For many women, perimenopause seems to arrive without warning. One month your cycle is predictable; the next, your period is early, your sleep is disturbed and you cannot remember why you walked into the kitchen.
Although perimenopause is usually associated with the 40s, hormonal changes can begin earlier. The symptoms can also be surprisingly varied, which means they are not always immediately connected with perimenopause.
So, what is considered a common part of the transition, and which changes should be discussed with your GP?
What Is Perimenopause?
Perimenopause means “around menopause”. It describes the transitional stage leading up to menopause, during which levels of hormones such as oestrogen and progesterone begin to fluctuate.
Menopause itself is reached when you have not had a period for 12 consecutive months. Until then, changing or irregular periods may be part of perimenopause.
Perimenopause most commonly begins during the 40s, but every woman’s experience is different. Some notice gradual changes over several years, while others experience symptoms much more suddenly.
Can Perimenopause Begin in Your 30s?
It can, but symptoms or significant changes to your periods before the age of 40 should not automatically be assumed to be perimenopause.
Menopause occurring before the age of 45 is described as early menopause. When it occurs before 40, it is known as premature menopause or premature ovarian insufficiency.
There are also several other reasons why periods, mood, sleep or energy levels might change. These include pregnancy, thyroid conditions, polycystic ovary syndrome, endometriosis, fibroids, iron deficiency, certain medicines and periods of considerable physical or emotional stress.
If you are under 45 and believe you may be experiencing perimenopause, particularly if your periods have become very infrequent or stopped, speak to your GP. They can consider your symptoms, medical history and whether further investigation is appropriate.
Common Signs of Perimenopause
Perimenopause does not look exactly the same for everyone. Some women experience several symptoms, while others notice only a change in their cycle.
Common changes can include:
- Periods becoming earlier, later, heavier or lighter
- Hot flushes or night sweats
- Difficulty falling asleep or staying asleep
- Feeling unusually tired
- Mood changes, irritability or anxiety
- Poor concentration or “brain fog”
- Headaches or more noticeable migraines
- Heart palpitations
- Reduced sex drive
- Vaginal dryness or discomfort during sex
- Aching joints or muscle discomfort
- Changes in body shape or weight
- Needing to urinate more often
Symptoms may come and go. You might feel completely yourself for several weeks and then find that several symptoms appear together. This unpredictability is often one of the most frustrating parts of perimenopause.
What Is “Normal”?
Changes to the timing and flow of periods are common during perimenopause. A previously regular cycle may become shorter, longer or occasionally skip a month. Hot flushes, disturbed sleep and changes in mood or concentration are also widely reported.
However, “common” does not mean that you simply have to put up with symptoms that are affecting your work, relationships, confidence or quality of life. Support and treatment are available, and you do not need to wait until your periods stop before speaking to your GP.
It can be useful to keep a simple diary of:
- Period dates and changes in flow
- Hot flushes and night sweats
- Sleep quality
- Mood and energy levels
- Headaches or migraines
- Any vaginal or urinary symptoms
Looking for patterns can make it easier to explain what has changed and how frequently symptoms are occurring.
What Should Be Checked?
Not every change in your late 30s or 40s is caused by perimenopause. Arrange an appointment with your GP if:
- Your periods stop unexpectedly before the age of 45
- Your periods become very heavy or interfere with everyday life
- You regularly bleed between periods
- You experience bleeding after sex
- You develop new or severe pelvic pain
- Symptoms are having a significant effect on your mental health
- You are concerned that something simply does not feel right
Heavy bleeding may include needing to change period protection every one to two hours, using two types of protection together or regularly bleeding through clothing or bedding.
Once you have gone for 12 months without a period, any subsequent bleeding or spotting should always be checked by a GP, even if it happens only once.
Seek urgent medical advice if bleeding is extremely heavy, you feel faint or very unwell, or you experience severe abdominal or pelvic pain.
Supporting Yourself Through Perimenopause
There is no single perfect perimenopause routine. Small, consistent habits are generally more manageable than attempting to change everything at once.
Eat Regular, Balanced Meals
Include a variety of vegetables, fruit, wholegrains, protein and healthy fats. Protein-rich foods can be particularly helpful for maintaining muscle as we get older, while calcium and vitamin D have important roles in maintaining normal bones.
