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Hormone levels drop

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Estrogen and progesterone levels drop throughout perimenopause. This causes a variety of physical and mental symptoms, although the precise effects vary from woman to woman. By the time a woman reaches menopause – usually defined as two years after her last menstrual period – her hormone levels are even lower.

Periods stop

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Many women experience years of irregular periods once they enter perimenopause. Their periods may also be heavier or lighter than usual. Eventually, the periods stop. A woman under 45 is not usually considered to be in menopause until she has experienced two years without a period. An older woman is presumed to be in menopause when one year has elapsed from her last period.

Hot flushes

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Hot flushes are a common complaint for many perimenopausal women. For an unlucky proportion, these hot flushes continue after menopause is reached. A woman experiencing a hot flush feels very hot very suddenly. She may turn red in the face and she may sweat profusely. Many women describe hot flushes as beginning in their ears and spreading out across the rest of the body.

Mood swings

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Fluctuating hormone levels frequently prompt mood changes. This is called perimenstrual mood instability, and it can last for many years. Feelings of moodiness, tearfulness and low energy are all common. Some women experience more extreme mood changes, which they find very difficult to cope with. Hormone Replacement Therapy (HRT) may help.

Less interested in being intimate

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Declining levels of estrogen, progesterone and also testosterone can affect sex drive during both the perimenopause and the menopause. The precise impact on an individual varies but vaginal dryness and reduced ability to climax are both common. This can be distressing but some women may find that HRT or topically applied estrogen help.

Sleep problems

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Sleep problems are common during the perimenopause and menopause. Hot flushes are a frequent problem and some women find they are worse at night. Sleeping with a window open and using cotton sheets and light bedding can help a little. Higher anxiety levels may also provoke insomnia, and many women describe waking much earlier than normal in the mornings.


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It’s common for women to experience a drop in self-esteem and confidence as they go through the menopause. Declining hormone levels may be partially to blame for this. However, some women also struggle with their body image at this time, particularly if they gain weight or notice changes to their hair and skin. This can obviously also affect their self-esteem.


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Some women experience palpitations during perimenopause. These are mildly irregular heart beats that feel like flutterings in the chest. Although they can be alarming, they’re rarely a cause for concern. That said, it’s always sensible referring these sort of concerns to an appropriate health care provider. Usually, the palpitations settle once the woman enters menopause.


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Headaches and migraine are a fairly common experience for women going through perimenopause. Likely to result from fluctuating hormone levels, they’re most common in women who also experience headaches during their periods. Over-the-counter painkillers are usually all that’s needed but it’s also worth making sure you get as much rest and hydration as possible. Exercise can also help.

Vaginal dryness


Vaginal dryness is a very common side-effect of the perimenopause. It’s caused by declining hormones so can often be solved with HRT. However, if HRT is not an option, a good lubricant can help. Just make sure it’s a water-based lubricant if you’re also using condoms. Vaginal dryness usually persists into the menopause and can progress to vaginal atrophy. Again, HRT and lubricants can help.

Intimate pain

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Some women find that penetration becomes painful during the perimenopause and menopause. Often, this is due to insufficient natural lubrication. However, it can also result from the fact that, at this point in their lives, some women take longer to become aroused. Plenty of water-based lubricant, an understanding partner, and a willingness to explore alternatives can all help.

Irregular bleeding

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It’s common for periods to become irregular during the perimenopause. Spotting in between periods is also pretty normal for most women at this stage of their lives. However, it’s best to refer any concerns to your healthcare provider – and particularly if you experience any bleeding after menopause. Although post-menopausal bleeding is usually attributable to vaginal atrophy, polyps or some other benign condition, it can be a sign of serious disease and so always needs checking out.

Suffering in silence

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It’s all too common for women to feel very alone as they go through the menopause. Although it’s something every woman experiences – whether it’s a natural menopause or induced by surgery or medication – it is still something that isn’t much talked about in wider society. As a result, women may struggle to get the support their need at work and even in their immediate families.

Memory and concentration

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The vast majority of women report problems with memory and concentration as they go through the menopause. For some, the issue is little more than temporary “brain fog”. However, others are more profoundly affected, even to the extent that some women will feel they have no choice but to quit their employment. Workplace education and more knowledgable primary healthcare providers are the best tools to deal with this largely unacknowledged issue.

