Gynaecology · 6 min read

Perimenopause: what is actually happening

Menopause is a single day — twelve months after the last period. Perimenopause is the years leading up to it, and it is the part that actually affects how women feel. It commonly begins in the forties and sometimes earlier.

A great many women in this phase are told they are too young for it, and go several years without anyone connecting their symptoms to the obvious cause.

What is happening

Hormone levels stop being steady and start fluctuating, often quite sharply, before eventually declining. It is the fluctuation rather than the decline that produces most of the symptoms, which is why they come and go and why a single blood test on a single day is a poor way to diagnose it.

Cycles usually become irregular — closer together, then further apart, with bleeding that varies from very light to unusually heavy.

Symptoms that are worth mentioning

Hot flushes and night sweats. Sleep that breaks up and does not restore. Mood changes, irritability, and anxiety that feels out of proportion. Difficulty concentrating and word-finding — often the most alarming symptom, and frequently mistaken for something worse. Vaginal dryness and discomfort. Joint aches. Reduced interest in sex.

Any of these is worth raising. Women routinely mention the hot flushes and leave out the sleep and the mood, which are often the ones doing the most damage.

What can be done

There are hormonal and non-hormonal approaches, and the right one depends on your symptoms, your history and what matters most to you. Vaginal symptoms in particular respond very well to local treatment that carries almost none of the considerations of systemic treatment, and they are chronically under-treated because women do not raise them.

We will go through benefits and risks with actual figures rather than a blanket reassurance or a blanket warning. Both of those have been handed out at different times and neither helped anyone decide.

The part that gets least attention

Bone and heart health. Bone loss accelerates around the menopause and cardiovascular risk changes. This is the least discussed part of menopause care and the part that matters for the longest, and it is worth a conversation even if your symptoms are mild.

One thing not to wait on

Bleeding that restarts after a year with no periods always needs to be looked at. It is usually nothing serious. It is not something to watch for a few months.

Written and reviewed by Dr. Jigna Jasoliya, M.S. (Obstetrics & Gynaecology), Gujarat Medical Council Reg. G/25348. Published 2026-10-17. Last checked 2026-10-17.

This article is general information, not medical advice about your own situation. If something here applies to you, come and talk to us.