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Starting menopause

The years leading up to your final period (sometimes called 'perimenopause') can be a time of much change for women. Hormones are changing wildly which can cause physical and mental symptoms. It's also a confusing time with a lot going on. Here we explain what perimenopause is and how it can impact your life.

What is perimenopause?

Perimenopause is the years leading up to menopause during which periods may begin to change. Often your periods will slow down, however, how your period changes is dependent on your own body. Some women will also start to experience menopausal symptoms. These symptoms are the result of hormone levels changing - often swinging from high to low very quickly.

What causes perimenopause?

Like the menopause - it is caused by your ovaries beginning to stop functioning at their optimal. With time, the ovaries ability to produce important hormones declines. Critically, it's the drop in the hormone oestrogen that triggers symptoms. Oestrogen is in a partnership with another hormone - follicle-stimulating hormone (FSH). When oestrogen drops, FSH rises [1]. Sometimes an FSH blood test will be used to assess whether someone is approaching menopause.

How do I know if I am in perimenopause?

The biggest clue is probably changes to your periods (combined with being in your 30s/40s/50s in age). However, the symptoms of menopause can start before your periods change. So it's worth being aware of them.

The most common ones include:

  • Hot flushes (and night sweats)
  • Vaginal dryness
  • Discomfort during sex
  • Problems with sleep
  • Mood problems
  • Anxiety
  • Depression
  • Lower libido (or sex drive)
  • Problems with memory and concentration.

Mood changes are often reported - but it can be hard to link these directly to hormones. If you're feeling low make sure you talk to your doctor or other medical professional. Often, women are offered antidepressants before menopause is even discussed. Prepare for any appointments with doctors by tracking all of your symptoms to share with your doctor. This will help them understand the full picture, and if you could be starting the menopause transition.

You can also try Alva's assessment before seeing a GP. This tool will help you to learn where you might be at in the menopause transition and support you with what to do next.


  1. Hillard, T., Abernathy, K., Hamoda, H., Shaw, I., Everett, M., Ayres, J. and Currie, H., 2017. Management Of The Menopause. 6th ed. British Menopause Society.

  2. nhs.uk. n.d. Menopause - Symptoms. [online]
    Available at: https://www.nhs.uk/conditions/menopause/symptoms/ [Accessed 10 October 2019].