Perimenopause & menopause: understanding it

Perimenopause usually starts in the mid-40s, but it can begin as early as the mid-30s or as late as the mid-50s. It lasts about four years on average, and can last up to eight. For some people it is only a few months.

Hormone levels go up and down during this time, a bit like a bumpy road. Periods may come closer together or further apart, and be heavier or lighter than before.

Many people don’t realise their low mood, anxiety or poor sleep is linked to perimenopause, because they are still having periods. Tracking your mood alongside your cycle can help you see the pattern.

Menopause is confirmed when you have gone 12 months in a row without a period. In the U.S., the average age is 52, and the usual range is 45 to 58.

Your mother’s age at menopause can give a rough guide to yours. Smoking can bring menopause up to two years earlier.

Once you reach menopause, you are postmenopausal for the rest of your life. Most symptoms ease over time, but some can last for years. Hot flashes last an average of 9 years after menopause, and up to 14 years for some.

Some changes, like joint pain and vaginal dryness, can carry on after menopause. They are worth mentioning at check-ups.

Anxiety around menopause can show up as worry, restlessness, a racing heart, tight muscles, trouble concentrating or sleep problems. Some people have panic attacks for the first time.

People who have always been prone to anxiety, or who had postpartum depression, are sometimes more likely to develop panic disorder around menopause. But anyone can.

Women are more vulnerable to depressive symptoms during the move into menopause. Some mood swings are expected. But strong sadness, irritability or loss of enjoyment can be signs of depression, which deserves care.

Cleveland Clinic says low mood or loss of pleasure on most days for at least two weeks is a reason to talk to your provider.

Mood swings, tension and tearfulness are common, especially in perimenopause when hormone levels bounce up and down.

Things that can help

• Move your body every day, even a short walk
• Name it: “This is a hormone wave. It will pass.”
• Step away for a few minutes and breathe slowly
• Tell the people you live with what is going on
• Write it down, so you can spot patterns later

Brain fog, body changes and unpredictable feelings can leave you doubting yourself at work and at home. This is a common part of the transition, not a sign that you have lost who you are.

Cleveland Clinic suggests journaling, a gratitude practice or a creative hobby that gives you a sense of achievement. Small wins can rebuild trust in yourself.

Turning red and sweating in a meeting, on a date or in a shop can feel embarrassing. Some women start avoiding situations, or worry all day about the next flash. That steady worry can wear down confidence and mood.

Night sweats break up sleep, and poor sleep makes irritability, anxiety and low mood worse. So helping hot flashes often helps your mood too.

Try

• Keep a fan at your desk and by your bed
• Keep your bedroom cool, with light, natural-fibre bedding
• Sip cold water, or run cold water over your wrists
• Take slow, steady breaths when a flash starts
• Wear light layers you can take off quickly

Common triggers include spicy food, alcohol, caffeine, hot drinks, smoking, stress and heat. Tight or synthetic clothing can make things worse too.

Rather than cutting out lots of foods, a Cleveland Clinic doctor suggests finding your own personal triggers. A simple log for a couple of weeks can show what sets yours off.

Ideas for better nights

• A calming routine before bed: dim lights, no screens, a warm shower
• Avoid caffeine after noon, and go easy on alcohol
• Exercise earlier in the day rather than late at night
• Keep the bedroom cool; try layers you can kick off
• Keep to regular sleep and wake times, even at weekends
• Skip long daytime naps if they make nights harder
• White noise can help if you wake easily

The NHS says cognitive behavioural therapy (CBT) can help with hot flushes, as well as low mood, anxiety and sleep problems. It doesn’t make the flashes disappear. It helps you respond to them with less distress, so they bother you less.

Try

• A “landing spot” by the door for keys, glasses and phone
• Doing one thing at a time, with fewer tabs open
• Doing the hardest thinking at your best time of day
• One list, in one place, for everything
• Phone reminders for appointments and tasks

Poor sleep and anxiety both make it harder to concentrate and remember. Easing night sweats and worry often clears some of the fog too.

Regular movement also helps mood and sleep, which supports a clearer head.

Before 55, women have a lower risk of heart disease than men. After menopause, women’s risk becomes the same as men of the same age.

Regular check-ups, staying active and not smoking all help protect your heart.

After menopause, women lose bone faster than before, which raises the risk of osteoporosis.

Weight-bearing exercise, like walking or dancing, plus resistance exercise, like using weights, helps keep bones strong. Calcium-rich foods help too.

About half of postmenopausal women have trouble holding in urine. Many feel too embarrassed to mention it, but it is common and help exists.

Many women gain about 5 pounds after menopause, often around the tummy. This can be hard on body image.

Regular exercise helps mood, sleep and hot flashes. Weight-bearing exercise like walking, running or dancing, plus resistance exercise like weights, helps keep bones strong.

The Office on Women’s Health suggests aiming for at least 30 minutes of activity on most days.

A balanced diet with plenty of fruit, vegetables and whole grains helps. Calcium-rich foods like milk, yoghurt and kale support bones. Some sunlight on your skin helps your body make vitamin D.

Cutting back on caffeine, alcohol and smoking can help hot flashes, sleep and bones.

Relaxing activities like yoga, tai chi and meditation can help with mood. Stress is also a common hot flash trigger, so calming your brain can help your body too.

Other ideas from Cleveland Clinic

• A creative hobby that gives you a sense of achievement
• Guided meditation or breathwork
• Journaling or a gratitude practice
• Therapy, for perspective and coping tools

Talking to others going through the same thing, like friends or colleagues, can help. Cleveland Clinic suggests a support group, ideally one led by a menopause specialist.

Perimenopause can start 8 to 10 years before your last period, and symptoms like low mood, anxiety and poor sleep can begin well before periods stop.

The NHS lists mood swings, anxiety, brain fog and trouble sleeping alongside hot flushes. For some women, the mental symptoms are the hardest part.

Hot flashes can last up to 14 years after menopause for some women. That is why it is worth getting support rather than waiting it out.

Menopause can come before 45, or even before 40, and surgery or cancer treatment can bring it on at any age.

Early advice can lessen the effects of menopause on your health, relationships and work. You deserve to feel well.

Steps

1. Track your symptoms, mood and periods for a few weeks before you go
2. Write down your top three concerns, starting with the one that bothers you most
3. Say how symptoms affect your life: work, sleep, relationships
4. Mention your mood, not just your body
5. Ask: “Could this be perimenopause? What are my options?”
6. Bring someone with you if it helps you remember

Some other conditions share symptoms with menopause. For example, an underactive thyroid can cause tiredness and low mood. Your provider may suggest tests to rule other causes out. If your periods stopped before 40, testing hormone levels may be considered.

A therapist can help with the emotional side, including CBT for mood, anxiety, sleep and hot flashes. Your clinical provider can talk with you about treatment options for your symptoms.

It is OK to ask for a second opinion, or to see a provider with a special interest in menopause. Whatever path you choose together is valid.

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