How to know if you’re starting menopause

Have you felt your body’s natural routine changing? Are you noticing your periods becoming irregular, experiencing brain fog, raised levels of anxiety or mood swings, worsening sleep, weight gain or hot flushes? You may be experiencing symptoms of perimenopause. Hormone health and menopause expert Dr. Katie Hodgkinson explains how to recognise the early signs of menopause, the 5 common signs and symptoms of perimenopause, and how to manage your symptoms.

You may also be interested in reading the results of our customer survey of over 1,500 women that reveals the most effective changes you can make to your diet during menopause.

What is perimenopause?

Perimenopause, menopause and post-menopause are stages in a woman’s life that reflect the natural decline of ovarian function, where oestrogen production decreases and ovulation stops. This affects the hormones of the menstrual cycle, resulting in monthly periods coming to an end and bringing about other associated changes, signalling the end of a woman’s fertility.

Perimenopause is the first stage of this process, referred to as the ‘menopause transition’. It is a delicate transitional period that usually begins 4-10 years before menopause, when the ovaries gradually produce less oestrogen, progesterone and testosterone, and lasts until menopause. 'Menopause' is the point when the ovaries stop releasing eggs and when a woman has gone without a menstrual period for 12 consecutive months.

During perimenopause, women can experience up to 30 common symptoms, and on average will experience at least 10 symptoms, according to a consumer survey of over 1,500 women**. There may also be changes to the menstrual cycle including heavier or lighter periods, increasing episodes of skipped or missed periods, and heightened symptoms of PMS including cramps, breast tenderness, fatigue and irritability. Our latest customer survey of over 1,500 women going through all stages of menopause revealed that 60% of women going through perimenopause experience PMS symptoms. Despite the reduction in oestrogen levels, it is still possible to become pregnant during the perimenopause.

When does perimenopause start and end?

Women can experience perimenopause at different ages. As it is a gradual change in hormones, some women notice signs of transition to menopause in their 40’s while others notice changes in their mid-30’s.

The length of each stage of the perimenopause can vary for each individual. While the average length of perimenopause is between 3-4 years, some women may only be in this stage for a few months, but it can extend as long as 10 years for others.

Changes in oestrogen levels in perimenopause

During a woman’s fertile life stage, the body produces oestrogen, progesterone, follicle-stimulating hormone (FSH) and luteinizing hormone (LH).

As you approach perimenopause, the ovary’s output of oestrogen, FSH and progesterone fluctuates and leads to a gradual reduction of these hormones. These hormonal changes can occur in your late 30s and early 40s, and the declining ovarian function often causes changes to the menstrual cycle and a range of perimenopausal symptoms, including bloating, breast tenderness, hot flushes, night sweats and issues with mood, memory, and concentration.

How do you know you're starting perimenopause?

Each woman experiences perimenopause differently - while some have few or no symptoms, others will suffer from debilitating symptoms. As hormones shift during the years leading up to menopause, the frequency, intensity, combination, and duration of symptoms vary widely from one to another. The most common physical and worst mental symptoms of perimenopause include joint aches or pain, weight gain, insomnia, exhaustion, social anxiety, depression, feelings of worthlessness, and loneliness.

Discover our Menopause Hub which has extensive resources to help support women through all stages of menopause.

5 signs and symptoms of perimenopause

If you’ve found yourself asking ‘how do you know if you have started perimenopause?’, here we share signs to look out for.

1. Changes in your menstrual cycle

The early transition of perimenopause is defined by almost regular periods and occasionally skipped cycles; as ovulation becomes more unpredictable, cycles can become more irregular with periods becoming lighter or heavier, and the length of time between periods might be longer or shorter.

There can be phases of skipped or missed cycles that can last over 60 days and then your cycle could run like clockwork once again. This menstrual irregularity lasts until reaching menopause. Learn more about perimenopause periods.

2. Worsening PMS symptoms and mood changes

PMS (premenstrual syndrome) often occurs 1-2 weeks before menstruation and symptoms usually ease after a period arrives. PMS symptoms will vary between individuals, and our survey showed 65% of women experience anxiety as a result of PMS symptoms, and other symptoms include mood swings, irritability, breast tenderness, and bloating.

Some women are more likely to experience heavier PMS symptoms during perimenopause due to the body’s enhanced sensitivity to hormone fluctuation and irregular ovulation. Our survey showed PMS symptoms affected 20% of women during menopause. For women who haven’t had PMS before, they may find the mood changes and physical symptoms difficult to adjust to. The foods you reach for, and just as importantly the foods you avoid, can all help relieve PMS symptoms - learn more about the best foods for PMS symptoms.

