What Happens to Your Body Before Menopause?

As women approach menopause, the body enters a natural phase of transition called perimenopause. This period, which can span several years, is marked by hormonal changes that may influence many aspects of physical, mental, and emotional wellbeing. Understanding these changes and what to expect can help you feel more prepared, informed, and confident in managing your health during this important life stage.

What Is Perimenopause?

It is the transitional time leading up to menopause, the point when menstrual periods permanently stop. It’s your body’s gradual shift away from the reproductive years. Most women enter perimenopause in their mid-to-late 40s, though it can begin as early as the late 30s.

During this phase, the ovaries begin to slow down and produce less estrogen and progesterone—the two primary female hormones that regulate menstruation and support various functions in the body. T

These hormonal changes are not abrupt. Instead, they occur gradually and may fluctuate month to month, resulting in symptoms that vary in intensity.

Perimenopause officially ends once you’ve gone 12 consecutive months without a menstrual period. At that point, you are considered to be in menopause.

How Long Does Perimenopause Last?

Perimenopause doesn’t follow a set timeline. For some women, it may last only a few years, while others may experience symptoms for up to a decade. On average, perimenopause lasts about 4 to 7 years.

The duration of this phase can be influenced by several factors, including genetics, overall health, lifestyle habits, and whether you smoke or have certain medical conditions. For example, women who smoke may experience menopause earlier than non-smokers. Similarly, those who have undergone certain cancer treatments or pelvic surgeries may transition more quickly.

Some may have mild symptoms and irregular cycles that resolve quickly, while others may need support and treatment to manage more pronounced changes.

Key Hormonal Changes and Their Effects

The hallmark of perimenopause is hormonal fluctuation especially a decline in estrogen levels. These hormones don’t decrease in a straight line. Instead, they can rise and fall unpredictably, which can make symptoms feel inconsistent or confusing.

Estrogen plays a critical role in regulating the menstrual cycle, but it also affects the brain, bones, heart, and urinary and reproductive systems. As estrogen levels shift, you may notice a wide range of physical and emotional changes. Some of the most common symptoms include:

1. Irregular Periods

Your menstrual cycle may become noticeably different. Periods might arrive earlier or later than expected, become heavier or lighter, or occasionally skip altogether. Some women may even experience months without a period followed by a return of regular bleeding.

These changes can make it harder to predict ovulation or manage symptoms like cramps and bloating. If your bleeding becomes unusually heavy, lasts longer than normal, or returns after several months without a period, it’s a good idea to speak with your GP to rule out other conditions.

2. Hot Flushes and Night Sweats

Hot flushes are sudden sensations of heat that typically affect the upper body and face. They may be accompanied by sweating, a rapid heartbeat, or a flushed appearance. Night sweats are hot flushes that occur during sleep and can disrupt rest.

These symptoms can last anywhere from a few seconds to several minutes and vary in intensity. Some women experience them a few times a week, while others may have them multiple times a day.

3. Sleep Disruptions

Many women in perimenopause report trouble falling or staying asleep. Night sweats, anxiety, or a general restlessness can make it difficult to get a restful night. Over time, poor sleep can contribute to fatigue, low energy, and difficulty concentrating during the day.

Practicing good sleep hygiene such as sticking to a bedtime routine, limiting caffeine late in the day, and creating a comfortable sleep environment can be helpful.

4. Mood Changes and Anxiety

Fluctuating hormone levels can have a real impact on your mood. You might feel more irritable, anxious, or emotionally sensitive than usual. Some women describe these changes as feeling "on edge" or easily overwhelmed.

Increased mood swings, feelings of sadness, or a lower stress tolerance are also common. If mood changes are severe or persistent, they may indicate depression or anxiety, which can and should be treated.

5. Vaginal Dryness and Discomfort

Lower estrogen levels during perimenopause can cause the lining of the vagina to become less moist, thinner, and less flexible. This may lead to dryness, irritation, and discomfort, especially during sexual activity or when using certain hygiene products. Some women may also notice increased sensitivity or itching in the area.

