Perimenopause: The Chapter Nobody Warned You About

Last month I wrote about menopause. This month I want to talk about the chapter that comes before it.

Perimenopause. Most women haven't heard much about it. And the ones who are living through it often don't know that's what's happening.

That's worth fixing.

What perimenopause actually is

Menopause is more like a moment in time. It's the point at which you've gone twelve consecutive months without a period.

Everything before that, sometimes years before that, is perimenopause.

The transition can start anywhere from your late 30s to your late 40s. The average is around 47, but earlier is not unusual. And it can last anywhere from a few years to a full decade.

Which means many women are well and truly in perimenopause before they've ever heard the word used in relation to themselves.

The symptoms that don't look like hormones

This is where things get complicated. Perimenopausal symptoms are easy to explain away.

Sleep starts becoming unreliable. Not dramatically, just harder to come by. You wake at 3am and can't settle. You're tired in a way that sleep doesn't seem to fix.

Mood shifts in ways that feel disproportionate. Things that wouldn't have bothered you before now do. You feel anxious without a clear reason, or flat in a way that's hard to name.

Brain fog. Forgetting words mid-sentence. Walking into a room and having no idea why. This one catches women off guard more than almost anything else.

Periods change. They might get shorter, longer, heavier, lighter, or more irregular. The cycle you've had for decades starts behaving differently.

Joint aches. Skin changes. A libido that's gone quiet. Headaches that appear out of nowhere.

None of these symptoms, on their own, scream hormones. Together, they often do.

Why it takes so long to work out what's happening

Part of it is timing. Women in their late 30s and early 40s are often juggling a lot, work, family, relationships, and it's easy to attribute feeling off to external pressure rather than internal change.

Part of it is the language. "Perimenopause" isn't a word most women grow up hearing. Menopause gets discussed, eventually. Perimenopause rarely does.

And part of it is that women are sometimes told, explicitly, that they're too young. Too young for hormones to be the issue. Too young for this conversation to be worth having.

That is not always helpful.

What's actually going on hormonally

During perimenopause, oestrogen levels don't decline smoothly. They fluctuate.

Sometimes significantly. It's this fluctuation, not a simple drop, that drives many of the symptoms women experience.

Progesterone tends to decline earlier and more steadily. This shift in the ratio between the two hormones affects sleep, mood, and cycle regularity before oestrogen levels fall in any dramatic way.

The body is in transition. And transitions are, by nature, unpredictable.

When to seek support

You don't need to wait until symptoms are unbearable. If something feels off and you suspect hormones might be involved, that's worth raising with your GP.

A good starting point is tracking what you're experiencing, when symptoms occur, how long they last, whether there's a pattern across your cycle. That information is genuinely useful in a consultation.

If your GP thinks a specialist review is warranted, they can refer you on. You're welcome to come and see me through GYON at Mater Private Suites. A consultation is a conversation. It doesn't commit you to anything.

Perimenopause isn't a brief warm-up act. For many women, it's a significant phase in its own right, one that deserves to be named, understood, and taken seriously.

If some of what you've read here sounds familiar, you're not imagining it. And you don't have to just push through.

X Margie