What nutrients support PMS symptoms?

Vitamin E and essential fatty acids have been shown to help combat PMS symptoms including breast tenderness and low mood. Great foods to reach for if you're experiencing PMS symptoms include almonds, peanuts and sunflower seeds as well as plant oils such as sunflower, soya and olive oil. Essential fatty acid food sources include omega 3 fatty acids (oily fish such as salmon, mackerel, and sardines), linolenic acid and oleic acid.

3. Hot flushes and night sweats

Hot flushes are one of the most common symptoms of perimenopause and, based on our survey, will be experienced by up to 75% of women**. Hot flushes are characterised by feelings of intense heat spreading through your chest, face and neck, accompanied by sweating, rapid heartbeat and a flushed appearance.

How to stop hot flushes and night sweats

Reducing intake of caffeine, alcohol and spicy food, and regular physical activity has been shown to help manage and reduce the intensity of hot flushes. These stimulants can also aggravate PMS symptoms and interfere with sleep.

Plant oestrogens (phytoestrogens), which are naturally occurring plant compounds that act similarly to human oestrogen, have been shown in studies to relieve perimenopausal symptoms, particularly hot flushes. Foods containing plant oestrogens include linseeds, flaxseeds, oats, chickpeas, and soy-based foods such as tofu, tempeh, miso and edamame.

4. Fatigue, poor sleep and emotional changes

Melatonin, the hormone which regulates sleeping patterns, can be impacted as a result of perimenopausal changes, leading to sleep disturbances and increased fatigue. Fatigue, poor sleep and mood swings affect more than three quarters of women during menopause.

Oestrogen and progesterone are powerful hormones that affect all tissues in the body, including the brain. The shifts in hormone levels during perimenopause may lead to mood swings or not sleeping well, causing a variety of emotional changes including:

Exhaustion
Lack of motivation
Difficulty concentrating
Social anxiety
Mild depression
Feelings of worthlessness or being invisible
Not wanting to work
Feeling inadequate sexually
Loneliness
Poor sleep or insomnia.

Learn more from our experts on the 8 worst symptoms of menopause and why menopause causes anxiety and mood swings.

Managing emotional changes during perimenopause can be difficult, but it is possible through diet, nutrients, exercise and breathing. Magnesium has been studied for helping the body cope with tiredness and fatigue and supports a healthy nervous system for physical and mental function. You may also be interested in 'How do I know if I'm deficient in Magnesium.'

5. Weight gain

Fluctuating hormones in perimenopause and the natural ageing process can disrupt your metabolism and impact lean body mass, resulting in women often losing muscle and gaining fat during this phase. More than two thirds of women experience bloating and weight gain during menopause, while research shows 90% of women will experience worsening gut health during menopause.

Our gut and hormones are connected, and imbalances in hormones affect the whole body including weight, the appearance of skin, and hair growth and hair thinning. Hormonal changes, along with lifestyle factors, increase the risk of weight gain, particularly around the abdomen area, which is also linked with worsening hot flushes and night sweats.

Tips to help manage weight

Staying active in ways you enjoy such as walking, swimming, cycling and running, and including weight-bearing and muscle-strengthening exercises into your routine may help reduce weight gain, and it is associated with fewer perimenopausal symptoms.

Remember, you can also be more active during your daily routine: try taking the stairs; parking further away from your destination and walking; gardening; or even dancing! Read our nutritionists advice on how to manage your weight in a healthy way.

How to manage perimenopausal symptoms

A combination of a healthy diet, regular physical activity, and managing stress is associated with fewer perimenopausal symptoms. Limiting consumption of processed foods and drinks, alcohol intake, refined sugars and unhealthy fats is encouraged.

Following a traditional Mediterranean diet may also offset symptoms and has been shown to contribute to a healthy heart during perimenopause. Learn more in the best foods and diet for managing menopause symptoms.

*Based on a UK survey conducted by DR.VEGAN^® of 32 customers, nationally representative, during November 2022. All research findings reflect our own research efforts and have not been influenced by any external organisations or third-party entities.

**This article includes data based on a UK survey conducted by DR.VEGAN^{^®} of 996 customers of MenoFriend^{^®}, nationally representative, during January & February 2024. All customer survey findings reflect our own efforts and have not been independently verified or influenced by any external organisations or third-party entities.

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