Summary

• Perimenopause can be a challenging time for women which can last between eight to ten years before menopause. It begins due to the ovaries producing less oestrogen as the body starts to prepare to stop releasing eggs. The first signs of perimenopause will differ for every woman and tend to start in their mid-40s.

• Oestrogen has three different forms: estradiol (the strongest), estrone and estriol. They are essential for the reproductive process and help regulate functions in other parts of the body, including the brain and central nervous system, bones, liver and urinary tract. The ovaries produce the majority of the estrogens in the body, but they can also be formed by other tissues, such as skin, muscle and body fat.

• There are two stages of perimenopause. The early stage is marked by the changes in menstrual flow and the length of cycles. The late stage is the transition to menopause which will be when women begin to miss their periods until they finally stop.

• Your body may start to show signs that perimenopause is ending during the last few years. Some symptoms may become worse (such as hot flashes and sleep), while others have a tendency to improve (including headaches and mood). Once there has been no period for 12 months (including spotting), perimenopause has officially ended, and you have reached menopause. 

Introduction

Perimenopause is the transitional time that ends in menopause once your periods have stopped. It can be a difficult time for women and go on for anytime between eight to ten years before menopause. Women tend to be in their mid-40s when they start to notice the first signs of perimenopause, but it can start earlier. Perimenopause happens because the ovaries begin to produce less oestrogen, and the body prepares to stop releasing eggs.

Although this is a natural and normal progression in a woman's reproductive cycle, perimenopause symptoms can be challenging to manage. Having a better understanding of what to expect will allow you to be a little more prepared. This article aims to provide you with the basic knowledge of how long to expect perimenopause to last.

When Does Perimenopause Start?

Two major female hormones are produced by the ovaries – oestrogen and progesterone. During perimenopause, the production of these hormones declines and fluctuates until it eventually stops. While menopause is associated with a change women go through during their late 40s and 50s, perimenopause can begin in their early 40s or 30s (especially for those who smoke, as Italian researchers have reported from the University of Naples Federico II). This makes it hard to determine what age you can expect to start perimenopause.

Perimenopause happens when the amount of oestrogen your body produces declines. Oestrogen has three different forms:

1. Estradiol (the strongest form)

2. Estrone

3. Estriol

The ovaries produce the majority of the estrogens in the body, but they can also be formed by other tissues, such as skin, muscle and body fat. These estrogens are essential for the reproductive process and also play a vital role in regulating functions of other parts of the body, including the brain and central nervous system, bones, liver and urinary tract.

There are over 30 perimenopause signs which can each affect women differently and occur at different stages. So many women will wonder, what are the first signs of perimenopause? Unfortunately, this is not the same for every woman, so you must be aware of various possible signs. You might experience any of the following which are signs of menopause starting:

• Irregular periods

• Hot flashes

• Sleep problems

• Mood changes

• Sexual function

• Changes in cholesterol levels

• Weight gain

• Loss of bone

Researchers at the National Taipei University of Nursing and Health Sciences reported many women would also feel fatigued, but it can still be challenging to pinpoint when perimenopause starts.  For many women, there will not be a need to diagnose perimenopause. However, a hormone test can be completed to check follicle-stimulating hormone (FSH) and oestrogen levels.

What Are The Stages of Perimenopause?

Menopause does not happen overnight, and the period of perimenopause will usually go on for a few years before the last menstrual cycle. It can be a drawn-out process filled with various symptoms as your ovaries begin producing fewer hormones, causing your menstrual cycle to become erratic or irregular.

There are two stages in the transition:

1. Early Stage – Perimenopause can begin for some women in their 30s (known as early menopause), but for most, it starts in their mid-40s and 50s. This phase is marked by changes in menstrual flow and the length of the cycle. Some women also experience sudden surges in oestrogen too.

2. Late Stage – The last stages of perimenopause tend to happen to women in their late 40s and 50s. During the last stages of transition to menopause, women will begin to miss their periods until they eventually stop. In addition, estrogen levels will drastically drop around six months before menopause. This oestrogen reduction triggers a variety of symptoms, including hot flashes, sleep issues and weight gain.

Many women find perimenopause and menopause incredibly disruptive to daily life. Some factors can make symptoms harder, such as a lack of vitamin D, as reported by European Review for Medical and Pharmacological Sciences in 2022. However, with around 50% of the population going through this natural progression, more people are starting to share their perimenopause experience.

