Your periods are less regular than before. Sometimes they're too frequent, sometimes several weeks apart. You feel exhausted for no apparent reason, your stomach seems constantly bloated, and the pounds keep piling on despite your efforts. Welcome to perimenopause, this transitional period experienced by three out of four women but still too rarely discussed. This phase can begin as early as your mid-thirties and last from two to eight years before menopause. Understanding what's happening in your body will help you navigate this period more easily and know when to take action.
Direct answers to your questions
- Starting age: usually between 40 and 47 years old, but can start as early as 35 years old
- Duration: from 2 to 8 years old (average of 4 years old)
- Possible pregnancy: Yes, as long as there haven't been 12 consecutive months without a period.
- Weight gain: approximately 2 to 2,5 kg on average, mainly in the abdominal area
- Tired : very common, caused by hormonal changes and sleep disorders
Premenopause, Perimenopause, Menopause: Let's Untangle It All
First of all, let's clarify the terms because confusion reigns. In medical language, several phases are distinguished, but in everyday language (and even among healthcare professionals), the terms are often mixed up.
The three phases of the transition
- Premenopause (or perimenopause) This refers to the transition period before menopause. Your ovaries are still functioning, but irregularly. Cycles become erratic, hormone levels fluctuate, and the first symptoms appear.
- Menopause This corresponds to the permanent cessation of menstruation. It is officially diagnosed after 12 consecutive months without menstruation. The average age in France is 51 years.
- Postmenopause is the period that follows, until the end of life. Some symptoms persist, others disappear.
In this article, we will primarily use the term "premenopause" because that is the one you are probably using in your research and conversations. Remember that premenopause and perimenopause generally refer to the same thing in everyday language.
At What Age Does Premenopause Begin?
Perimenopause does not follow a universal timetable. Every woman is unique, and the age of onset varies considerably depending on many factors.
Factors that Influence the Age of Onset
Several factors determine when you will enter perimenopause, some controllable, others not.
- Heredity plays a major role. If your mother entered perimenopause early, you are more likely to experience the same thing.
- Smoking advances perimenopause by 1 to 2 years in heavy smokers
- Certain medical treatments Treatments like chemotherapy or radiation therapy can trigger early perimenopause.
- Ovarian surgery or the removal of an ovary reduces the follicular reserve
- Extreme BMI (very low or very high) can influence the age of onset
Please note: The age of your first period, the number of pregnancies and the use of hormonal contraceptives do NOT have a significant impact on the age of perimenopause.
How to Recognize the Symptoms of Premenopause
The signs of perimenopause are numerous, varied, and above all unpredictable. Some women experience almost none, while others experience several symptoms that disrupt their daily lives. Approximately 75% of women experience at least some bothersome symptoms.
Changes in the Menstrual Cycle
This is often the first and most characteristic sign of perimenopause. Your periods become unpredictable.
Typical changes in the cycle
- Shorter cycles (21 days instead of 28)
- Longer cycles (35-45 days or more)
- Alternating short and long cycles without apparent logic
- Irregular periods (absence of menstruation for 1 or 2 months)
- Heavier or, conversely, very light periods
- Period duration varies (2 days or 10 days)
Vasomotor Symptoms
The infamous hot flashes can appear as early as perimenopause, although they are more common in the later stages.
- Hot flashes: a sudden sensation of intense heat in the face, neck and upper body, lasting from 30 seconds to 5 minutes
- Night sweats: heavy sweating during the night which may require changing clothes
- Palpitations: The sensation that the heart is beating faster, sometimes associated with hot flashes
Amplified Premenstrual Syndrome
If you already had premenstrual syndrome before, it can intensify considerably during perimenopause.
- Breasts were particularly painful and tender.
- Marked irritability
- Unpredictable mood swings
- Increased anxiety
- Headaches or migraines
Sleep Disorders and Intense Fatigue
Fatigue is one of the most reported and debilitating symptoms of perimenopause, affecting approximately 68% of women.
Fatigue in perimenopause explained
This fatigue is different from simple weariness. It combines physical and mental exhaustion, difficulty concentrating, and a drop in energy from the moment you wake up. Several mechanisms explain it.
- The drop in estrogen levels disrupts energy and sleep regulation
- Sleep disorders caused by night sweats creates a chronic sleep debt
- The decrease in melatonin makes falling asleep more difficult
- Frequent awakenings during the night fragment restorative sleep
- stress and anxiety related to bodily changes worsen insomnia
A Canadian study has shown that premenopausal women take on average 30 minutes longer to fall asleep than younger women.
