Perimenopause & Menopause FAQs: What Every Woman Needs to Know

These terms are often used interchangeably, but they refer to two distinct phases of a woman’s life.

Menopause is a single, specific point in time. It is officially diagnosed 12 consecutive months after your last menstrual period.[4] Once you’re there you're now in the post-menopause phase. This is when your ovaries have stopped producing eggs, and your estrogen and progesterone levels are consistently low.[3]

Perimenopause, on the other hand, is the journey leading up to that point. It's a transition, a gradual process that can begin as early as your mid-30s or 40s and can last for several years, sometimes even a decade.[3] During this time, your ovarian function is declining, and your hormones are in a state of flux. I can feel like a hormonal rollercoaster, with estrogen and progesterone levels rising and falling erratically.

These fluctuations are what cause the wide range of symptoms that we associate with menopause, such as hot flashes, mood swings, and irregular periods. While menopause is a single, retrospective diagnosis, perimenopause is a dynamic phase where your body is actively adjusting. Understanding this distinction is the first step toward managing your symptoms and feeling in control of your health.

The average age of menopause is around 51,[3,5] but perimenopause can begin much earlier, typically in your mid-30s or 40s. 

The start is not a clear-cut event but a gradual process you may notice through subtle changes in your body and menstrual cycle, so it’s important to be aware of your body's signals and understand that these changes may be a normal part of this new phase of life.

The most common first sign is a change in your menstrual cycle. It’s often the body's earliest and most noticeable signal that its hormonal rhythm is beginning to shift.[3]

These changes can look different for everyone:

• Your periods may become irregular, with the time between them getting shorter or longer.
• The flow can change, becoming heavier or lighter than what you're used to.
• You might find that your premenstrual symptoms, like cramping or breast tenderness, become more intense.
  

Beyond the menstrual changes, there are a number of other symptoms that can start to appear as your hormones fluctuate. These include the classic hot flashes and night sweats, which are a direct result of hormonal shifts affecting your body's internal thermostat.[1] You might also notice mood swings, increased anxiety, or feeling more irritable than usual. Sleep disturbances, such as trouble falling asleep or staying asleep, are also common.[2]

These are what we consider the "early" or initial signs. However, as the perimenopausal journey continues, other symptoms can emerge or worsen. It’s important to remember that these are all part of a natural process and you don’t have to go through it alone. Listening to your body and speaking with your general practitioner can be key to finding effective ways to manage symptoms if and when you need to.

From a medical standpoint, this is a very important question. While it's true that your fertility naturally declines as you approach menopause, you can absolutely still get pregnant during perimenopause. Ovulation becomes more sporadic and unpredictable, but it doesn't stop entirely.[3]

This is why our medical practitioners always advise patients to continue using contraception if they are not planning to conceive. You should continue to use a reliable form of birth control until you have reached the official definition of menopause, a full 12 consecutive months without a menstrual period.[2] This is the only way to be sure that pregnancy is no longer a possibility. In fact, if you go through menopause under the age of 50 years, contraception is advised for 2 years after this, and if menopause occurs after the age of 50, then you would still need contraception for another 1 year. Guidelines may vary, so check with your general practitioner for personalised advice.

The honest answer is that it's different for everyone, but we do have some general timelines.

The symptoms of perimenopause, which are caused by fluctuating hormone levels, can last for a wide range of time, typically anywhere from 4 to 10 years.[3] It’s important to understand that this is a transitional period, so the symptoms can change in intensity and frequency throughout this time.

Once you have reached menopause and your hormone levels are consistently low, many of the most bothersome symptoms, like hot flashes and night sweats, tend to lessen over time. However, some symptoms can continue into the post-menopause phase, particularly those related to the long-term effects of lower estrogen levels, such as vaginal dryness.[1]

While this may sound daunting, the good news is that with the right understanding, strategies and medical support, these symptoms can be managed effectively so you can continue to live your life to the fullest.

Mood swings and anxiety are incredibly common during perimenopause. The feelings you're experiencing are not a reflection of a personal failing; they're a physiological response to the significant hormonal fluctuations happening in your body.[2]

The primary culprit is estrogen, which plays a key role in regulating neurotransmitters in your brain, such as serotonin and norepinephrine, that influence mood. As your estrogen levels fluctuate erratically during perimenopause, it can directly impact your brain chemistry, leading to feelings of irritability, sadness, and heightened anxiety. It’s important to remember that these feelings are often hormonally driven.

