Early menopause, perimenopause, pre-menopause: What to expect

Menopause, the point in a woman's life where she stops ovulating, is a known fact of female ageing. What is lesser known about this stage of life, however, is that it is preceded by something called perimenopause: a period of transition where the ovaries gradually start to produce less oestrogen.

A woman is considered perimenopausal until one year has passed since she has last had her period. After 12 months with no menstrual bleeding, a woman is then considered to be in the menopause.

This can happen at any time in a woman's life, and it is different for everyone. For some, they may have what is known as "early menopause", which happens at a younger age than usual. Both the perimenopause and the early menopause have similar symptoms and treatments. Here, we'll go through everything you need to know about these conditions, what to expect and how to manage your health during this natural change.

Understanding the perimenopause and the early menopause

People often get perimenopause and early menopause confused, as they are essentially the same thing but occur at different ages. So, let's clear things up first:

Early menopause

According to the NHS, for most women, menopause will start between the ages of 45 and 55. If you are experiencing menopausal symptoms before 45, you could be going through early menopause.

Early menopause can happen for a variety of reasons. This can be completely natural and run in the family, where the ovaries stop working in the 20s or 30s. Cancer treatments can also cause early menopause, as can autoimmune diseases and smoking can even increase your chances.

Perimenopause

Typically starting in a woman's 40s, the precise onset of perimenopause (also known as pre-menopause) may be difficult to pinpoint. As perimenopause marks a gradual decline in hormones oestrogen and progesterone, the rate at which each woman's levels change, and how she is affected by this over time is unique to everyone. Although this usually happens in a woman's 40s, it can begin as early as your mid-30s. You might experience perimenopause for two years, or it may go on for ten; again, this is different for every woman. In fact, some women do not even report experiencing perimenopausal symptoms at all!

There is a delicate balance of hormones within a woman's body. As your hormones change during perimenopause, the balance of chemicals within the body changes, which triggers certain responses in the brain as the body naturally adjusts. This can bring on physical as well as emotional symptoms, which vary in nature depending on your particular chemical makeup.

For example, oestrogen stimulates serotonin, a major mood neurotransmitter that brings on feelings of happiness. When your oestrogen levels drop, it can, in turn, cause a drop in serotonin within your brain, causing feelings of sadness or depression. Oestrogen and progesterone also work to manage the production of cortisol, the hormone that triggers feelings of stress, and so feelings of panic, stress and anxiety may be heightened as these hormone levels change, too.

Symptoms of early menopause and perimenopause

For both early menopause and perimenopause, the symptoms are the same. As both are taking you towards the change of menopause, the same thing is happening to your body.

The first sign of perimenopause or early menopause is usually irregular periods. You may miss one, or have them too frequently, or have them temporarily regularise before becoming irregular again. Your periods may be heavier than usual, or much lighter. Some women taking birth control pills may not experience irregular periods, but may notice other symptoms such as unexplained mood changes, or hot flushes.

During the last one to two years of perimenopause, oestrogen levels decline at a faster rate, which usually brings on symptoms also experienced by menopausal women. These commonly include:

• Hot flushes
• Breast tenderness
• Lowered libido
• Fatigue
• Mood swings
• Anxiety or depression
• Difficulty sleeping
• Weight gain
• Hair thinning or loss

Not all of these symptoms are experienced by all women, and not all will experience them in the same capacity: it depends on how your body responds to your changes in hormone levels. If you aren't sure whether you're perimenopausal or not, you can go to your GP and get a blood test that will measure your hormone levels.

Related: Osteorporsis and the Menopause

Is there anything I can do to ease perimenopause and early menopause symptoms?

Whilst it's true that you can't prevent your body from going through its natural process of ageing, there are ways you can manage symptoms to support your body as it adjusts to these new changes. Lifestyle factors, particularly nutrition, exercise, and exposure to stress all work to affect our balance of hormones, and so can help to offset some of the discomfort experienced.

For instance, excessive consumption of caffeine and alcohol, known stressors, can exacerbate feelings of anxiety, whilst intake of vitamin E may relieve tension and reduce feelings of stress, due to its antioxidant properties. Omega-3 fats have also been found to help with feelings of depression, as well as prevent hair loss: another symptom of perimenopause.

Your diet can be a big help when relieving perimenopause and early menopause symptoms. Check out what to eat during menopause to help ease your symptoms.

The key is to be aware of the new health needs wrought by this stage of life and to support your body through a rich, balanced diet in natural, whole foods, the right menopause supplements, and regular exercise. Menopause may be a concerning point of change for many women, but it's nothing you should fear: just something you'll need to prepare for.

For women who struggle with symptoms, your GP can offer you treatments, such as hormone therapy or antidepressants. If you are concerned, speak with your GP to see how they can help.

You can also try supplements to help support your body through perimenopause or early menopause. Check out our guide on the best menopause supplements to help you find what would work for you. Or head to our range of menopause supplements to get the support you need.