What is perimenopause?

Perimenopause is the time leading up to menopause when the ovaries begin to run out of eggs and the menstrual cycle (period) may become irregular. During this time, women may experience premenstrual and menopause-like symptoms (see below). This transition time from having regular periods to menopause can average between four to six years, but may be as short as one year or as long as ten years.

Perimenopause begins with the onset of irregular periods and/or other symptoms and finishes 12 months after the final menstrual period (menopause). Many women experience perimenopause symptoms, however some women experience no symptoms; their periods may continue regularly and then one day just stop. Every woman experiences perimenopause differently.

What are the symptoms of perimenopause?

Physical and emotional symptoms of perimenopause can include:

• Mood swings
• Sore breasts
• Bloating
• Headaches/migraines
• Hot flushes/sweats
• Reduced capacity to cope with daily activities
• Increasing tiredness
• Insomnia
• Wakefulness
• Weight gain
• Forgetfulness
• Lack of concentration

Your periods may also change, becoming:

• Infrequent and lighter
• Irregular in pattern
• Irregular in flow, e.g. heavier than normal/with clots
• Associated with increasing pain
• Increasing in premenstrual symptoms

If your periods are very irregular, heavier than normal and interrupting your daily life, see your general practitioner.

What can I do?

There is no test to determine when you will have your final period. Hormone levels can fluctuate enormously during perimenopause, making it hard to identify whether an egg will be released or not. During perimenopause it is important that you do the following:

• Use contraception until 12 months after your final period if you are over 50, or until two years after your final period if you are under 50. This is important, as perimenopausal women can ovulate twice within one cycle, and women can still ovulate up to three months before their final period (menopause)
• Increase/maintain healthy eating habits. Maintaining a healthy and balanced diet containing a variety of fresh foods may help reduce perimenopause symptoms
• Increase/maintain physical activity. Aim for 30 minutes of moderate intensity physical activity on all or most days of the week
• Create a cooler environment:
  - have fans throughout the house and always carry a small hand fan
  - have air conditioning in your home to cool your environment
  - use a water facial spray when experiencing a hot flush
  - have cool drinks available when experiencing hot flushes
    - wear layers of clothing, so you can take off as much as you need when hot
• Seek help from your GP if concerned about physical or emotional symptoms
• Discuss treatment and management options with your health practitioner, if necessary
• Take preventative health measures to reduce your risk of chronic disease (see below)

When should I see my health practitioner?

If any of the following apply to you, see your GP:

• Symptoms are interfering with your quality of life
• Bleeding between periods or after intercourse
• Experiencing distressing premenstrual symptoms
• Your periods are either heavier than normal or more painful than normal

What treatments or management options are available?

Depending on your symptoms and medical history, your health professional may recommend the following treatment and management options:

• Combined oral contraceptive pill
• Hormone replacement therapy (HRT)
• Mirena intra-uterine device – progestin releasing IUD (for heavy bleeding)
• Complementary therapies (see an accredited naturopath)

Perimenopause: start thinking about your future health

Menopause can bring many changes to a woman's life, including an increased risk of chronic disease such as type 2 diabetes and cardiovascular disease. The perimenopause phase is a good time to focus on your health, learn how you can reduce your risk and take action, before you reach menopause.

Ways to maintain good health into the future

• Maintain a healthy weight - live a healthy lifestyle, prevent weight gain and lose weight if necessary to prevent chronic disease
• Have regular health checks (blood pressure, cholesterol/blood fats, blood glucose, mammograms after age 40, bowel cancer screens after age 50, Pap tests until age 70).
• Look after your emotional health: talk to your GP about perimenopause management options and how to control the physical symptoms to help improve your general wellbeing.
• Look after your bone health - obtain sufficient levels of vitamin D and calcium and have regular bone density reviews.
• Don't smoke: Quitting smoking reduces many health risks. Need help to quit? Visit www.quit.org.au.

Further Resources

Perimenopause podcast (2.9 MB)

Content updated 19 April 2012