Let’s talk about perimenopause (before it sneaks up on you)
Perimenopause isn’t something we learn much about in school. It’s not always dinner party conversation. And for many women, it doesn’t come with a neat heads-up. One day your cycle’s doing its usual thing, and the next, things feel... off.
At femme, we believe knowledge is power – especially when it comes to your hormones. So here’s your no-nonsense guide to what happens during perimenopause, when it can start, and the evidence-based options available if symptoms begin affecting your life. For a closer look at what can and cannot actually be changed, our guide to whether perimenopause can be reversed separates symptom management from misleading claims.
First things first: what is perimenopause?
Perimenopause is the transition leading up to menopause, when hormone levels fluctuate and symptoms can begin before periods stop completely. It can last for several years and commonly happens during the 40s, although symptoms can begin earlier.
Key point: for someone who is not using hormonal contraception that affects bleeding, natural menopause is usually defined after 12 months without a period. Hormonal contraception, HRT and some medical situations can make bleeding patterns harder to use on their own, so diagnosis is not always as simple as counting months.
Common signs of perimenopause
Every woman’s experience is different, but common symptoms can include:
- Changes to periods, including irregular, heavier, lighter or skipped periods
- Mood changes
- Sleep problems
- Problems with memory or concentration, often described as brain fog
- Hot flushes or night sweats
- Vaginal dryness
- Changes in sex drive
- Anxiety or low mood
- Fatigue
These symptoms can be associated with the hormonal changes of perimenopause, but they are not unique to it. New or concerning symptoms still deserve proper assessment rather than being automatically attributed to hormones.
When does perimenopause start?
There’s no universal start date. Menopause most often happens between ages 45 and 55, and perimenopausal symptoms can begin months or years beforehand. Some women notice changes earlier.
Important: you do not need to wait for your periods to stop before seeking support. If symptoms are affecting your quality of life, talk to your GP. If periods stop or menopausal symptoms develop before age 45, medical advice is particularly important; menopause before 45 is considered early, and loss of ovarian function before 40 may need assessment for premature ovarian insufficiency.
How to support your body through perimenopause
1. Track your cycle and symptoms
Understanding your baseline can help you notice changes. Apps, journals and wearable tools can help you record cycle length, sleep, symptoms and temperature trends. Our guide to tracking your cycle during perimenopause explains what temperature data can and cannot tell you. A device such as Tempdrop can collect overnight temperature data, but it does not diagnose perimenopause.
2. Prioritise sleep and stress support
Sleep disruption is a common menopause symptom. A regular sleep routine, reducing late caffeine or alcohol, and addressing night sweats or anxiety can help some people, although persistent sleep problems may need treatment rather than another lifestyle hack.
3. Nourish yourself properly
A balanced diet with enough protein, fibre, calcium-rich foods and a range of fruit and vegetables supports general health through midlife. You do not need a restrictive “hormone-balancing” diet. Our evidence-led guide to foods for menopause symptoms, bone health and heart health gives a more practical starting point, while our look at the Japanese diet and menopause symptoms explores why dietary patterns may matter.
4. Be selective with supplements
Vitamin D is routinely recommended in the UK according to seasonal and individual guidance. Other supplements such as magnesium, omega-3s or B vitamins are not automatically necessary for every woman in perimenopause. Check your diet, medicines and individual needs before adding them.
HRT and other treatment options
Hormone replacement therapy (HRT) is the main medicine used to treat menopause and perimenopause symptoms. NHS guidance says it is safe and effective for most people with symptoms, although it is not suitable for everyone and the balance of benefits and risks depends on individual health history.
HRT is not something you need to fear or something everybody must take. It is one evidence-based option to discuss with a GP or menopause specialist alongside other treatments for specific symptoms, including vaginal oestrogen and non-hormonal options where appropriate.
The takeaway: perimenopause is a new chapter, not something to ignore
Perimenopause does not mean you have to “put up with” symptoms that are affecting your work, sleep, relationships or quality of life. It is a time to get curious about your health and ask for support when you need it. There can also be positive changes through this stage of life; our guide to the benefits and positive changes associated with menopause looks at healthy ageing without minimising difficult symptoms.
The more you know, the better equipped you are to advocate for yourself – whether that’s at your GP’s office, in your relationships, or simply in understanding why your cycle and symptoms may be changing.
At femme, we’re here to make sure you’re not caught off guard. No drama. No doom. Just useful information, support and tools.
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