Dr Norman Swan

Physician, journalist & broadcaster

It’s the transition leading up to menopause but perimenopause is actually a life stage in its own right. So here we are, answering the questions you’ve always wanted to ask about what really happens before menopause.   

What’s the difference between perimenopause and menopause?

Perimenopause is the time before menopause sometimes described as the “late reproductive stage”.1 Triggered by fluctuations in the body’s production of the hormone oestrogen, perimenopause can last from one to several years, generally during a woman’s 40s, although there’s a lot about timing most that’s still under investigation.1-2

Menopause occurs 12 months after a woman’s final period, signifing the end of a woman’s reproductive life when the ovaries no longer release eggs that can be fertilised and lead to pregnancy.2 Fifty-one years is the average age of Australian women at menopause however it can occur much earlier or later. 2

According to the Menopause Alliance Australia, “premature and early menopause affects 12 out of 100 women under the age of 45”.3

How will I know I’m in perimenopause?

Like puberty and pregnancy, a woman’s experience of perimenopause is highly individual and not a medical condition. There’s also no formal diagnosis or test for perimenopause.4 The best way to know what’s going on is to notice any troubling changes, seek evidence-based information and talk to your GP.3-5 

Some women will first notice changes to the cycle frequency (periods may occur more frequently in early perimenopause while the break between them later increases until bleeds stop entirely) or heaviness of their periods.1 Others notice the infamous hot flushes, sweating more, sleep disturbances, burning/itching/dryness of the vulva and vagina, less interest in sex, fatigue, low mood or anxiety.1-5 Then again, other women experience minimal or no troubling symptoms at all.3  

“Some women are quite surprised when their periods suddenly stop,” physician Dr Norman Swan says.6 “In terms of how long it lasts, some women barely notice they’ve had menopause. Their hot flashes and feelings like that [are] very transient, they’ve hardly noticed them at all. And Some women get lots of symptoms with hot flashes. They get lots of problems with their periods, and pain and so on, and have quite a rough time and that can last years but eventually it does settle down.”6

The good news is help is available if symptoms are preventing you from living well and it starts by talking with your GP.

I’m only in my 30s, could I really be experiencing perimenopause?

“Menopause can start from actually quite a surprisingly young age,” says Dr Swan. “There are some women who can have menopause in their 30s: premature menopause.” 6

For these women, perimenopause – the time before menopause which is technically 12 months after the final period – will also be early. Alternatively, other women may find perimenopause doesn’t start until much later and their menopause will occur well into their 50s. 

“So there’s a wide range, probably 15 or 20 years, when menopause can come on,” Dr Swan says.6

Women who experience early menopause due to surgery or cancer treatment may experience more intense hormonal symptoms and should be offered menopausal hormone therapy (MHT) which a recent article in the Medical Journal of Australia suggests should be continued until at least 50 years old.7

Is brain fog real?

Absolutely, says the Menopause Alliance Australia which reports almost two-thirds of women experience some kind of cognitive function changes around menopause.8 Struggling to concentrate or remember what task you were going to assign to a team member and/or feeling dizzy are some of the ways dubbed “brain fog” can manifest in perimenopause and beyond. 

What about mood changes – are they real too?

Yes. Feeling more up and down than normal or just a bit off is not unusual. In 2020, US researchers surveyed 1436 women between aged 35 to 55 years.1 When they were asked whether they experienced “just not feeling like themselves” during this phase of life, 64 per cent of participants indicated they felt this way half of the time or more.1 So if you are feeling off, or foggy, it’s worth knowing other women do, too. Talk to your family, friends and work about your needs and what might be helpful to you during this time. 

Can I really use menopausal hormone therapy (MHT) for unwanted symptoms during perimenopause?

Yes, MHT is indicated for many of the unpleasant symptoms women can experience before they reach menopause.3-4 What kind of treatment your GP will prescribe depends on whether your symptoms are mainly vulvovaginal (in which case oestrogen cream or pessaries inserted into the vagina can be effective) or systemic, such as hot flushes and sweating (for which patches, gels and oral tablets containing oestrogen, progestogen or a combination both are widely used).8-9

Isn’t HRT dangerous? 

Hormonal medicines for managing symptoms associated with all stages of menopause are proven to be safe and effective despite what the Medical Journal of Australia describes as “two decades of widespread dissemination of conflicting, and often frightening, information about menopause treatment.”7

Additionally, a 2023 study published in the Journal of the American Medical Association states the “best candidates for starting [M]HT are younger than age 60 years, are within 10 years since menopausal onset, and do not have elevated risks for cardiovascular disease or breast cancer.”10

Talk with your GP about whether MHT may be helpful to you and how lifestyle changes such as diet, exercise, sleep hygiene and stress management can be powerful gamechangers as well.

References

  1. Coslov N, Richardson MK, Woods NF. Symptom experience during the late reproductive stage and the menopausal transition: observations from the Women Living Better survey. Menopause. July 2021. 26;28(9):1012-1025. Accessed January 9, 2024. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8549458/
  2. Jean Hailes for Women’s Health. What is menopause? December 27, 2023. Accessed December 28, 2023. https://www.jeanhailes.org.au/health-a-z/menopause/about-menopause
  3. Menopause Alliance Australia. Menopause myths and facts. 2022. Accessed January 8, 2024. https://menopausealliance.au/menopause/menopause-myths-and-facts/
  4. Menopause Alliance Australia. Perimenopause. 2022. Accessed January 9, 2024. https://menopausealliance.au/menopause/perimenopause/
  5. Menopause Alliance Australia. Hormones, what happens to them? 2022. Accessed January 9, 2024. https://menopausealliance.au/menopause/hormones-what-happens-to-them/
  6. MyDr. At what age do women go through menopause – you ask, Dr Norman Swan answers. [nd]. Accessed December 28, 2023. https://mydr.com.au/womens-health/at-what-age-do-women-go-through-menopause/
  7. Davis SR, Magraith K. Advancing menopause care in Australia: barriers and opportunities. Med J Aust 2023;218 (11): 500-502. Accessed December 28, 2023. https://www.mja.com.au/system/files/issues/218_11/mja251981.pdf
  8. Menopause Alliance Australia. Brain fog. 2022. Accessed January 8, 2024. https://menopausealliance.au/menopause/brain-fog/
  9. Australasian Menopause Society. AMS Guide to MHT/HRT Doses Australia only. October 2023. Accessed January 8, 2024. https://www.menopause.org.au/hp/information-sheets/ams-guide-to-mht-hrt-doses 10.  Crandall CJ, Mehta JM, Manson JE. Management of menopausal symptoms: a review. JAMA. 2023;329(5):405–