I often see women in their late 30s or 40s who have a feeling that something has begun to shift in their bodies and they cannot quite explain why, as they still get their period. Their first thought is more often than not, “Is menopause beginning?” What they are actually experiencing is perimenopause, which is the transitional phase leading up to menopause. Understanding this stage is essential because it is often where the earliest and most confusing hormonal changes occur, and it provides an opportunity to find solutions to help ease the menopausal journey right from the word go.
What is perimenopause?
Perimenopause refers to the years before menopause when the body gradually transitions away from regular ovulation. During this time, hormone levels — particularly oestrogen and progesterone — fluctuate in an unpredictable way, more often than not quite dramatically.
It is these hormonal fluctuations that drive many perimenopause symptoms. The biggest distinction is that perimenopause is not defined by hormone deficiency alone but by hormonal variability. The body is, in effect, trying to recalibrate itself. Perimenopause ends once you have gone 12 consecutive months without a period. At that point, you have reached menopause.
How does perimenopause differ from menopause?
It is crucial to understand the difference between perimenopause and menopause, as confusion here often leads to misunderstanding symptoms and incorrect solutions.
Perimenopause is a phase and a process that unfolds over time. Hormones rise and fall unpredictably and symptoms may come and go. Menstrual cycles are still present but they begin to change.
In contrast, menopause is a single moment in time, defined retrospectively after a year without periods. After menopause, hormone levels stabilise at a lower level, which means symptoms may become more consistent rather than fluctuating. In my experience, many women find perimenopause more unsettling than menopause itself because of its unpredictability.
When does perimenopause start?
For most women, it begins in their early to mid-40s. However, it is not unusual for early signs of perimenopause to appear in their late 30s. Genetics, lifestyle factors and overall health play a role, so there is no fixed timeline — it may vary between women depending on where they are in their hormonal journey. This is one of the reasons hormone testing for women can be so useful, as it helps map out exactly where you are in that journey rather than relying on guesswork.
The first signs of perimenopause
The first signs of perimenopause are often subtle and easily dismissed. In many cases, the earliest clue is a change in the menstrual cycle. Periods may become irregular — arriving earlier or later than expected, becoming heavier or lighter, or occasionally being missed altogether.
Alongside cycle changes, many women begin to notice shifts in how they feel emotionally. They may start to feel increased irritability, anxiety or a sense of being less resilient than usual. Sleep is another area that is often affected early on. This manifests as difficulty falling asleep, frequent waking or a general sense of poor-quality rest.
What to expect in perimenopause
My biggest piece of advice to women navigating perimenopause is to prepare for variability. Symptoms do not tend to follow a neat or predictable pattern, and this can make it difficult to manage.
You may experience months where you feel entirely yourself, followed by periods where symptoms such as fatigue, brain fog or low mood seem to appear out of nowhere. This reflects the underlying hormones that influence energy, mood and metabolism, which can rise and fall quite sharply during this time.
How long does perimenopause last?
On average, it spans between four and ten years. Again, this is completely individual to each woman.
When to seek support
My main piece of advice for women is that they do not need to wait for menopause to seek help. Too often, women are told to wait it out until their periods stop. In reality, perimenopause is the time when support can help restore balance to your hormones and ease symptoms. If perimenopause symptoms are affecting your quality of life — whether that is through ongoing sleep disruption, difficult mood changes or significant cycle irregularity — it is entirely appropriate to seek guidance, and a well woman check is often a good place to start.
Early intervention may include lifestyle and nutritional strategies, as well as discussion of medical options where appropriate, such as Bioidentical Hormone Replacement Therapy (BHRT). It’s worth knowing the myths and facts around BHRT before ruling it in or out, and understanding when you can expect to see results once treatment begins.
At The Natural Doctor, the aim is not simply to endure this phase but to navigate it as easily as possible and get the help you need. If you would like advice and support on how to navigate this variable phase, get in touch with us today for expert guidance — the natural way.
