Perimenopause symptoms: key signs, prognosis and how it differs from the menopause

Swooping and dipping hormones in the years leading up to your last period can cause a lot more than hot flushes and night sweats. Here's everything you need to know about the perimenopause..

What is perimenopause?

We’ve all heard of the menopause. But some of us may not necessarily have heard of the perimenopause. So what exactly is it? Well, simply, it’s the period right before the menopause begins, and your periods stop.

What is the average perimenopause age?

Occurring in the years running up to your final period, it usually begins as you approach your late 40s to early 50s.

How long does perimenopause last?

The average length of perimenopause is reported to be around 4 years, but it can vary anything from a couple of months to 10 years. The jury is still out as to whether these are caused by the hormonal roller coaster or whether it’s just coincidental that they happen at the same time as hormones start to dwindle.

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What are the common symptoms of the perimenopause?

Tingling tongue, achy joints or itchy skin? Even those with heads deeply buried in the sand when it comes to any sign of menopause have heard of classic symptoms such as flushes, sweats and insomnia. But you may be surprised to learn that a range of less familiar – and more surprising – symptoms may also occur at this time. Gynaecologist Dr Heather Currie reveals the surprising symptoms that can occur in the years before your final period…

A woman examining her tongue

One of the weirder symptoms of the perimenopause affecting four out of 10 women, this is thought to be a result of activation of pain-sensitive nerve cells surrounding the bitter taste buds at the back of the tongue, which can be damaged by dwindling oestrogen.

MORE: Menopause weight gain: what they don’t tell you

Symptoms, which can also affect gums, lips and other areas of the mouth, typically start between three years before and 12 years after menopause.

Help yourself

  •  Drink plenty of fluids but avoid fizzy drinks
  •  Steer clear of alcohol and products containing it such as mouthwashes which can irritate the lining of your mouth
  • Avoid spicy foods and acidic foods and drinks, such as tomatoes, orange juice, soft drinks and coffee
  • Try mild or flavour-free toothpastes or ones for sensitive teeth

Hot flushes affect six to eight out of ten perimenopausal women. First signs often include a vague sensitive skin sensation followed by an intense whoosh of heat that can cause you to break into a sweat lasting for three to five minutes. ‘Fluctuating hormones are thought to make the body oversensitivity to normal ups and downs of body temperature,’ explains Ms Domoney.

Help yourself:

  • Avoid caffeine, hot spicy foods and alcohol
  • Wear natural fibres, loose layers of clothing you can take on an off and keeping the bedroom cool.
  • HRT can also be great at making them magically disappear.
  • You could also try Natural Health Practice Black Cohosh Plus, which contains Black Cohosh, Red Sage. Milk Thistle. Agnus Castus and Dong Quai, £19.97 (60 capsules)

Woman stomach pain

A 2009 review found irritable bowel syndrome (IBS) symptoms such as abdominal pain, bloating, bowel discomfort and changes in bowel patterns together with diarrhoea and/or constipation are to become more common perimenopausally both in women with and without IBS. They are thought to be caused by the effects of fluctuating oestrogen and progesterone on pain ‘pathways’ in the gut and the brain.

MORE: Postmenopausal? 7 ways your body changes after the menopause

Help yourself

  •  Exercise, stress management, regular meals and limiting caffeinated and fizzy drinks and alcohol can help
  • Insoluble fibre (bran) found in wholemeal bread and cereals can exacerbate symptoms so steer clear
  • Soluble fibre found in foods such as oats, pulses and linseeds can by contrast help, especially with bloating, so try to eat every day
  • Probiotics can help rebalance gut bacteria, which may be a factor in IBS. Try Activia yoghurts from supermarkets or a probiotic supplement such as Bio-Kult £8.99 (30 capsules) from pharmacies.

More than half of women experience joint and muscle aches and pains perimenopausally. Ms Currie explains, “Oestrogen is responsible for stimulating collagen, a fibrous protein that gives the skin, strength and resilience and helps act as a scaffold for it and other tissues.” Danish research meanwhile suggests that oestrogen has an anti-inflammatory effect.

