Perimenopause: Signs You’re Starting Menopause

Perimenopause – the limbo between having regular periods and entering full menopause – can bring big mental and physical changes for many people – and sometimes, change can be daunting.

Starting perimenopause without knowing what to expect is like jumping on a rollercoaster, unsure of when it’ll stop.

But information is power, which is why we spoke to an expert about what to expect. Dr Ornella Cappellari from Meg’s Menopause has shared her knowledge with us, so that we can help you to feel more prepared for the journey ahead.

Perimenopause – what is it and when does it begin?

Perimenopause begins when your ovaries start to slow their production of oestrogen.  On average, this phase begins four years before menopause. In some people, perimenopausal symptoms can begin as early as 10 years before the menopause.

What are the signs of perimenopause?

For some, perimenopause can mark the beginning of a relatively easy slide into menopause. But for others, the road is rockier – the symptoms are more pronounced, and they affect both the mind and body. Everybody is different, so both mild symptoms and more severe ones can be considered normal.

There are many symptoms of perimenopause and menopause, but here are the most common ones:

Perimenopause periods

One of the clearest signs of perimenopause approaching is if your menstrual cycle is changing. This doesn’t necessarily mean shorter, lighter periods – they can become heavier and longer, too – or they might even disappear for a little while, and then come back.

In this menopausal transition, perimenopause periods can manifest in different ways for different people. The difference relies on how your body processes the changing levels of oestrogen and progesterone during perimenopause.

Your monthly period may continue on with about the same length and flow. But it’s possible you may notice your cycle getting longer. You could also experience missed or irregular periods, or you may have shorter periods.

In addition to varying cycle lengths, many who go through perimenopause may notice a change in their period’s flow. Whether it’s a heavier or lighter flow, perimenopause periods are likely to be quite irregular.

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You can be sure you’ve reached menopause when you have gone for 12 months in a row without having a period, but you can still get pregnant while perimenopausal – so be mindful of that!

Hot flushes

A hot flush feels like heat rising through your body, followed by an inescapable urge to unclothe and cool down! Once a hot flush starts, it can’t be stopped, but it can be eased by shedding layers of clothes and opening the window, or going for a walk; this too shall pass!

If you find you’re getting hot flushes often, avoiding spicy foods and alcohol might help. If you choose to start HRT (Hormone Replacement Therapy), you can ameliorate hot flushes and other symptoms.

Insomnia or difficulty sleeping

Sometimes menopause can make a good night’s sleep feel like a fond but distant memory. And if you’re not sleeping well, it can have an impact on every part of your life; your concentration, memory, mood, appetite and energy levels…. If you find yourself snapping at your partner or children over something trivial, or crying because you’ve misplaced your keys – don’t worry, it gets better once your body settles into a new norm.


Due to hormone levels fluctuating, headaches are a common symptom of perimenopause. Make sure to stay hydrated and spend time away from screens. If you wear glasses, make sure your prescription is up to date, too. Our eyes change as we get older!

Mood swings

During perimenopause and menopause, our emotional pendulums can swing from one mood to another very quickly. This, again, is because of the change to our hormone levels – hormones govern so many of the processes in our bodies, including our emotions.

You might find that you have heightened sensitivity – and perhaps you’ll feel your emotions more deeply. This doesn’t have to be a bad thing as long as you’re communicating what’s happening for you with your nearest and dearest (so that they can support you through it – and perhaps brace themselves!)

Loss of libido

Loss of libido is another very common symptom for people experiencing perimenopause and menopause. For some people, this might not be much bother, but for others, this can be a real loss, whether from a mixture of hormonal fluctuation or because of the physical effects of ageing. However, there are ways to tackle some of the more physical problems, such as vaginal dryness – so if you find that the change to your sex life is getting you down, speak to your doctor.

Even though these symptoms are the most common ones there are other menopausal symptoms. The reality is, we are all different and our bodies respond to ageing in different ways. If you’re struggling with perimenopausal or menopausal changes, the most important thing is knowing that you’re not alone and the best action you can take is to speak out about it and find some solidarity in other people who understand what you’re going through.

And just remember: it is a normal physiological process and you will get to the other side stronger than ever, with a deeper understanding of yourself.

Do you have any tips for entering perimenopause? Let us know in the comments below.

About Dr Ornella Cappellari

Dr Ornella Cappellari is a life science researcher with a specific interest in endocrine system and hormonal body regulation. She has a PhD in Human Molecular Medicine from University of Rome, works at Royal Veterinary College, and collaborates with other institutions such Manchester University and University of Bari, Italy. She thinks it’s pivotal to make people aware in this stage of their life of the influence of their daily choices, and that’s why she works actively on the topic for Meg’s Menopause and other charities.

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