Perimenopause is the run-up to menopause, and it can last years. For many women it starts around age 45, sometimes earlier. You usually notice a changing cycle, plus symptoms like hot flushes, worse sleep and shifting moods. The last period falls around age 51 on average.
What I often hear: women think menopause only counts once periods stop. The years before then feel confusing, because the symptoms are already there while you still have periods.
Below you'll read what perimenopause is, which symptoms go with it, and which blood values matter.
What is perimenopause?
Perimenopause literally means "around menopause". It's the phase when your ovaries gradually make less estrogen while you still menstruate. Your hormones swing more in this period than before.
Perimenopause ends twelve months after your last period. From that point it's called postmenopause. The phase in between is exactly when most symptoms surface.
Its length varies a lot. In some women perimenopause lasts a year or two, in others seven years or longer. That spread is normal and says little about how you feel.
At what age does perimenopause start?
For most women perimenopause starts between 45 and 50, but some notice the first changes around 40. The phase lasts several years on average, sometimes longer. There's no fixed calendar.
If perimenopause clearly starts before 40, that's a reason to discuss it with your GP. It needn't be worrying, but it's good to rule out other causes.
Which symptoms go with perimenopause?
Symptoms differ per woman and per stage. Some women mainly notice their cycle changing, others mainly hot flushes or sleep problems. The table below sketches the stages, the age and the hormones that shift. Read it as a rough overview, not a fixed route.
| Stage | Age (indicative) | Core symptoms | Hormones |
|---|---|---|---|
| Early perimenopause | Around 40 to 47 | Cycle becomes irregular, first hot flushes | Estrogen fluctuates, FSH varies |
| Late perimenopause | Around 47 to 51 | Skipped periods, more hot flushes and sleep problems | Estrogen falls, FSH rises more often |
| Postmenopause | After the last period | Symptoms may ease, dryness can persist | Estrogen low, FSH persistently raised |
If you recognise yourself here, a menopause panel can bring several hormones into view at once. For more on estrogen, read estrogen and menopause.
Which blood values matter?
In perimenopause your hormones swing strongly, which makes blood tests harder to read. Still, a few values come into view when you want to place your symptoms or rule out other causes.
FSH rises on average but jumps from cycle to cycle. Why one measurement says little because of this, you'll read in our piece on the FSH value and menopause. Your thyroid is also worth ruling out, because an underactive thyroid sometimes looks like menopause.
If you mainly feel tired, see our explainer on feeling tired during menopause. Often sleep and iron matter just as much.
When is it useful to get checked?
A check adds most when symptoms affect your daily life, when you're younger than 45, or when you want to rule out other causes. In a recognisable perimenopause around 50, a test is usually not needed.
Tracking your cycle and symptoms often helps more than a single number in this phase. Discuss your story and any results with your GP, especially if symptoms persist.
How do you track your perimenopause symptoms?
Because your hormones swing, the pattern over weeks says more than one snapshot. A simple log helps. Note your periods, your hot flushes, your sleep and your mood, for example with a score from 1 to 10.
Picture someone who tracks how often she wakes at night for three months. At her appointment she shows a clear pattern, instead of a vague feeling. That makes the conversation with the GP more concrete.
If something striking changes, such as much heavier bleeding or bleeding after menopause, discuss it with your GP. That isn't a standard part of the transition.
Every blood test result includes a professional assessment from a BIG-registered doctor. For treatment decisions, discuss your results with your GP.
Sources
- Harlow SD, et al. Executive summary of the Stages of Reproductive Aging Workshop +10. J Clin Endocrinol Metab. 2012. PMID 22344196.
- Baker FC, et al. Sleep and sleep disorders in the menopausal transition. Sleep Med Clin. 2018. PMID 30098758.
- Thuisarts.nl. I am going through menopause. Dutch College of General Practitioners (NHG).
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