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The perimenopause
Answers to common questions about the years of change before menopause: periods, symptoms, tests, pregnancy and treatment.
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What is perimenopause?
Perimenopause is the phase before menopause, until one year after the last menstrual period, when the changes of menopause begin to happen. The length of this phase varies from one woman to another. It can last between 1 and 3 years, or longer.
The pattern of my periods has changed lately. Does this mean I am in the perimenopause?
During this phase, the levels of the hormones oestrogen and progesterone in your body are erratic. This may cause a wide variation in your menstrual cycles and flow.
Your menstrual cycles may at first be shorter, followed by longer intervals between periods. The flow may vary from prolonged spotting to heavy periods with clots.
A woman is said to be in the menopause when she has not had a period for one whole year.
Should I be worried about these changes in my periods?
See a gynaecologist if you have:
- heavier or longer periods than usual
- vaginal bleeding in between your periods
- bleeding after sexual intercourse
- any bleeding after your periods have stopped for a year or more
Heavy or prolonged periods may result in anaemia (a low level of red blood cells in the body), and this needs to be treated.
What should I expect during a consultation with the gynaecologist?
Questions about you
Your doctor will ask about your medical history, past surgeries, medications and lifestyle. This is important so that you and your doctor can agree together on the treatment that suits you best, because not all women are the same.
An examination
If you are sexually active, your doctor will perform a vaginal examination, cervical screening (a Pap smear or HPV test) if it is due, and a transvaginal pelvic ultrasound, with your consent. If a vaginal examination cannot be done, a pelvic ultrasound with a full bladder is enough.
Tests
A pregnancy test will be done to rule out pregnancy, and appropriate blood tests will be carried out.
Further tests, only if needed
Other invasive investigations, such as an examination under anaesthesia (EUA), an endometrial biopsy or a hysteroscopy, may be needed, depending on your doctor's findings.
What treatments are available for my heavy or prolonged periods?
Treatment options for abnormal bleeding in the perimenopause include:
Non-hormonal medicines
Non-steroidal anti-inflammatory drugs (NSAIDs) and antifibrinolytics (for example, tranexamic acid).
Hormonal medicines
The combined oral contraceptive pill, or menopausal hormone therapy (MHT).
Levonorgestrel intrauterine system (LNG-IUS)
A small hormone-releasing device placed in the womb.
Surgery
Such as a hysterectomy. This is usually kept for when medical treatment fails or is not suitable.
Can I have symptoms of menopause while I am still having periods?
Yes. Many women start to have symptoms of menopause even before their last period. In fact, perimenopausal women have more symptoms than postmenopausal women, because their oestrogen levels go up and down.
The range of symptoms varies. Symptoms are usually stronger the longer the gap since your most recent period, and ease once a period starts again. Fortunately, not all women have severe symptoms.
What are the common symptoms of perimenopause?
These are the more common symptoms during the perimenopause:
- A change in the menstrual cycle and flow
- Abdominal bloating
- Headaches
- Breast swelling and tenderness
- Mood swings
- Anxiety
- Depressive symptoms
- Memory problems
- Skin dryness or itchiness
- Muscle and joint pains (myalgia, arthralgia)
- Disturbed sleep patterns
- Weight gain, mainly around the midriff
- Hair loss
- Vasomotor symptoms (VMS), such as hot flushes and night sweats
- Reduced sexual function
I think I am in the perimenopause. Should I get a blood test to measure my hormone levels?
The perimenopause is diagnosed from the clinical signs and symptoms of menopause. For women aged 45 and over, measuring the levels of follicle-stimulating hormone (FSH) and estradiol in the blood is unnecessary at this stage. In younger women, your doctor may check FSH.
Your doctor may also suggest other tests, such as a full blood count to check for anaemia, or thyroid hormone levels to rule out thyroid problems.
A good time for a health check
The perimenopause is also a good time to get an overview of your overall health, with screening tests for:
- diabetes
- cholesterol
- cervical cancer
- breast cancer (breast screening)
I am sexually active. Can I still get pregnant in the perimenopause?
Yes, you can.
Even with irregular periods, you may still ovulate and become pregnant. Ovulation is also unpredictable during this phase, so you will need reliable contraception if you do not wish to conceive.
Keep using contraception until one year after your last menstrual period if you are 50 or over, or two years after it if you are under 50. If you use hormonal contraception, which can hide your periods, ask your doctor when it is safe to stop.
Can I take menopausal hormone therapy (MHT) during the perimenopause?
Yes. Your doctor may start you on MHT if you are having menopausal symptoms, after assessing the risks and benefits for you. However, MHT is not a contraceptive, so you may still need to take additional precautions if you do not wish to become pregnant.
As an alternative to MHT, if it is safe for you, your doctor may suggest the combined oral contraceptive pill (COCP). The COCP has the advantage of:
- regulating your periods
- relieving symptoms
- preventing an unwanted pregnancy
Keep learning
Signs & symptoms
From hot flushes and irregular periods to brain fog and joint pains.
Read moreTreatment & therapies
Lifestyle changes, MHT and non-hormonal options.
Read moreYour first appointment
What to expect when you see a doctor about menopause.
Read moreWorried about your symptoms?
Your doctor can help you work out what is going on and talk you through your options.