Is It Perimenopause? Early Signs Every Woman Should Know

The truth is that perimenopause is a normal stage of life, but it can bring a wide range of symptoms that affect work, family life, exercise and overall wellbeing. The good news is that understanding these changes is the first step towards managing them.

What is perimenopause?

Perimenopause literally means "around menopause." It is the transition leading up to menopause, which is defined as 12 consecutive months without a menstrual period.

For many women, perimenopause begins in their 40s, although it can start in the late 30s for some. Rather than hormones gradually declining in a straight line, oestrogen and progesterone fluctuate significantly. These hormonal ups and downs are responsible for many of the symptoms women experience (Santoro et al., 2021).

Perimenopause can last anywhere from two to ten years, with an average duration of around four to eight years (Harlow et al., 2022).

It's more than just hot flushes

Hot flushes and night sweats are well known, but they are often not the first symptoms women notice.

Early signs can include:

• Changes in menstrual cycle length
• Heavier or lighter periods
• Mood changes or increased anxiety
• Poor sleep
• Fatigue
• Brain fog or forgetfulness
• Reduced exercise recovery
• New joint aches and stiffness
• Headaches
• Changes in libido
• Vaginal dryness
• Bladder urgency or recurrent urinary tract infections

Many women experience only a few of these symptoms, while others experience several at once.

Why do symptoms seem to come and go?

Unlike menopause, where hormone levels remain consistently low, perimenopause is characterised by fluctuating hormones.

Some months your ovaries may produce high levels of oestrogen, while other months they produce much less. Progesterone often begins to decline earlier because ovulation becomes less regular (The Menopause Society, 2023).

This explains why symptoms can feel unpredictable. You might feel completely normal one week and struggle with sleep, mood or joint pain the next.

Exercise may suddenly feel different

One of the most common things I hear from women in clinic is:

"I've always exercised, but suddenly my body doesn't feel the same."

Many women notice they:

• recover more slowly
• lose muscle more easily
• gain fat around the abdomen
• develop tendon or joint pain
• feel less energetic after exercise.

These changes are real. Oestrogen plays an important role in muscle repair, tendon health and recovery following exercise (Sipilä et al., 2020; Daly et al., 2023).

The answer is not to stop exercising. In fact, regular resistance training becomes even more important during this stage of life.

Should you get your hormones tested?

Many women ask whether a blood test can diagnose perimenopause.

For women over 45 with typical symptoms, routine hormone testing is generally not recommended because hormone levels fluctuate from day to day and may not accurately reflect where you are in the transition (Australasian Menopause Society, 2023; NICE, 2024).

Instead, diagnosis is usually based on:

• your symptoms
• changes in your menstrual cycle
• your age
• a thorough discussion with your healthcare provider.

Blood tests may still be appropriate in younger women or when another medical condition needs to be excluded.

What can you do now?

While we cannot stop perimenopause, we can support the body through it.

Current evidence suggests women benefit from:

• progressive resistance training two to four times per week
• regular weight-bearing activity
• adequate protein intake
• sufficient calcium and vitamin D where needed
• good sleep habits
• managing stress
• discussing symptoms early with an informed healthcare professional.

For some women, menopausal hormone therapy (MHT) is also an appropriate and effective treatment after discussion with their doctor.

How can a pelvic health physiotherapist help?

Perimenopause affects much more than your reproductive system. It influences your muscles, joints, pelvic floor, bladder, tendons and confidence to exercise.

A pelvic health physiotherapist can assess how these changes are affecting your body and help you build a plan that keeps you strong, active and doing the things you enjoy.

The earlier you understand what's happening, the more options you have to support your health.

References

Australasian Menopause Society. (2023). Information Sheets and Clinical Guidance.

Daly, R. M., Gianoudis, J., & Beck, B. R. (2023). Exercise recommendations for women across the menopause transition. Journal of Clinical Medicine, 12, 4308.

Harlow, S. D., Gass, M., Hall, J. E., et al. (Updated 2022). Executive summary of the Stages of Reproductive Aging Workshop (STRAW+10). Menopause.

National Institute for Health and Care Excellence (NICE). (2024). Menopause: Diagnosis and Management (NG23 update).

Santoro, N., Roeca, C., Peters, B. A., & Neal-Perry, G. (2021). The menopause transition: Signs, symptoms and management. Journal of Clinical Endocrinology & Metabolism, 106(1), 1–15.

Sipilä, S., et al. (2020). Muscle and physical function during the menopausal transition. Maturitas, 134, 1–8.

The Menopause Society. (2023). The Menopause Guidebook (10th Edition).