The perimenopause

The perimenopause, or the menopause transition, is the stage of a woman's reproductive life that begins several years before the menopause, when the ovaries gradually begin to produce less oestrogen. It usually starts in a woman's forties, but can sometimes start in her thirties.

The perimenopause lasts up until the menopause, the point when the ovaries stop releasing eggs. In the last one to two years of the perimenopause, this decline in oestrogen accelerates. At this stage, many women experience menopausal symptoms.

How long does the perimenopause last?

The average length of the perimenopause is four years, but for some women this stage may last only a few months or may continue for 10 years. The perimenopause ends the first year after menopause (when a woman has gone 12 months without having a period).

What are the signs of perimenopause?

You will know you are transitioning into menopause when you begin experiencing some or all of the following symptoms:

• Hot flushes.
• Breast tenderness.
• Worsening of premenstrual syndrome.
• Decreased libido (sex drive).
• Fatigue.
• Irregular periods.
• Vaginal dryness; discomfort during sex.
• Urine leakage when coughing or sneezing.
• Urinary urgency (a pressing need to urinate more frequently).
• Mood swings.
• Difficulty sleeping.

How do I know if changes in my periods are normal perimenopausal symptoms or something to be concerned about?

Irregular periods are common and normal during the perimenopause. However other conditions can cause abnormalities in menstrual bleeding. If any of the following situations apply to you, seek medical advice to rule out other causes:

• Your periods are very heavy or accompanied by blood clots
• Your periods last several days longer than usual
• You spot between periods
• You experience spotting after sex
• Your periods occur closer together

Potential causes of abnormal bleeding include hormonal imbalances, contraceptive pills, pregnancy, fibroids, blood clotting problems or, rarely, cancer.

How is the perimenopause diagnosed?

Often your doctor can make the diagnosis based on your symptoms. Blood tests to check hormone levels may also be beneficial but may be difficult to evaluate due to erratic fluctuations of hormones during this period. If there is doubt, your doctor may suggest repeating the tests at different times for comparison.

Can I get pregnant if I am perimenopausal?

Yes. Despite a decline in fertility during the perimenopause stage, you can still become pregnant. If you do not want to become pregnant, you should continue to use some form of contraception until you are definitely past the menopause (you have gone 12 months without having a period).

For some women, getting pregnant can be difficult once they are in their late thirties to early forties due to a decline in fertility. However, if becoming pregnant is the goal, there are fertility-enhancing treatments and techniques that can help you get pregnant.