What is perimenopause? Signs, symptoms and stages explained

Learn what perimenopause is, when it starts, common signs and how long it lasts. Blackmores' guide to hormonal changes, symptoms and when to speak with your GP.

Perimenopause is a defined biological life stage with a start point, an end point and a recognised hormonal pattern. The Australian Government Department of Health, Disability and Ageing describes it as the phase leading up to your final period and the 12 months that follow, commonly beginning in your 40s and lasting an average of two to ten years.

Understanding the terminology helps. Perimenopause, menopause and postmenopause describe three different things, and they are often used interchangeably in everyday conversation. This article sets out what perimenopause is, when it typically begins, how it differs from menopause, the changes that can occur along the way, and how to prepare for a conversation with your GP.

What is perimenopause?

Perimenopause is the transitional phase before and just after your final menstrual period. During this time, the ovaries gradually produce fewer eggs, and levels of oestrogen and progesterone fluctuate rather than following the steady monthly rhythm of earlier reproductive years.

Perimenopause is identified by a change in cycle pattern. The Australasian Menopause Society describes it as the period preceding menopause through to one year afterwards, characterised by hormonal fluctuation, cycles where ovulation does not occur, and the onset of cycle irregularity. Under the Stages of Reproductive Aging Workshop criteria, the Australasian Menopause Society also notes that perimenopause begins when there are persistent differences in cycle length of seven or more days between consecutive cycles, and continues until 12 months after the last menstrual period.

One point worth knowing early: ovulation still happens during perimenopause, so pregnancy remains possible and contraception is still relevant.

When does perimenopause usually start?

Perimenopause commonly begins in your 40s, though it can start earlier or later. Healthdirect notes that most Australian females reach menopause between 45 and 55 years of age, with an average age of 51.

There is no way to predict the exact timing, since factors such as family history, general health and medical treatments can all influence when the transition begins.

Can perimenopause start in your early 40s?

Yes. Starting in your early 40s sits within the typical range rather than outside it. Some women experience menopausal symptoms for two to 10 years before their final menstrual period, which means changes can begin well before the average menopause age of 51.

Two related terms are useful here. Jean Hailes for Women's Health describes menopause occurring between 40 and 45 as early menopause, and menopause occurring before 40 as premature menopause, also referred to as premature ovarian insufficiency. Both are recognised clinical situations that warrant a conversation with a doctor rather than self-assessment at home.

Perimenopause vs menopause: what is the difference?

Menopause is a single point in time. Perimenopause is the stretch of time around it.

Healthdirect explains that you have reached menopause when you have gone 12 consecutive months without a period, which means menopause can only be confirmed looking backwards. Perimenopause is the stage leading up to that point, beginning when periods become irregular and lasting until 12 months after the final period. Everything after that is postmenopause.

You may also come across the word premenopause. The Department of Health, Disability and Ageing defines premenopause as the years from your first period through to the start of perimenopause, so it describes a different span of time again.

Early signs of perimenopause to be aware of

Experiences vary widely, and the distribution is broader than public conversation often suggests. Jean Hailes for Women's Health reports that around 20% of women have no symptoms at all, around 60% experience mild to moderate symptoms, and around 20% have symptoms severe enough to significantly interfere with daily life.

The 2023 Jean Hailes National Women's Health Survey reported a similar pattern among Australian women aged 45 to 64: one quarter said symptoms they attributed to menopause made daily activities difficult, while another quarter reported no substantial impact.

How periods can change during perimenopause

Cycle changes are usually the first thing women notice. Fluctuating hormone levels can make periods:

• Shorter or longer in cycle length
• Heavier or lighter in flow
• Closer together or further apart
• Skipped altogether for a month or more

None of the changes above confirm perimenopause on their own. They are patterns commonly reported during this life stage, and a healthcare professional is the right person to interpret them.

If bleeding is very heavy or lasts longer than usual, if you bleed between periods, or if you bleed after intercourse, it is advised to visit a healthcare professional. The Australasian Menopause Society adds that bleeding occurring after 12 months without a period should also be investigated. These patterns warrant assessment rather than watchful waiting.

Sleep, mood, energy and temperature changes in perimenopause

Alongside cycle changes, national guidance from the Department of Health, Disability and Ageing lists commonly reported experiences including hot flushes and night sweats, changes to sleep, shifts in mood and energy, difficulty concentrating or finding words, and changes in libido.

Some of these overlap with each other. Disrupted sleep, for example, can influence how you feel the next day, which makes it harder to attribute any single change to hormones alone.

How long can perimenopause last?

Perimenopause lasts between two and 10 years, according to national guidance from the Department of Health, Disability and Ageing. Jean Hailes for Women's Health similarly describes perimenopause as the time leading up to and just after menopause, with menopausal symptoms most likely to start during this phase.

The wide range reflects genuine variation. The age at which symptoms start, and how long they last, cannot be predicted in advance.

Perimenopause or something else?

Many of the changes associated with perimenopause overlap with other explanations. Stress, disrupted sleep, thyroid function, iron levels and life circumstances can all produce similar experiences, and several may be present at once.

This is one reason self-assessment has limits. Jean Hailes for Women's Health explains that in the expected age range for menopause (45 to 55), it is not usual for a doctor to measure hormone levels for diagnosis; symptoms and period changes are used instead. For women under 45, hormone testing may be more useful.

Persistent changes are worth discussing with a healthcare professional, who can look at the full picture rather than one variable in isolation.