The Signs Perimenopause is Ending 

During the last few years of perimenopause, your body may start to show signs perimenopause is ending. Some symptoms can increase in severity and frequency during the last few years of your perimenopause cycle, while others may begin to ease and become less intrusive.

Signs Perimenopause is Ending include the following:

• Time Between Periods – The length of time between periods will increase near the end of perimenopause until they stop altogether. If there are around 60 days or more between periods, it is a pretty strong sign that you are in late perimenopause.

• Less Frequent Headaches – Wildly fluctuating hormones start to settle down to their new lower levels near the end of perimenopause, which can help ease those headaches. In addition, women suffering from menstrual migraines will notice the debilitating headaches are fewer and farther between as periods start to space out.

• More Hot Flashes – Unfortunately, as perimenopause is nearing the end, the hot flashes may increase. When you are hot, your body reacts the same as when experiencing a hot flash. Your blood vessels dilate, and you will start to sweat to help cool down the skin. Oestrogen plays a role in body temperature control, so lowered hormone levels can cause the brain thermostat to malfunction.

• Problems Sleeping – With hot flashes, night sweats, hormonal fluxes and most likely increased anxiety, it can be tough to get a good night's sleep. In addition, due to the hormone fluctuations, women can have insomnia which starts at perimenopause and continue to be an issue through the menopause years.

• Stable Mood – Here is some good news. The British Menopause Society reported that the challenging ups and downs which affect around 75% of women during perimenopause are likely to stabilise as we begin to enter menopause. This means that although hormones may be low as you reach menopause, they will be at a consistent low.

No two bodies are the same, even in the same families, so the age and rate of ovary function decline differ hugely. Many women will also wonder how long perimenopause lasts, which also differs for everyone. What can be confirmed is once you have not had a menstrual cycle for 12 months (including spotting), perimenopause will officially end, and you have reached menopause.

Closing Thoughts

Menopause is a natural biological part of a woman's life cycle but can be challenging to manage. Gaining a greater understanding of what to expect from perimenopause and the length of time symptoms are likely to last can help women look after their bodies better.

Looking after our bodies at all stages of our life can allow us to age well and continue to live an active and fulfilled life well into our menopausal years. Instead of focusing on our chronological age and shifting to thoughts of biological age, it is possible to make the changes needed to have a smoother journey through perimenopause.

Frequently Asked Questions (FAQs)

How do you know when perimenopause ends? 

You can tell that perimenopause is coming to an end as the time between periods will increase until they stop altogether. Once you notice around 60 days or more between menstrual cycles, it is likely a sign you are entering late perimenopause. Perimenopause stops once you have not had a period for a full 12 months (including any spotting).

What are the first stages of perimenopause? 

For most women (but not all), the first stage of perimenopause is a change in your normal period pattern. Some women notice other symptoms, including changes in mood, headaches, reduced sex drive, problems sleeping and hot flushes.

Do perimenopause symptoms last all month?

Perimenopause symptoms can last for months or even years. For some women, it can be pretty constant, while for others, symptoms can disappear and then come back again. This can lead women to fall into a false sense of security, especially if they have been attempting to manage a particular perimenopause symptom, for it disappears and comes back with a vengeance a few weeks later.

What's worse, perimenopause or menopause?

There are three stages of menopause:

1. Perimenopause – The time leading up to menopause)

2. Menopause – When you have stopped producing hormones that cause a period, and there has been no period for a year

3. Postmenopause – The time after menopause has occurred

All stages come with challenges, but with a healthy lifestyle and focus on ageing well – life can be gratifying during the 30-plus years many women live postmenopause.

How can I stop perimenopause?

Perimenopause is a natural transitional period all women go through, and it is impossible to stop it. However, there ate some things which have been found to accelerate the onset of menopause. Examples include smoking, excessive alcohol, lack of vitamin D and unhealthy diets.

References

https://rbej.biomedcentral.com/articles/10.1186/s12958-020-0567-7

https://glycanage.com/self-care/menopause/age-perimenopause-starts

https://www.europeanreview.org/wp/wp-content/uploads/3493-3505.pdf

https://www.sciencedirect.com/science/article/pii/S1028455921001388

https://glycanage.com/self-care/menopause/does-menopause-have-to-put-a-pause-on-your-life

https://thebms.org.uk/2021/08/the-british-menopause-society-response-to-the-department-of-health-and-social-cares-call-for-evidence-to-help-inform-the-development-of-the-governments-womens-health-strateg/