Perimenopause: what happens in your body

Perimenopause is one of the most significant phases in a woman’s life – yet many are not fully aware of what is happening in the body during this time. It often begins unnoticed, with hormonal fluctuations that can manifest as irregular cycles, hot flashes, sleep disturbances, or mood swings. Did you know that perimenopause can start as early as the late 30s and last up to 10 years before menopause is reached?

In this article, you will learn when perimenopause begins, which symptoms may occur, and what hormonal changes are involved. You’ll also receive practical tips on how to better manage this phase through natural measures, nutrition, and, if needed, medical support.

Table of Contents

• What is perimenopause?
• When does perimenopause start and how long does it last?
• What are the symptoms of perimenopause?
• How can symptoms be relieved?
• Summary

What is perimenopause?

Perimenopause is the natural transition phase before menopause and marks one of the most important phases of the menopausal transition. During this time, the body begins to gradually reduce the production of female sex hormones, particularly estrogen and progesterone. This leads to hormonal fluctuations that can cause physical and emotional changes. Although fertility declines during perimenopause, pregnancy is still possible as long as ovulation continues – therefore, effective contraception is important if pregnancy is not desired.

Perimenopause can last several years and ends with menopause, which is defined as the point at which a woman has not had a menstrual period for twelve consecutive months. Only then is menopause considered to have officially begun (Mayo Clinic, 2023).

When does perimenopause start and how long does it last?

Perimenopause typically begins between the ages of 40 and 50, but it can start in the late 30s for some women. Its duration varies individually and averages between 4 and 10 years. It ends with menopause.

Did you know?

The exact timing of perimenopause depends on genetic factors, lifestyle, and overall health. Women whose mothers entered menopause early often experience the transition earlier as well. Smoking, being underweight, or chronic stress can also lead to an earlier onset of perimenopause. Environmental factors such as hormone-disrupting substances found in plastics or pesticides may also play a role (NHS, 2021).

What happens in the body?

During perimenopause, progesterone levels decline first, causing irregular menstrual cycles. At the same time, estrogen levels fluctuate significantly, leading to symptoms such as hot flashes, sleep disturbances, and mood swings. The body responds by increasing production of follicle-stimulating hormone (FSH) in an attempt to stimulate the ovaries. These fluctuations are part of the hormonal changes that prepare the body for menopause.

What are the symptoms of perimenopause?

Perimenopause is characterized by hormonal fluctuations that can cause a wide range of physical and emotional symptoms. The intensity and frequency of these symptoms vary greatly – some women notice few changes, while others are significantly affected.

Common symptoms during this phase:

Important: Not every woman experiences all of these symptoms. Complaints can range from mild to severe and may change over the course of perimenopause (Cleveland Clinic, 2024).

When should you seek medical advice?

• If symptoms are very distressing or significantly impact daily life
• In cases of highly irregular or very heavy bleeding
• If you experience heart palpitations, depression, or extreme exhaustion

Hormone testing: when does it make sense?

Since perimenopausal symptoms are caused by hormonal fluctuations, hormone testing can help clarify your hormone levels. It may be particularly helpful in cases of severe symptoms such as irregular cycles, sleep disturbances, or mood swings to check levels of estrogen, progesterone, or FSH. With Homed-IQ's hormone tests for women, these values can be conveniently analyzed from home.

The women’s hormone test provides insight into your hormonal balance, while the fertility test gives information about your ovarian reserve. The menopause blood test specifically measures values such as FSH and estradiol to help interpret changes during the menopausal transition. All test results are analyzed in ISO-certified laboratories.

How can symptoms be relieved?

The discomforts of perimenopause can be alleviated through lifestyle adjustments, natural methods, and medical treatments. Which measures are helpful depends on the type and intensity of the symptoms.

Here are some proven tips to support the body during perimenopause:

Reduce hot flashes and night sweats

• Avoid alcohol, caffeine, and spicy foods, as they can intensify hot flashes.
• Wear breathable clothing made of natural fibers and use lightweight bedding to minimize night sweats.
• Relaxation techniques such as yoga or meditation may help reduce the frequency of hot flashes.

Improve sleep

• A consistent sleep routine with regular bedtimes promotes restful sleep.
• Avoid screens (phones, laptops) at least one hour before bedtime.
• Herbal teas containing lemon balm can have a calming effect.
• Ensure sufficient intake of magnesium and calcium, as these nutrients support bone metabolism and help reduce muscle cramps and sleep disturbances. Good sources include dairy products, leafy greens, nuts and seeds, or targeted supplements.

Balance mood swings

• Engage in regular physical activity – walking, yoga, or moderate strength training boosts the release of feel-good hormones.
• Maintain a balanced diet rich in omega-3 fatty acids and B vitamins, which support the nervous system and may reduce mood swings.
• Stay socially connected, as communication with others can help manage emotional fluctuations.

Counteract weight gain

• A protein- and fiber-rich diet helps stabilize metabolism.
• Avoid excessive consumption of sugar and refined carbohydrates to reduce blood sugar fluctuations.
• Strength training supports muscle growth and helps maintain your basal metabolic rate.

Sources: Cleveland Clinic, 2024; Brown, 2023

Medical support for severe symptoms

If perimenopausal symptoms significantly impact daily life, medical treatments may be considered:

Hormone replacement therapy (HRT): When is it appropriate?

Hormone replacement therapy (HRT) can compensate for declining estrogen and progesterone levels and help relieve symptoms such as hot flashes, sleep disturbances, mood swings, and bone loss.

Types of hormone therapy:

• Systemic HRT (pills, patches, gels) → Used for more pronounced symptoms and affects the entire body.
• Local HRT (vaginal creams, suppositories, rings) → Specifically used to treat vaginal dryness and urinary symptoms.

HRT is not suitable for every woman—particularly those with a history or risk of breast cancer, thrombosis, or cardiovascular disease. It should only be used after a personalized medical evaluation. Talk to your doctor to weigh the benefits and risks of hormone therapy (Cleveland Clinic, 2024).

Summary

Perimenopause is the transitional phase before menopause and marks one of the most important hormonal changes in a woman’s life. During this time, estrogen and progesterone levels decline, which can lead to symptoms such as hot flashes, sleep disturbances, mood swings, and changes in the menstrual cycle. Many symptoms can be relieved through lifestyle changes such as healthy eating, regular exercise, and targeted relaxation techniques. For severe symptoms, hormone therapy (HRT) or herbal alternatives may be an option—but this should always involve individual medical advice.