Joint aches and muscle pain

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It’s during the perimenopause that many women experience joint and muscles aches for the first time in their lives. Thought to be yet another consequence of falling hormone levels, the effects can be debilitating. Appropriate exercise and stretches can help, as can certain supplements and, if appropriate, HRT. Some women find the issue largely resolves after entering menopause but for others it’s a long term problem that they must find ways to manage.


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It’s common to put weight on during perimenopause and menopause. The exact cause is unclear but many women find that their calorie requirement drops and their metabolic rate slows. It’s also common for any weight gain to be unevenly distributed: around the hips and belly are the most usual areas. To keep excess weight off, women may need to adjust their diets and exercise more.


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Always more prone to urinary tract infections (UTIs) than men, many women see an increase in the number of infections as they progress through the menopause process. This is probably due to a thinning of the lining of the urethra – another side-effect of falling estrogen levels – which makes it more prone to damage and so more vulnerable to infection.


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Many women report rising anxiety levels during perimenopause. Probably attributable to fluctuating hormones, the anxiety can prove crippling. Unfortunately, it’s a symptom that is still widely dismissed by healthcare providers and discounted by employers. As a result, women may struggle to access practical support for their anxiety. For some people, mindfulness exercises, yoga, and walks in the fresh air can help. Others may need medication.

Skin and hair

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Changes to skin and hair texture are a common side-effect of menopause. Skin frequently becomes dryer, and you may also notice more wrinkles and age spots. As a result, you might decide to adjust your skincare and makeup regime. Hair, too, often becomes dryer and may also change texture. Increased frizziness is a frequent complaint but some women also notice previously straight hair becoming wavy.


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Even previously phlegmatic, easy-going women can experience bursts of irritability as they go through the menopause. The causes are not clear but are almost certainly linked to the declining levels of estrogen and progesterone – sometimes referred to as the “nurturing hormones”. Not all women will classify their new behavior as irritability. Some prefer to describe it as “being forthright” or “not putting up with things” that they’d previously have tolerated.

Goodbye to PMS

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Menopause isn’t all bad news. Once you’re through perimenopause, there’s a very good chance you can wave goodbye to all the PMS symptoms that have been plaguing you for years. No more bloating, cravings, or fits of crying that come from nowhere – and, if you’re lucky, any irritability or other mood swings will also subside.


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Until you finally reach the menopause, period cramps may continue to be a part of your life. Indeed, unfortunately, they can really seem to ramp up during the perimenopause. This isn’t necessarily because your periods are more painful but because they may come more frequently and last for longer. The usual remedies still apply: hot water bottles, over-the-counter painkillers, and chocolate.

Lower back pain

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Lower back pain can be a real pain – literally and figuratively. And, unfortunately, until you reach menopause, it’s a possibility every time you have a period. Some women are more prone to lower back period pain than others, some women will experience it only occasionally, and others not at all. Again, painkillers can help but you may also like to try massage or even acupuncture.


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Perimenopause is often a time of lowered energy levels. Unfortunately, it’s also often a time of poor quality sleep. Combine the two and, chances are, you have an exhausted woman. As a result, it’s very important to rest whenever you can. Eating a good diet and having a healthy exercise regime are also beneficial. However, if all else fails, reassure yourself with the fact that many women describe feeling reenergized once they reach menopause itself.

Sensitive breasts

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Breast tissue is very sensitive to fluctuating hormones. You’ve probably already noticed cyclical increased tenderness when you have your period. Unfortunately, this can increase during perimenopause and even get worse. It’s also possible that your breasts may change in size or shape. Make sure you are wearing a supportive, comfortable bra in the right size – and get the fit checked every few months.

Increased risk of certain health problems

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It’s important to appreciate that declining female hormones increase your risk of suffering from several serious health conditions, including heart disease and osteoporosis. A healthy diet and exercise can help you manage this increased risk. HRT can also help – and many doctors recommend it for women experiencing an early menopause (generally under the age of 45).

Loss of muscle mass

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It’s common to put on weight during the menopause. Most of this weight gain is due to the body laying down more fat stores. However, along with this extra fat, most women also experience a decline in muscle mass. This can make you look fatter, or flabbier, even if you haven’t put weight on. Exercise, particularly strength training is key in stemming muscle mass loss – and will also help ensure you don’t put on too much extra fat.