Other Common Symptoms
- Vaginal dryness: discomfort, pain during intercourse
- Decreased libido: less interest in sexuality
- Memory and concentration problems: frequent forgetfulness, difficulty staying focused
- Joint pain: more pronounced in the morning, improving after movement
- Urinary problems: More frequent urges, sometimes slight leakage
- Skin changes: drier skin, thinner hair
Premenopause and Weight Gain: The Bloating Belly
Weight gain during perimenopause is a major concern. On average, women gain 2 to 2,5 kg during this period, primarily around the abdomen. But understanding the underlying mechanisms allows for effective action.
Why Does the Stomach Bloat Specifically
Before perimenopause, fat is distributed primarily on the hips, thighs, and buttocks (gynoid body shape). With the drop in estrogen, this distribution changes dramatically, and fat migrates towards the abdomen (android body shape).
The three causes of a bloated stomach
1. The accumulation of visceral fat
Estrogen slows down the activity of an enzyme involved in the formation of visceral fat (the fat surrounding the organs). When estrogen levels drop, this enzyme is activated and fat accumulates in the abdomen.
2. Water retention
Hormonal fluctuations disrupt the body's fluid balance. Tissues retain water more easily, leading to a feeling of bloating, especially in the abdomen and legs.
3. Digestive bloating
The drop in estrogen levels alters the gut microbiota. The ratio of certain bacteria changes, promoting bloating, constipation, and digestive discomfort.
Metabolism Slows Down
Beyond fat distribution, the basal metabolic rate naturally slows down with age AND with perimenopause. Two phenomena combine.
- Muscle wasting (Sarcopenia) begins as early as 30-35 years of age and accelerates during perimenopause. However, muscles burn more calories at rest than fat.
- Basal metabolism It decreases by about 5% every 10 years after age 40. You burn fewer calories than before with the same level of activity.
Result: If you eat and exercise exactly the same way as before, you will gain weight. It's simple math, not a lack of willpower.
How to Lose Weight During Premenopause
Losing weight during perimenopause is more difficult than before, that's a fact. But not impossible. Strategies simply need to be adapted to this new physiology.
Strategies that actually work
Increase your protein intake
Protein helps preserve muscle mass and increases satiety. Aim for 20-30g per meal (lean meat, fish, eggs, legumes, tofu).
Prioritize weight training
Cardio alone is no longer enough. Strength training (weights, resistance bands, bodyweight exercises) maintains and develops muscle mass, boosting metabolism. 2-3 sessions per week are sufficient.
Reduce your intake of refined sugars and alcohol.
Your carbohydrate tolerance decreases during perimenopause. Favor complex carbohydrates (whole grains, legumes) and limit alcohol, which promotes abdominal fat storage.
Manage stress and get enough sleep
Cortisol (the stress hormone) and lack of sleep both promote the storage of abdominal fat. 7-8 hours of sleep and stress management techniques are essential.
Eat fiber
Fiber improves digestion, reduces bloating, and promotes satiety. Vegetables, fruits, whole grains, flax seeds.
Be realistic: A weight loss of 0,5 to 1 kg per month is a reasonable goal during perimenopause. Drastic diets risk worsening muscle loss.
Can You Get Pregnant During Perimenopause?
The short answer is yes. And that's probably the most important information in this article if you don't want to get pregnant.
As long as there haven't been 12 consecutive months without a period, pregnancy remains possible.
Even if your cycles are irregular, even if you haven't had a period for 2-3 months, your ovaries can still occasionally release eggs. Fertility is reduced but not eliminated. Gynecologists recommend continuing contraception for up to 12 months after your last period if you are over 50, or 24 months if you are under 50.
Fertility Statistics in Premenopause
Statistics show that the chances of spontaneous pregnancy decrease drastically with age, but never fall to zero during perimenopause.
- Between 40 and 44 years old: 10 to 20% of pregnancies occur spontaneously in premenopausal women
- Between 45 and 49 years old: approximately 12% of pregnancies are spontaneous.
- During perimenopause: less than 2% according to some experts
- After 41 years: 50% of women are unable to conceive naturally
The remaining eggs are often of lower quality, increasing the risk of miscarriage and complications. However, pregnancies are still possible and occur regularly, sometimes completely unexpectedly.
What Contraception During Premenopause
If you do not wish to become pregnant, contraception remains necessary. Some hormonal methods have the added benefit of regulating the symptoms of perimenopause.
