Perimenopause refers to the period leading up to menopause when a woman’s body starts transitioning toward the end of her reproductive years. Unlike menopause, which is marked by the cessation of menstrual periods for 12 consecutive months, perimenopause can last several years. This natural part of aging for women often remains widely misunderstood.

Perimenopause vs. Menopause

There’s often confusion between perimenopause and menopause. While menopause is a well-known term and frequently discussed, perimenopause is not spoken about enough. This lack of conversation leaves many women unprepared for the changes they experience in their 40s, 50s, and sometimes even late 30s.

In Australia, the average age for women to reach menopause is 51 to 52. Perimenopause usually starts in a woman’s 40s. On average, it lasts four to six years, but it can last between one and 10 years.

Understanding the difference between these two stages is crucial for managing symptoms and maintaining well-being during this transitional life phase.

What Causes Peri-Menopause?

During perimenopause, the ovaries gradually produce fewer eggs, leading to fluctuations in two crucial hormones:

  • oestrogen
  • progesterone

These hormones are vital for regulating the menstrual cycle and maintaining reproductive health. As women approach their late 30s or early 40s, this natural hormone production slows down, which in turn triggers the onset of perimenopausal symptoms.

Genetics play a significant role in determining when perimenopause begins. If your mother or older sisters experienced early perimenopause, you might, too. Lifestyle factors like smoking, diet, and exercise habits can also influence the onset and progression. For example, smoking can accelerate the onset of perimenopause, while a balanced diet and regular exercise might help manage symptoms more effectively.

Signs That You May Have Started Perimenopause

Irregular Periods: One of the earliest and most common signs is changes in the menstrual cycle. Periods may become irregular, with frequency, duration, and flow variations.

Mood Changes: Fluctuations in mood, including irritability, anxiety, and depression, are often reported. Hormonal fluctuations influence these changes.

Fatigue: Persistent tiredness and a lack of energy, even after adequate rest, can be a sign of perimenopause.

Changes in Skin and Hair: Hormonal changes affecting skin and hair health may cause thinning hair and dry skin.

Other signs include hot flashes, sleep disturbances, vaginal dryness, and low libido. It really comes down to what stage of perimenopause you are in and what your oestrogen levels are like.

Diagnosing Perimenopause

In most cases, recording a symptom score helps diagnose perimenopause (and I use this term very loosely—perimenopause is not a condition to ‘diagnose’, and it is most definitely not a deficiency state). This method not only aids in ‘diagnosis’ but also educates women and provides a basis for assessing treatment efficacy.

I always explain to my clients that checking Follicle Stimulating Hormone (FSH), Anti-Müllerian Hormone (AMH), serum estradiol, and progesterone levels is unnecessary for diagnosing perimenopause in most women. Similarly, a routine androgen profile test for all perimenopausal women is also unnecessary and costly and, most of the time, won’t change the treatment plan.

Many women come to consultations expecting to be sent for a blood test to diagnose perimenopause. It’s important to explain why I use the symptom score rather than a blood test. Blood tests for FSH and estradiol can fluctuate daily and, therefore, may not always be helpful or necessary. Using symptom scores can provide a more accurate and consistent diagnosis.

Managing Perimenopause

I know this all sounds daunting, but it can be managed through Nutritional, Herbal, and Western medicine. The important thing to remember is that there are people out there to support you. Together, we can navigate this journey and help you feel your best.

At Katie Blakely Wellness we are so passionate about supporting women through perimenopause, not only making this life stage bearable, but helping you to enjoy it. Like all transitions, it’s normal to have ‘bumps’ in the road and have some challenges pop up, but it’s amazing to see what a huge difference you can notice in your symptoms and overall wellness with some simple dietary swaps and a bit of extra nourishment. While perimenopause is definitely not a ‘deficiency-state’, and there’s absolutely nothing ‘wrong’ with you, your needs are changing a bit at this time & that’s something that we can help you embrace. 

If you’d like to explore how we can work together, you’re more than welcome to book in a free discovery call with me to learn about how Clinical Nutrition can support you through this journey. We also have heaps of exciting content on the way diving into perimenopause, and a free talk coming up soon at Croydon library!

More than just one on one:

We know that one on one consultations simply aren’t right for everyone, and that’s why we are in the process of putting together some really great resources for those of you who would prefer to watch webinars or do self-paced online courses. Please keep an eye on our webinars page to see what we have available. By joining the mailing list we will also let you know when new resources are uploaded.

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This blog does not provide individualised health advise. The information mentioned in this blog is educational in nature and is here to help you make informed decisions regarding your health. It is essential that you work with your healthcare practitioners to assess what is right for you.

Reference list:

Ceylan, B., & Özerdoğan, N. (2015). Factors affecting age of onset of menopause and determination of quality of life in menopause. Turkish Journal of Obstetrics and Gynecology, 12(1), 43-49.

Harlow, S. D., & Paramsothy, P. (2019). Menstruation and menstrual disorders: The epidemiology of menstruation and menstrual dysfunction. UpToDate. Retrieved from

Harper, J. C., Phillips, S., Talaulikar, V., & the rest of the authors. (2022). An online survey of perimenopausal women to determine their attitudes and knowledge of the menopause. SAGE Open Medicine. Advance online publication.

Jean Hailes for Women’s Health. (n.d.). Perimenopause. Retrieved July 3, 2024, from

Santoro, N., & Epperson, C. N. (2017). Perimenopause: From research to practice. Journal of Women’s Health, 26(10), 1037-1045. doi: 10.1089/jwh.2017.6509

The Australasian Menopause Society. (n.d.). Diagnosing menopause. Retrieved from


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