While lifestyle changes, such as regular exercise, a balanced diet and stress management, can be very effective in helping to stabilise mood, you should know when to seek help. 

If these feelings become severe, persistent, or begin to impact your daily life, it's crucial to speak with a healthcare professional. We can help you understand what's happening and discuss a range of options, from further lifestyle adjustments to medical treatments, to help you feel like yourself again.

This is a common question and you're not alone in this experience. It's often not just about what you're eating, but how your body is changing.

The primary driver of weight gain is the decline in estrogen. This hormonal shift can slow your metabolism, meaning your body burns fewer calories for energy. At the same time, your body may begin to store fat differently, with more fat accumulating around the abdomen.[6,7] Understanding these changes is the key to managing your weight.

The truth is, both weight gain and successful fat loss during perimenopause are complex, but they are absolutely manageable with the right approach. 

This requires being more intentional with your nutrition and your exercise, adapting your approach to suit this phase of your life.

Focusing on a balanced diet rich in protein and fibre can help you feel fuller and more satisfied, while incorporating calcium and vitamin D can support bone density which is crucial for as you approach menopause.

Resistance training is so valuable at all ages, but particularly as you approach this stage of life. Building and maintaining muscle mass is the most effective way to naturally boost your metabolism and counteract hormonal changes. Resistance training and other high-impact activities are also essential for maintaining bone density, which can decline with reduced estrogen, increasing your risk of osteoporosis.

Pairing the right nutrition and exercise for this stage of life, along with lifestyle adjustments can be a powerful tool for feeling strong and in control as you navigate this chapter. Remember, small, consistent changes are often the most sustainable and effective way to support your body.

For some women, even with a strong commitment to lifestyle changes, the hormonal shifts of perimenopause can make weight management particularly challenging, in these cases there are modern medical options that can provide support.

It’s crucial to understand that modern medical options are not a magic fix, they are designed to be a supportive tool used in conjunction with a healthy diet and regular physical activity. 

These options can help you reset your relationship with food and make it easier to stick to your nutrition and exercise goals. However, the long-term success of any weight management strategy, even with medication, relies on sustainable lifestyle changes.

If you need more advice on creating a healthy weight loss plan that is right for you, you can connect with health practitioners at Moshy, we know weight loss isn’t one-size-fits-all.

That’s why we offer:

• Personalised plans with AHPRA-registered health professionals
• Ongoing support from dietitian's
• Access to evidence-based tools and treatments

The short answer is, no, a hormone test is not typically required to diagnose perimenopause or menopause.

Here’s why: The diagnosis is primarily based on your age, your symptoms, and your menstrual history. A single blood test is not a reliable indicator because hormone levels, particularly estrogen, fluctuate so much during perimenopause. You might get a test result one day that shows a high estrogen level, and the next day it could be low. These unpredictable swings are what cause many of the symptoms, but they also make a one-off blood test unreliable for diagnosis.

Instead of relying on a single test, I encourage my patients to track their symptoms and menstrual cycle. This provides a much more accurate picture of what's happening in your body and helps us determine if your symptoms align with the perimenopausal transition. This information, combined with your age and health history, is what allows us to make a confident diagnosis and discuss the best strategies for managing your symptoms.

Note: If you are experiencing severe or persistent symptoms, we always recommend consulting with your Doctor for personalised medical advice.

It can feel intimidating to bring up topics like hormonal changes, mood swings, or weight gain with your doctor, but remember that this is a completely normal and healthy part of life. We are here to support you without judgment.

To make the conversation easier, I recommend preparing a few key points beforehand. Consider writing down:

• Your symptoms: List everything you're experiencing, no matter how small it seems.
• When they started: Note the approximate timeline and whether they are consistent or come and go.
• How they impact your life: Explain how these symptoms affect your sleep, mood, energy, or daily activities.
• Your questions: Write down any questions you have about perimenopause, menopause, or your overall health.

By having this information organised, you can ensure a productive and comprehensive conversation with your doctor. Don't hesitate to reach out to a professional; it's the most proactive step you can take to feel in control of your health.

Remember, this transition is a natural part of life, and you don’t have to go through it alone.

Moshy offers a variety of tools to support you, including dietitian-designed meal plans, educational resources and consultations with our team of medical professionals for those exploring weight management options.

Designed by leading health professionals, our program helps you lose weight and body fat effectively while providing long-term support.

We combine breakthrough weight loss solutions with ongoing guidance and connect you with a community of like-minded women on the same journey.

Let Moshy help you make informed dietary choices and achieve your health goals today!