Perimenopause

This is a medical term used to describe the period of time leading up to the menopause. It is the initial stage of the process in which there is a shift from regular ovulation and menstruation to a cessation of both of these.

This means an end to your fertility and is known as the menopause.

Is perimenopause the same as premenopause?

There is some confusion over this as both terms are often interchanged with each other.

The difference between the two is that the perimenopause is the first stage of the process in which there are significant changes to your hormone levels.

Whereas the premenopause is the second stage which directly leads up to the menopause. This is a stage in which you will experience the biological symptoms of this change which include hot flushes, night sweats and mood swings.

Erratic hormone levels

The perimenopause is a time when your hormone levels will start to decrease. Your ovaries produce the female hormones oestrogen and progesterone which are responsible for your fertility. But these naturally fall during this time which impacts upon your reproductive abilities and menstrual cycle.

This process varies from one woman to the next. Many women find that their hormone levels tend to fluctuate during this stage which affects their menstrual periods.

Signs of this include lighter periods although they can also become heavier than normal. You may find that you skip a period or miss several periods.

Irregular periods are another sign of the perimenopause as are cramps.

If you are normally regular as clockwork with your periods but have noticed these changes then it may be a sign that you are entering the menopause.

Basically, you are in the early stages of the menopause process.

When does perimenopause start?

This varies between women. It usually starts in your 40’s although it is not uncommon to experience these signs in your late 30’s.

On average, it starts around the ages of 45 to 47.

Causes of perimenopause

To start with, your periods are becoming lighter and less frequent which is due to decreased egg production by the ovaries.

Reduced egg production

The ovaries release an egg each month during ovulation. This egg passes down the Fallopian tube, ready for fertilisation. But if this doesn’t happen then it is broken down and expelled by the body during menstruation.

The ovaries also produce the female hormones oestrogen and progesterone plus tiny amounts of testosterone (male hormone).

These hormones are discussed in detail in our female hormones and menopause section.

A reduction in the number of eggs produced at this time means a fall in oestrogen levels which then impacts upon your menstrual cycle.

Follicle stimulating hormone (FSH)

This hormone is produced by the body’s pituitary gland and is present in both men and women. It plays an important part in regard to fertility and conception.

It stimulates the production of sperm in men.

It stimulates production of eggs in women and the release of a hormone called ‘estradiol’in the early stages of the menstrual cycle.

FSH normally increases each month as preparation for the menstrual cycle. It encourages the release of an egg as part of this cycle which is either fertilised or eliminated from the body during a menstrual period.

Oestrogen levels rise at this point whilst FSH levels fall.

High levels of FSH can be an indication that your ovaries are shutting down egg production which means that the menopause has started.

A drop in oestrogen levels forces up levels of FSH which also acts a trigger for the ovaries to produce eggs.

But the ovaries are unresponsive to this which further increases FSH levels.

However, high levels of FSH may be the sign of an underlying disease so it is important to seek medical advice about this.

Are you still fertile at this stage?

The answer to that is yes although it is difficult to become pregnant during this time. This is due to an irregular ovulation cycle which will eventually end.

But never assume that you will not become pregnant as it can and does happen.

Other signs of perimenopause

Another sign that you are in the early stages of the menopause is weight gain. This is by no means automatic but many women find that they gain a few pounds in their late 30’s or their 40’s.

Headaches, vaginal dryness and emotional changes such as feeling sad or ‘blue’ are also signs of this stage.