- Progestin-only pill: effective and safe up to age 50 for most women
- Hormonal IUD (Mirena): Reduces heavy periods, effective for 5 years
- Copper IUD: Hormone-free, effective for up to 10 years but may worsen heavy periods
- Condoms: simple and hormone-free
- Implant: effective for 3 years
Please note: If you are taking hormonal contraception, it can mask the symptoms of perimenopause and make it difficult to know if you are menopausal. Hormone testing may be necessary but should be done after 4-6 weeks without hormones.
Manage your irregular periods with peace of mind
The unpredictable cycles of perimenopause make managing menstrual products difficult. Our period panties offer up to 12 hours of protection, ideal when you never know when your period will arrive.
What's Happening in Your Body
Understanding hormonal mechanisms helps demystify what you're experiencing. Perimenopause isn't a dysfunction; it's a natural transition in your reproductive system.
The Hormonal Dance Disrupted
Normally, your menstrual cycle is regulated by a precise hormonal dance between the hypothalamus, pituitary gland, and ovaries. During perimenopause, this coordination gradually breaks down.
The main hormonal changes
- The follicular reserve decreases At birth, you had approximately 1 million eggs. By age 40, you have about 25,000 left. Their quality also declines.
- Inhibin B drops This hormone, produced by the follicles, normally signals the pituitary gland to slow down the production of FSH. When it decreases, FSH increases.
- FSH rises Your pituitary gland is trying to stimulate the less responsive ovaries by producing more FSH.
- Estrogen levels fluctuate erratically. Contrary to popular belief, they do not decrease linearly. They can even be higher than normal some cycles, then very low the following cycle.
- Progesterone drops first The cycles often become anovulatory (without ovulation), therefore without progesterone production.
The paradox of perimenopause: This is not a period of "estrogen deficiency" as is often believed. Rather, it is a period of imbalance and unpredictable fluctuations, sometimes with very high estrogen peaks.
How to Know if You Are in Perimenopause
The diagnosis of perimenopause is primarily clinical, based on your symptoms and age. Further tests are usually not necessary.
The Signs That Don't Lie
You are probably in perimenopause if you check several of these boxes.
- You are between 40 and 50 years old
- Your cycles have become irregular for several months
- You experience at least 2-3 of the symptoms described (fatigue, hot flashes, sleep disturbances, amplified PMS, abdominal weight gain)
- These symptoms appeared gradually and persist
Are the Exams Necessary?
In most cases, no. Your doctor can make the diagnosis without an examination. Hormone tests (FSH, estradiol) are not routinely recommended because levels fluctuate so much from day to day that they give unreliable results.
Certain tests can be useful in certain cases:
- You are under 40 years old with symptoms of perimenopause (suspected early menopause)
- Your symptoms are atypical or very severe.
- You are taking hormonal contraception that masks the signs
- You want to know if you can stop using contraception
Living Better During Premenopause on a Daily Basis
Perimenopause lasts an average of 4 years. It's best to implement strategies that genuinely improve your quality of life rather than simply enduring it.
Anti-inflammatory Food
Certain foods help reduce inflammation related to hormonal fluctuations and stabilize blood sugar.
- Omega-3: oily fish (salmon, sardines, mackerel), flax seeds, walnuts
- Phytoestrogens: Soybeans, flax seeds, legumes (modest effects but may help)
- Calcium and vitamin D: Dairy products, sardines, almonds (to prevent osteoporosis)
- Magnesium: Green vegetables, dark chocolate, almonds (help with sleep and reduce stress)
Adapted Physical Activity
Exercise is probably the most effective intervention for managing perimenopausal symptoms. Studies show benefits for hot flashes, sleep, mood, and weight.
- Weight training 2-3 times per week: preserves muscle mass and bone density
- Moderate cardio 30 min/day: brisk walking, swimming, cycling (reduces hot flashes)
- Yoga or Pilates: improves flexibility, balance and stress management
- Daily stretching: reduces morning joint pain
Sleep Hygiene
When sleep is already disrupted by night sweats, optimizing your environment becomes even more important.
The golden rules for better sleep:
- Cool room (ideally 18°C)
- No screens 1 hour before bedtime
- Regular bedtimes and wake-up times, even on weekends
- Avoid alcohol and coffee after 16pm
- Eat a light dinner 2-3 hours before bedtime
- Relaxation techniques (breathing, meditation, reading)
Plants and Supplements
Some plants may provide relief, although the scientific evidence is mixed. Discuss this with a healthcare professional.