These symptoms are treatable. Moisturisers, lubricants, or prescription treatments such as vaginal estrogen creams can significantly improve comfort and quality of life.

6. Bladder and Urinary Changes

You may notice a need to urinate more frequently, urgency, or even accidental leakage during activities such as coughing or laughing. Estrogen helps support the tissues in the bladder and urethra, so as levels fall, urinary symptoms may become more noticeable.

Recurrent urinary tract infections (UTIs) may also become more common during perimenopause. If you experience these symptoms, your GP can help assess and recommend treatment.

Other Physical and Cognitive Changes

Beyond the core symptoms of perimenopause, women may also experience a variety of physical and mental changes that can affect everyday functioning and confidence.

1. Brain Fog

You may have trouble concentrating, remembering details, or finding the right words. Many women refer to this experience as "brain fog." While these cognitive symptoms can be frustrating, they are usually temporary and improve after menopause.

2. Weight Gain and Body Changes

A slowing metabolism and shifting hormones can make it easier to gain weight, especially around the abdomen. Muscle mass may decrease, and fat distribution can change, even without major changes in eating or activity levels.

Staying active and maintaining a nutritious diet can help support a healthy weight during this stage.

3. Joint and Muscle Aches

Some women report increased stiffness, soreness, or joint discomfort during perimenopause. While these symptoms can sometimes be mistaken for normal ageing, they may be linked to changing hormone levels.

4. Skin and Hair Changes

As estrogen levels drop, the body produces less collagen, which can cause the skin to feel drier, become thinner, or react more sensitively. Hair may also lose volume, become finer, or shed more easily. These changes often develop gradually but can become more noticeable as perimenopause progresses.

Can You Still Get Pregnant During Perimenopause?

Yes. Ovulation becomes less predictable during perimenopause, but pregnancy is still possible until you’ve gone a full year without a period. If you’re sexually active and not planning to conceive, you should continue using contraception.

Talk to your GP about safe contraceptive options and whether your current method is still suitable for this phase of life.

How to Manage Perimenopause Symptoms

There’s no single approach that works for every woman, but many find relief with a combination of lifestyle adjustments, medications, and supportive therapies.

Lifestyle Tips

• Engage in regular physical activity to support mood, weight, and sleep

• Eat a balanced diet rich in calcium, vitamin D, and whole foods

• Limit alcohol, caffeine, and added sugars

• Practice mindfulness, deep breathing, or yoga for stress relief

• Prioritise good sleep hygiene

Hormone Replacement Therapy (HRT)

HRT can help ease moderate to severe symptoms such as hot flushes, night sweats, and vaginal dryness. It works by replacing estrogen your body no longer produces. HRT is not suitable for everyone, and risks vary depending on your medical history. Discuss the potential benefits and risks with your doctor.

Non-Hormonal Therapies

Some women benefit from:

• Low-dose antidepressants for mood and hot flushes

• Cognitive Behavioural Therapy (CBT) for emotional wellbeing

• Complementary therapies such as acupuncture or herbal remedies (used with medical guidance)

When to See Your GP

It’s important to see a GP or menopause doctor if you notice unusually heavy or irregular periods, feel overwhelmed by mood changes or anxiety, or find that symptoms are interfering with your sleep, daily routine, or relationships. You might also want to discuss ongoing contraception, fertility concerns, or explore options for managing discomfort. A GP can help assess your symptoms, check for any other underlying issues, and recommend treatments that suit your individual health needs.

Personalised Care for Every Stage of Womanhood

Perimenopause is a normal stage in a woman’s life but that doesn’t mean it’s always easy. The physical and emotional changes can be challenging, but with the right information and support, you can manage your symptoms and continue to feel well in your body.

If you’re experiencing perimenopausal symptoms or have questions about what to expect, our caring team of female GPs at Glen Iris General Practice is here to help. We take a compassionate and personalised approach to women’s health, offering support, advice, and treatment options tailored to your unique needs.