficult for women who have previously felt healthy and in control of their bodies.

It is also possible to experience some symptoms without having obvious changes in your periods.

Understanding what is happening can be an important first step towards finding the right support.

What can help?

There is no single approach that is right for every woman.

Management may include lifestyle measures, psychological support, non-hormonal treatments or hormone replacement therapy (HRT), depending on symptoms, medical history, preferences and individual circumstances.

The aim is not simply to treat a hormone level. It is to understand the woman as a whole and develop an approach that is appropriate for her.

When should you seek medical advice?

If you think you may be experiencing perimenopause, you do not have to struggle through the symptoms alone.

A consultation can provide an opportunity to discuss what has changed, consider other possible causes for your symptoms where appropriate, and talk through the treatment and support options available to you.

If your periods have changed significantly, you have new or troublesome symptoms, or you are simply wondering whether what you are experiencing could be related to perimenopause, it is reasonable to seek medical advice.

At VERA MD

At VERA MD, we believe menopause care should begin with listening.

Perimenopause can be a complicated and sometimes unsettling stage of life, but understanding the changes taking place can make them feel much less overwhelming.

Our aim is to provide personalised, evidence-informed care that considers your symptoms, your health and your individual circumstances.

You don't have to simply put up with feeling unlike yourself.

If you are unsure whether your symptoms could be related to perimenopause, a menopause consultation can be a good place to start.

This article is intended for general information and does not replace individual medical advice. If you have concerns about your symptoms or health, please speak with an appropriately qualified healthcare professional.