How to track changes before speaking to a GP

Walking into an appointment with a few weeks of notes makes the conversation more productive. A simple record might include:

• Cycle dates and flow. Note the first day of each period and whether flow was lighter or heavier than usual. Our guide to keeping track of your menstrual cycle covers a straightforward method.
• Sleep patterns. Bedtime, wake time and any night waking.
• Daily energy. A quick rating out of 10 is enough to reveal a pattern.
• Anything that felt out of the ordinary, with the date it occurred.
• Current medicines and supplements, including doses.

Four to six weeks of notes usually gives a GP enough to work with.

Everyday habits that support wellbeing through perimenopause

Daily habits form the foundation of feeling well through this life stage, and small consistent choices tend to be more sustainable than large short-lived changes.

Movement

The Australian 24-Hour Movement Guidelines recommend that adults aged 18 to 64 accumulate moderate to vigorous physical activity for 30 minutes or more on most days, include muscle strengthening activities on two or more days per week, and add functional activities targeting mobility, balance and coordination on three or more days per week.

The evidence for exercise and hot flushes is still developing and remains mixed. A 2022 systematic review and meta-analysis published in Climacteric found that exercise was associated with an improvement in vasomotor symptom (the clinical term for hot flushes and night sweats) severity compared with no treatment, though the certainty of evidence was rated very low and the effect weakened when higher risk studies were excluded. No significant difference was found for how often vasomotor symptoms occurred. The reviewers concluded that exercise might improve severity and that more rigorous trials are needed.

Sleep and routine

Australia's national movement guidelines recommend seven to nine hours of good quality sleep for adults, with consistent bed and wake times. Regular timing tends to matter as much as total hours.

Eating patterns

A varied diet built around vegetables, fruit, wholegrains, legumes, lean proteins and calcium-rich foods supports general health across midlife. Some women find that alcohol, caffeine and very spicy foods coincide with warmer episodes (or hot flushes), so a food and symptom diary can help you identify your own patterns.

Stress and connection

Midlife often coincides with caring responsibilities, career demands and financial pressure. Time outdoors, breathing practices, gentle movement such as yoga, and staying socially connected all contribute to how you feel day to day. You can find more across the Blackmores Women's Health Hub.

Supplement options and what to consider

Supplements sit alongside diet, movement, sleep and stress management rather than in place of them. If you are weighing up an option, it helps to look at what a formulation actually contains and to read the label warnings before you start.

Blackmores Peri & Menopause Balance is a formulation developed for this life stage. Each tablet contains Crocus sativus stigma extract dry concentrate 14 mg (equivalent to 42 mg dry), Trigonella foenum-graecum seed extract dry concentrate 300 mg (equivalent to 3 g dry), and Withania somnifera root extract dry concentrate 60 mg (equivalent to 1.5 g dry). The adult dose is one tablet twice daily, taken after food. It may help decrease hot flushes and night sweats associated with menopause, support the body's healthy stress response, help maintain emotional wellbeing and mood balance, and support healthy sleeping patterns and refreshing sleep.

This product is not for use during pregnancy or breastfeeding, or if you are likely to become pregnant, and is not for use if you have a pre-existing liver condition. It contains sulfites. If you have any pre-existing conditions or take any medications, talk to your health professional before use. Always read the label and follow the directions for use.

When to speak with a healthcare professional

Book an appointment with your GP if changes are affecting your work, sleep, relationships or day to day life. There is no need to wait until things become difficult to justify a conversation.

See a doctor if bleeding is very heavy or lasts longer than usual, if you bleed between periods, if you bleed after sex, or if you bleed after 12 months without a period. Persistent changes in mood, sleep or energy are also worth raising, since a GP can look at the whole picture and discuss the options available to you.

Frequently asked questions

What is perimenopause in simple terms?

Perimenopause is the transition leading up to your final period and the 12 months afterwards. Oestrogen and progesterone fluctuate during this time, periods become irregular, and a range of changes may occur. It ends once you have gone 12 consecutive months without a period.

At what age does perimenopause usually start?

Perimenopause commonly begins in your 40s, though it can start earlier or later. In Australia, menopause usually occurs between 45 and 55, with an average age of 51.

How long does perimenopause last?

Between two and 10 years, with an average of around four to six years. Individual experience varies considerably.

What is the difference between perimenopause and menopause?

Menopause is one specific point in time, confirmed once you have gone 12 months without a period. Perimenopause is the transitional phase leading up to and just after that point.

Can perimenopause affect sleep, mood and energy?

Changes to sleep, mood and energy are commonly reported during perimenopause. These changes can also have other causes, so persistent changes should be discussed with a healthcare professional rather than attributed to one factor.

Do I need a blood test to confirm perimenopause?

Tests are not usually needed for women over 45, where age, symptoms and menstrual history are used. For women under 45, hormone testing may be more useful.

Key takeaways

Perimenopause is the transition leading up to your final period and the 12 months that follow, commonly beginning in your 40s and lasting between two and 10 years. Menopause itself is a single point in time, confirmed after 12 months without a period, and usually occurs between 45 and 55.

Experiences vary widely, with around one in two women reporting mild to moderate symptoms, one in four reporting symptoms that affect daily activities, and one in four reporting none. Cycle change is often the first thing noticed, though many other changes overlap with stress, sleep and other explanations, which is why a healthcare professional is best placed to interpret them.

Movement, sleep, nutrition and stress management form the foundation of wellbeing through this stage, and tracking changes for four to six weeks makes a GP conversation more productive.

Always read the label and follow the directions for use.

Disclaimer: This article provides general information only and is not intended to diagnose, treat, cure, or prevent any disease. The information presented is not a substitute for professional medical advice. If you have concerns about your health, please consult your GP or healthcare provider for a personalised assessment and recommendations. Supplements should not replace a balanced diet.