Help yourself

  • Although it may be uncomfortable, exercise can help. Yoga, walking and muscle-strengthening exercises such as squats and lunges which help stabilize joints are good choices
  • A hot water bottle or heat pack can help increase mobility especially before exercise, while a cold pack can reduce inflammation and swelling
  • Eat more Brazil nuts – tthey are one of the best sources of selenium low levels of which are linked to arthritis. Other good sources include seafood, beef, chicken and vegetables. Alternatively try a supplement such as Healthspan Selenium 200mcg, £6.45 (180 tablets) (
  •  In studies GOPO® Joint Health supplement helps ease pain, improves mobility, reduces the need for painkillers and may even rebuild joint tissues and cartilage. It contains a rosehip extract and vitamin C, needed for collagen formation. Get them for £18.99, from Boots.


‘Itchy skin (medical name pruritus) is another common symptom, again usually caused by drier skin due to loss of oestrogen and collagen,’ says Heather Currie. Acne, thinning skin, wrinkles and changes in pigmentation are other reported symptoms. Unusual sensations, known as parasthesias, can also occur including tingling, numbness and something called formication, an unpleasant sensation which feels as if insects are crawling on or under your skin. These are thought to be caused by the effects of fluctuating hormones on the central nervous system. See the doctor if you experience these.

Help yourself

  • Increase intake of omega-3 fatty acids found in foods such as herrings, salmon, sardines, walnuts, fortified eggs
  •  Drink six-eight glasses of water a day to keep skin hydrated
  • Hot water can be harsh and drying so shower rather than bath and use warm water
  • Moisturise, moisturise, moisturise. E45 Intense Recovery Moisture Control body lotion is said to alleviate dryness in two weeks. £5.49 from Boots.
  • Avoid irritants. Smoky atmospheres, stress, and lack of sleep can exacerbate itchiness

Although they don’t often appear in medical textbooks, dizziness, light-headedness and vertigo frequently crop up on patient websites and forums and, says Ms Currie, often occur with flushes. The cause is unknown but a 2010 US study suggests a type of headache called vestibular migraine, which may or may not cause a headache, may be responsible. It’s thought to be due to hyperexcitability of the brain triggered by the effect of fluctuating oestrogen and progesterone on brain messenger chemicals.

Help yourself

  • Keep a diary to see if you can identify and avoid triggers – stress, poor sleep, light, noise and foods such as coffee, blue cheeses, chocolate and red wine are common ones
  • Stress management, exercise and limiting your intake of salt, especially around the time of your period may help
  • Prescribed medications from antidepressants to antiepileptic and certain blood pressure lowering drugs may help.

‘Palpitations – fast or irregular heart beats – are extremely common perimenopausally. We don’t know why but fluctuating levels of oestrogen causing sudden widening of the blood vessels – the same mechanism that causes hot flushes – may be responsible,’ says Heather Currie.

MORE: Menopause supplements: foods, vitamins and herbal remedies to help you cope

A recent study found that heart rate increased by, on average, four beats a minute during a hot flush. Palpitations often occur at night or while you are relaxing and are usually more of a nuisance than harmful.

Help yourself

  • Rest and breathe quietly for five minutes, and they will usually subside
  • Regular meditation can help keep them at bay
  • Steer clear of alcohol and caffeine, which can exacerbate palpitations. And don?t smoke
  •  Learn how to take your pulse so you can identify when it is fast – it should be 60-100 beats a minute
  •  If dizziness, fainting, or tightness in the chest or neck accompanies palpitations seek immediate medical help.

Perimenopause treatment: What are your options?

There are a number of natural ways you can ease your symptoms…

• Don’t smoke
• Get into regular sleep patterns
• Drink less alcohol
• Maintain a healthy weight
• Introduce more calcium into your diet

Alternatively, you could try hormone therapy, but always discuss this in detail with your doctor first.

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Is there a perimenopause test?

There are home-use test kits that measure the Follicle Stimulating Hormone, but this doesn’t necessarily give a conclusive answer on whether you are in the menopause or perimenopause.

Perimenopause supplements

Vitamin supplements such as Black Cohosh or Flaxseed, which is known for easing night sweats, can also be beneficial.

Calcium is great for helping with bone density, while Wild Yam is said to be an alternative to hormone treatment.

Ginseng is a natural mood booster, while St John’s Wort has been used historically to treat depression. For a full guide to the best supplements for the menopause or perimenopause click here.



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