If changes in your cycle have made your periods heavier, speak to your GP about whether your iron levels should be checked rather than immediately starting a high-dose iron supplement.
Make Time for Strength and Movement
Walking, swimming, cycling and other enjoyable cardiovascular activities can support general health and wellbeing. Strength and weight-bearing exercise are also valuable for maintaining muscles and bones.
The best exercise is not necessarily the most punishing one. It is the one you can do consistently without dreading every minute of it.
Protect Your Sleep Routine
Try to keep waking and sleeping times reasonably consistent. A cooler bedroom, breathable nightwear and reducing alcohol close to bedtime may help if night sweats or broken sleep are becoming troublesome.
Caffeine can also affect sleep and may make palpitations or hot flushes feel more noticeable in some people. Keeping a symptom diary can help you identify your own triggers without unnecessarily eliminating everything enjoyable from your life.
Make Space for Recovery
Hormonal changes, poor sleep and a busy life can be an exhausting combination. Gentle movement, breathing exercises, quiet time and realistic boundaries may support everyday wellbeing.
Rest is not laziness, it is basic maintenance.
Can Supplements Support Your Routine?
Supplements do not stop perimenopause or correct changing hormone levels. However, they can help provide particular nutrients when dietary intake is insufficient.
Magnesium
Magnesium contributes to normal psychological function, normal muscle function and the reduction of tiredness and fatigue. It is found naturally in foods including nuts, seeds, wholegrains, beans and leafy green vegetables.
A magnesium supplement may be worth considering if you struggle to obtain enough through your usual diet. Different forms and strengths are available, so always follow the product directions.
Vitamin B Complex
B vitamins perform several important roles in the body. Vitamins B6 and B12 contribute to normal energy-yielding metabolism, normal psychological function and the reduction of tiredness and fatigue. Vitamin B6 also contributes to the regulation of hormonal activity.
A balanced B-complex supplement can offer a convenient combination of B vitamins, but it should complement a varied diet rather than replace one.
Omega Oils
Oily fish such as salmon, sardines and mackerel provide the long-chain omega-3 fatty acids EPA and DHA. EPA and DHA contribute to the normal function of the heart, while DHA contributes to the maintenance of normal brain function.*
Plant foods such as flaxseed, chia seeds and walnuts provide alpha-linolenic acid, or ALA, another type of omega-3 fatty acid.
When choosing an omega supplement, check the label for the amounts and sources of the individual fatty acids rather than looking only at the total quantity of oil.
*The beneficial effects are obtained with a daily intake of 250mg EPA and DHA for heart function and 250mg DHA for normal brain function.
If you take medication, have a health condition, are pregnant, breastfeeding or awaiting surgery, speak to a healthcare professional before introducing a new supplement.
You Still Need Contraception During Perimenopause
Periods can become irregular during perimenopause, but pregnancy may still be possible until menopause has been reached. Do not use changing or missing periods alone as a sign that contraception is no longer needed.
Speak to your GP, nurse or pharmacist for advice appropriate to your age, cycle and current method of contraception.
When Should You Ask About Treatment?
You do not need to wait for symptoms to become unbearable. If hot flushes, sleep disruption, vaginal dryness, mood changes or other symptoms are affecting everyday life, speak to your GP.
Treatment should be based on your symptoms, age, medical history and personal preferences. Options may include hormone replacement therapy, non-hormonal treatment and targeted support for vaginal or urinary symptoms.
If symptoms begin before 45, obtaining appropriate advice is particularly important because early menopause can have longer-term implications for bone and cardiovascular health.
Listen to What Your Body Is Telling You
Perimenopause is a natural stage of life, but that does not mean every new symptom should automatically be blamed on hormones.
Changes to periods, sleep, mood and temperature can all occur during the transition. However, very heavy bleeding, unexpected bleeding, severe pain or symptoms developing at a younger age deserve proper assessment.
Understanding what is happening is the first step. From there, a combination of medical advice, nourishing food, regular movement, restorative sleep and carefully chosen nutritional support can help you approach this stage with greater confidence.
Disclaimer:
Information and other content provided in Lily & Loaf blogs should not be construed as medical advice and should not be considered a substitute for professional medical expertise. If you have any medical concerns, you should consult with your health care provider.