Low moods

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Experiencing low moods is common to most women going through the menopause. They’re partly a consequence of the fluctuating hormones and partly a natural reaction to the changes the woman is going through. The end of the fertile years can provoke strong feelings of sadness or even grief – and, for some women, these emotions are more persistent and harder to deal with. It’s important to seek help if you are struggling in this way.

How long it lasts

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The length of time it takes to reach menopause often surprises many people. The average woman spends ten years in perimenopause: this is ten years of irregular menstruation and breakthrough bleeding, challenging emotions and a variety of physical symptoms. Knowing when to seek help is important, as is realising that HRT has potential benefits when taken during the perimenopause, as well as once menopause is reached.

Ways to help

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Every woman’s menopause journey is unique. Some women genuinely sail through it with little or nothing in the way of either physical or emotional symptoms. Others really struggle. However, there’s a wealth of advice out there – especially from older women. Some people may choose to focus on diet and exercise, over-the-counter supplements, or homeopathy. Others may opt for HRT. Whatever you choose, it’s important to understand your options so you can make a balanced decision.

You are not alone

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When it comes to the menopause, it can sometimes feel like no-one else understands how you’re feeling. However, given that more than 50% of the population has – or will – experience the menopause, this isn’t the case. Luckily, times are changing and the menopause is featured more regularly in the media and is even becoming a boardroom topic. Normalizing this normal part of a woman’s life should help all women feel less alone.

Average age

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The average age for a woman to reach menopause is 51. This is the point at which her periods have definitively stopped. However, before this point is reached, she will have spent around ten years in perimenopause, experiencing a variety of symptoms. These may include erratic periods (which will eventually stop altogether), mood swings, weight changes, reduced libido, and insomnia.

Earlier or later

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Although the average age of menopause is 51, many women experience it at a much younger age, and some at a somewhat older age. Early or premature menopause can be particularly difficult, especially if the woman has not started or completed a much-desired family. Early menopause also brings additional health risks – and so it’s particularly important to seek medical advice if you’re having perimenopausal symptoms in your 20s, 30s or early 40s.

Causes of early menopause

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The age at which you’ll experience menopause is largely genetically determined. Obviously, however, surgical removal of your uterus or ovaries will trigger menopause, no matter your age. Chemotherapy also sometimes induces menopause. Additionally, it’s thought that smoking and a higher body mass index may lower the age at which you’ll experience menopause.

Know your perimenopause from your menopause

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Perimenopause is the less familiar precursor to the menopause. However, it’s crucial you understand the difference – because it’s during perimenopause that women are most likely to experience all the symptoms commonly ascribed to “the menopause”. You’re said to be in menopause once a certain amount of time (exactly how much depends on your age) has elapsed since your last period.

Knowing when you’ve reached menopause

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Contrary to popular belief, measuring hormone levels is an inexact science and can’t determine whether or not you’ve reached menopause. Instead, the general is that a woman over 45 is in menopause if she’s gone 12 months without a period. A woman under 45 is in menopause if she’s gone 24 months without a period. Reaching menopause often coincides with a reduction in many of the worst side-effects of perimenopause.

Hot flushes aren’t inevitable

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Hot flushes – or flashes – are one of the most well-known side-effects of the perimenopause. However, they’re not inevitable, and 25% of women will never experience them. On the other hand, unfortunately a small proportion will continue to experience them even after reaching menopause. Many women find HRT the most effective way of quelling hot flushes.

Don’t assume it’s the menopause

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Yes, if you’re a woman, you will experience menopause at some point. However, don’t assume that you’re having perimenopausal symptoms without first ruling out alternatives. Stress, pregnancy and some illnesses can all disrupt your menstrual cycle and cause many of the most common perimenopausal symptoms. Hormonal fluctuations prior to perimenopause are common, especially with conditions like polycystic ovary syndrome.

Feeling cold

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Did you know that hot flushes are sometimes quickly followed by a feeling of intense cold? This intense temperature fluctuation can make choosing what to wear tricky. Many women find that layers are best, allowing them to add and remove clothes as necessary. Natural fibres, such as cotton, linen and merino are preferable.

Reducing hot flushes

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Hot flushes are no fun at all, and can be very embarrassing when they happen in public. Some women find that cutting out, or at least reducing, spicy food, alcohol, and caffeine helps reduce the frequency and intensity of hot flushes. Supplements such as Vitamin E and Black Cohosh may also help. Frequently, it will be a case of trial and error to find what works best.