- Common sage: traditionally used for sweating and hot flashes
- Valerian, passionflower, lemon balm: to improve sleep
- Vitamin B6: can help regulate mood
- Magnesium: reduces fatigue and tension
Medical Treatments: What You Need to Know
If the symptoms become truly debilitating and impact your quality of life, medical treatments are available.
Progestins
In perimenopause, progesterone is often the first thing to be deficient. Progestin treatment (10-20 days per month) can regulate cycles and relieve amplified premenstrual symptoms, heavy periods, and sleep disturbances.
Hormonal Contraception
A low-dose pill or a hormonal IUD can kill two birds with one stone: contraception + regulation of premenopausal symptoms.
Hormone Replacement Therapy (HRT)
Hormone replacement therapy (HRT) is generally reserved for confirmed menopause rather than perimenopause. It combines estrogen and progesterone to compensate for the hormonal deficiency. While effective in relieving symptoms, it carries certain risks that should be assessed individually with your doctor.
Premenopause vs. Pregnancy: Can They Be Confused?
Fatigue, missed periods, nausea, tender breasts, mood swings, bloating... The early symptoms of pregnancy and perimenopause They can indeed look alike.
If in doubt, the only reliable solution is a pregnancy test. Urine test in pharmacy (to be done upon waking, with the first urine) or blood test in laboratory (more reliable, possible from 14 days after intercourse).
If the test is negative and the absence of periods persists, consult your doctor to confirm that it is indeed perimenopause and to rule out other causes.
When Medical Advice Becomes Necessary
Premenopause is natural and benign in the vast majority of cases. However, some situations require a consultation.
- Symptoms before age 40 : possibility of early menopause requiring further investigation
- Very heavy bleeding Soaking a protective layer in less than 1 hour, large clots
- Bleeding between periods or after the reports
- Persistent extreme fatigue : may indicate anemia (due to heavy periods) or a thyroid problem
- Severe depressive symptoms profound sadness, loss of interest, dark thoughts
- Severe pelvic pain unexplained
- Symptoms that can hinder your daily life inability to work, deteriorating relationships, social isolation
In France, the preventive health check-up between 45 and 50 years old This allows you to discuss these questions with a healthcare professional (doctor, midwife, nurse, or pharmacist). It's an opportunity to review your symptoms and get personalized advice.
Premenopause in Summary
Perimenopause lasts an average of four years and affects three out of four women, with a variety of symptoms (irregular periods, fatigue, abdominal weight gain, sleep disturbances). These symptoms reflect unpredictable hormonal fluctuations, not a dysfunction. Understanding what is happening in your body can already transform how you experience this period.
Concrete solutions exist to improve your daily life: an anti-inflammatory diet, strength training to preserve muscle mass, and managing sleep and stress. If symptoms become too bothersome, medical treatments (progestins, hormonal contraception) can provide relief. Perimenopause is a natural stage, not an inevitable fate. You have the power to take action to experience it peacefully.
Sources & Scientific References
- Health Insurance (Ameli). Perimenopause (premenopause): symptoms and contraception. Website: Ameli. 2023 Paper
- Santoro N. Perimenopause: From Research to Practice. Journal of Women's Health. 2016;25(4):332-339. DOI
- Harlow SD, Gass M, Hall JE, et al. Executive summary of the Stages of Reproductive Aging Workshop + 10: addressing the unfinished agenda of staging reproductive aging. J Clin Endocrinol Metab. 2012;97(4):1159-1168. DOI
- Burger HG, Hale GE, Dennerstein L, Robertson DM. Cycle and hormone changes during perimenopause: the key role of ovarian function. Menopause Ritual2008;15(4 Pt 1):603-612. DOI
- Prior JC. The endocrinology of perimenopause: need for a paradigm shift. Front Biosci (School Ed). 2011; 3: 474-486. DOI
- Grady D. Management of perimenopause. Obstetrics & Gynecology Clinics of North America. 2018;45(4):691-700. DOI
- Kravitz HM, Ganz PA, Bromberger J, Powell LH, Sutton-Tyrrell K, Meyer PM. Sleep difficulty in women at midlife: a community survey of sleep and the menopausal transition. Menopause Ritual. 2003;10(1):19-28. DOI
Warning : This article is for informational purposes only and is not a substitute for professional medical advice. If you have any concerns about your symptoms, consult a healthcare professional.
