What Is Perimenopause & When Does It Typically Occur?

Have you recently felt someone cranking up your body’s internal thermostat, leading to sudden hot flashes? Or noticed sudden belly fat appearing out of nowhere, or just constant fatigue? These are some of the common signs of perimenopause. 

Perimenopause is the transitional phase in a woman’s life that leads to menopause, marking the gradual end of a woman’s reproductive years. During this time, the body undergoes significant hormonal fluctuations, often bringing a mix of physical and emotional changes. From irregular period cycles, mood swings, to a sensitive bladder and hot flashes, it feels like the body sits on a hormonal rollercoaster as it enters perimenopause. 

Keep reading to understand what perimenopause is, when it typically begins, at what age menopause starts, the key signs, and effective relief strategies to navigate this transitional ovarian phase. 

At what age does menopause start & when does perimenopause begin?

In India, natural menopause typically occurs around the age of 46–48 years, which is about 4-5 years earlier than in Western populations, and the transitional phase known as perimenopause typically begins around four years before your final menstrual period. Most women start noticing early signs of perimenopause in their early 40s, although for some, it can begin as early as their mid-30s.  Certain medical conditions can also trigger the earlier onset of perimenopausal symptoms. 

One of the first signs of perimenopause is a noticeable change in your menstrual cycle, including fluctuations in duration, flow, and frequency. These irregularities occur due to a significant dip in your oestrogen levels, leading to hormonal turbulence. 

Signs of menopause & perimenopause

One of the earliest signs of perimenopause is a noticeable disruption in the menstrual cycle. Many women begin to experience shorter or longer periods, and the flow may vary. The frequency of periods also becomes irregular during this perimenopausal phase. However, if a woman experiences heavy periods during this stage, it is important to consult a doctor rather than assuming it is due to perimenopause. Typically, bleeding patterns in perimenopause become lighter and less frequent, not heavier. Persistent heavy bleeding should always be investigated. 

In addition to period irregularities, perimenopause comes along with a wide variety of other symptoms, like:

• Hot flashes

• Fatigue

• Vaginal dryness

• Changes in body composition, like weight gain

• Memory struggles, or brain fog

• Weakened bladder control

• Erratic or disrupted sleeping patterns

• Heart palpitations may occur sporadically during this period

• Breast tenderness or swelling

• Night sweats

Also, it is important to note that perimenopause does not mean that the menstrual cycle has completely ended; only that its timing and intensity keep fluctuating. 

Menopause is officially diagnosed when a woman has gone 12 consecutive months without a single menstrual period. At this stage, the oestrogen and progesterone levels drop significantly. Along with the dip in hormonal levels, a mixed bag of emotional and mental changes,  like mood swings, and increased risk of weight gain and other metabolic shifts, are seen. Postmenopausal women in India are at a higher risk of developing osteoporosis and cardiovascular disease owing to an earlier and more rapid decline in oestrogen levels.

What to do for perimenopause?

First and foremost, it’s important to understand that perimenopause is a natural phase of ageing. The hormonal fluctuations, mood shifts, and weight changes are part of this transition, and while they can be challenging, you cannot escape them. You have to navigate this transition with patience, self-compassion, and resilience. 

When it comes to managing perimenopausal symptoms, lifestyle adjustments are key. Here are a few practical strategies to support your well-being:

• Nutrition matters: Your diet plays a pivotal role in managing symptoms. Focus on whole, nutrient-rich foods like fruits, vegetables, lentils, sprouts, lean proteins, and healthy fats such as nuts, seeds, and avocados.

• Choose breathable fabrics: Hot flashes and night sweats can be disruptive. Opt for lightweight, breathable clothing made from natural fabrics like cotton or linen to help your body regulate temperature.

• Move your body: Consistent physical activity can significantly ease symptoms. Try weight training, swimming, brisk walking, or even dancing, whatever sails your boat and helps you be active and happy. 

• Limit alcohol and avoid smoking: Both can disrupt your hormonal balance and worsen the condition. Limiting or quitting it completely can help you feel more in tune with your body and mood. 

• Practice mindfulness: Mindfulness practices like meditation, breathwork, or gentle yoga can help manage anxiety, improve sleep, and support emotional regulation during this transition.

What might make perimenopause feel harder to handle?

Perimenopause and menopause mark a natural stage in a woman's life where sex hormones like oestrogen start declining. This hormonal shift can trigger both physical and emotional symptoms. While it’s difficult to avoid this phase, navigating it with practical lifestyle strategies is key. However, many lifestyle habits can exacerbate the perimenopausal symptoms. Some of them have been pinpointed below: 

• High levels of stress: Stress is an inevitable part of life. Dealing with it in small doses is still manageable; however, intense stress can disrupt the body's hormonal balance. When you take stress, your brain releases hormones like cortisol and adrenaline, and prepares the body to go into either a fight or flight mode. However, during perimenopause, a dip in oestrogen (a hormone that helps regulate cortisol) makes it tougher for your body to buffer the effects of stress. 

• Sugar: This sweetening agent is often referred to as a slow poison, and rightly so. Sugary snacks or drinks can enormously spike your blood sugar levels, followed by energy slumps, irritability, and brain fog. High sugar intake is also linked to poor concentration, disrupted sleep, and emotional instability. One might also have restless nights due to the stimulating effects of sugar on the body. 

• Caffeine: Your iced latte or an espresso might seem like an innocuous afternoon pick-me-up for you, but it comes with hidden costs. It stimulates the nervous system, which can worsen anxiety, jitteriness, and sleep cycles. Evidence also suggests that caffeine contributes to insomnia and lighter sleep, compounding the sleep difficulties already common in perimenopause.

• Alcohol: While it may seem hard to turn down a drink in social settings, alcohol is an identified trigger for perimenopausal symptoms. It dilates blood vessels and raises body temperature, which can worsen hot flashes and night sweats. Additionally, it also disrupts sleep cycle, metabolic rate, mood swings, and depression. 

• Dietary changes: Your diet plays a vital role in hormonal health. Consuming fatty, fried, sugary, or highly processed foods can cause your blood sugar levels to zigzag out of control, leading to hormonal chaos. Unhealthy eating, dehydration, insufficient sleep, and alcohol consumption together create a metabolic and hormonal environment that's difficult for the body to manage.

Dealing with perimenopause like a pro

Perimenopause is a natural, inevitable, and significant phase of life that can impact a woman’s physical health, emotional well-being, relationships, and social life. Educating yourself with the right guidance, practical strategies, and lifestyle adjustments empowers us to navigate this condition with resilience, confidence, and self-compassion. By recognising the early signs and symptoms, you can combat the hormonal turbulence with self-awareness and help you make informed decisions. 

Frequently Asked Questions

1. What is perimenopause, and how is it different from menopause?

Perimenopause is the transitional phase leading up to menopause, when your body starts producing less oestrogen. It can last anywhere from a few months to several years.

2. At what age does perimenopause usually start?

Perimenopause typically begins in your 40s, but some women may notice changes as early as their mid-30s. 

3. What are the early signs and symptoms of perimenopause?

Common early signs include irregular periods (longer, shorter, or skipped), hot flashes and night sweats, mood swings, trouble sleeping, fatigue, vaginal dryness, brain fog or decreased libido.