Spotting perimenopause: when your cycle starts to change

Perimenopause is the transition before menopause, when your cycle becomes more irregular. It often starts in your early to mid 40s. Typical perimenopause symptoms are fluctuating cycles, hot flushes, sleep problems and mood swings. It is a natural process, but one you don't have to put up with in silence.

Contents

• What is perimenopause?
• At what age does perimenopause start?
• What are the symptoms of perimenopause?
• How does the cycle change?
• What is normal, and when should you see a doctor?
• What can you do to feel better?
• Common questions about perimenopause

What is perimenopause?

Perimenopause is the phase shortly before menopause proper, when your body begins to shift hormonally. Your ovaries gradually do less, ovulation happens less often, and the hormones oestrogen and progesterone start to fluctuate.

The distinction matters: menopause itself is a single point in time, namely your very last period. You only know for certain in hindsight, once twelve months have passed without any bleeding. Perimenopause is the often multi-year stretch before that, when your body prepares for the transition. This is exactly the phase in which most symptoms show up.

Behind the fluctuations sits mainly a lack of progesterone. Because ovulation becomes rarer, the balancing progesterone is missing at times while oestrogen is still swinging up and down. That explains why perimenopause sometimes feels like a very pronounced case of PMS.

At what age does perimenopause start?

Usually in the early to mid 40s, for some earlier or later. According to Frauenärzte im Netz, the first cycle fluctuations caused by declining ovarian function appear in most women between 40 and 45. Perimenopause in the narrower sense begins on average at around 47 to 48.

How long it lasts varies a lot. For many women perimenopause stretches over several years, often about four, sometimes longer. Then comes menopause, on average around the age of 51.

Knowing that range helps you make sense of the signs. If you are in your mid 40s and your cycle suddenly goes haywire, that is often no coincidence but a normal part of this stage of life.

What are the symptoms of perimenopause?

Very varied, and not every woman notices all of them. For most, the first sign is the cycle itself becoming irregular. Other complaints often come along with it:

• Hot flushes and sweating: Up to 85 per cent of women going through menopause know hot flushes, many of them before the first cycle irregularities.
• Sleep problems: Falling asleep and staying asleep gets harder, often made worse by night sweats.
• Mood swings: Irritability, low mood or more inner restlessness, similar to severe PMS.
• Vaginal dryness and less desire: Falling oestrogen levels can make the mucous membranes drier.
• Other complaints: Joint pain, palpitations, trouble concentrating, thinner hair or changes in your skin.

That sounds like a lot, and for some women it is. Others get through this time with few, mild symptoms. Both are normal. If your symptoms weigh on you, that is a good reason to get support instead of simply waiting them out.

How does the cycle change?

It gets less predictable, in almost every direction. Typically the gaps between periods start to vary. Your cycle can get shorter, so your period comes more often, or longer, so that it occasionally skips. The bleeding itself often changes too, sometimes heavier, sometimes lighter than usual.

The reason is irregular ovulation. If no ovulation happens in one cycle, the whole rhythm shifts. Fluctuations like this are part of perimenopause and are usually harmless in themselves.

Menopause counts as reached only once twelve months in a row have passed without bleeding. Until then you are theoretically still fertile, even if it becomes less likely. If you don't want to get pregnant, contraception is still a topic during this time.

What is normal, and when should you see a doctor?

A lot is normal, but some things need checking. Irregular cycles, changing bleeding intensity, hot flushes and low moods are typical companions of perimenopause and usually no cause for worry.

These warning signs, on the other hand, should be checked by a doctor:

• Very heavy bleeding or bleeding with large clots.
• Bleeding between periods or after sex.
• Very short gaps, if your periods are regularly less than 21 days apart.
• Symptoms before your 40th birthday, because very early menopause needs investigating.
• Any bleeding after menopause, meaning blood that appears again after twelve bleed-free months. That always needs to be checked.

The last point is especially important. Bleeding after menopause is usually harmless, but it can also be a warning sign, so it should always be examined medically. And as a general rule: if your symptoms clearly affect your quality of life, that alone is reason enough to book an appointment, even without dramatic symptoms.

What can you do to feel better?

Quite a bit, and you have more influence than it sometimes feels. No miracle cure makes perimenopause disappear, but a few things help many women through this time:

Look after your sleep. A cool bedroom, fixed bedtimes and breathable clothing can take the edge off night sweats. Keep moving. Regular exercise does your mood, your sleep and your bones good, precisely because falling oestrogen affects bone density. Pay attention to what you eat. A balanced diet with enough calcium, protein and fibre supports your body through the change.

And get medical advice if you want it. There are effective treatments for stronger symptoms, from herbal options to hormone replacement therapy. Whether and what suits you is best discussed individually at your gynaecology practice. You don't have to grit your teeth and get through this phase alone.

This article is for general information and does not replace medical advice. If your symptoms are severe, unusual or persistent, please speak to your gynaecologist.