Understanding perimenopause: what it is, diagnosis and the 9 most common symptoms

Perimenopause is a significant transition in a woman’s life, marking the shift from reproductive years to menopause. Some even call it “second puberty.” This phase can begin as early as the mid-30s and typically lasts 10 years before menopause officially occurs. Understanding the hormonal changes in your body and therefore the symptoms that can result during perimenopause is crucial for managing your health through this phase and beyond.

What is Perimenopause?

Perimenopause is defined as the transitional period when a woman's menstrual cycle changes and she approaches menopause. It's also known as the menopausal transition. Menopause is a date in time where you haven’t had a period for the previous 12 months. It is an exact date, a point in time. Every day after this, you are post-menopausal. So, unlike menopause, perimenopause is a dynamic process over a long period of time, with fluctuating hormone levels, particularly estrogen and progesterone.

Can You Be Diagnosed with Perimenopause?

There is no single test to diagnose perimenopause definitively. Instead, healthcare practitioners rely on a combination of age, menstrual history, and symptoms. Blood tests measuring hormone levels, such as follicle-stimulating hormone (FSH) and estrogen, may provide some insight, but they are not always reliable due to fluctuating levels that can happen just over a 24 hour period.

A woman experiencing common symptoms in her late 30s or 40s is often considered to be in perimenopause, even if blood tests are inconclusive. Keeping a symptom journal can help track changes and provide valuable information for discussions with a healthcare provider.

The 9 Most Common Symptoms of Perimenopause

According to Dr. Jerilynn Prior, a leading researcher in women’s health, a midlife woman with regular cycles is likely to be in perimenopause if she has any 3 of the following 9 changes:

1. New-onset heavy flow

2. New-onset longer flow

3. Shorter menstrual cycles (25 days or less)

4. New mid-sleep waking

5. Increased menstrual cramps

6. Onset of night sweats, especially pre-menstrually

7. New or markedly increased migraine headaches

8. New or increased premenstrual mood swings, including a shorter temper and/or brain fog and noticeably increased forgetfulness.

9. Weight gain, especially around the middle, without changes in exercise or eating

What to Do Next?

Recognising perimenopause is the first step in managing its effects. Some of these changes might be very subtle, so keeping a journal of where you are at in your cycle and noting down some of the symptoms is very helpful in identifying patterns.

There are five pillars of health which I consider crucial to having an easier transition during perimenopause. These include nutrition, exercise, sleep, stress and toxic load. Working on optimising each of these, will make the journey through perimenopause so much easier. This is what I work with my clients on, and we do it in a gentle, sustainable way, meeting them wherever they are at, achieving great results. I’ll cover nutrition and exercise in one of my next articles, in the meantime, grab my free Sleep and Energy guide here to gain access to some tools to support sleep and stress.

Stay tuned for the next article, where we will explore the four stages of perimenopause and how to support each phase naturally, using key supplements I use in clinic every day.