Perimenopause: what happens to your body, and what you can do.
Perimenopause usually begins in the mid to late 40s, earlier for some women. It typically lasts several years, sometimes much longer. We help you understand what is happening in your body and what can help.
The transition to menopause, not menopause itself.
Perimenopause is the transition to menopause, the period in which the ovaries gradually reduce their function. Oestrogen swings, rising and falling irregularly, progesterone declines, FSH rises. Menopause itself is confirmed in hindsight, once the last period was twelve months ago.
In Switzerland, women are 51 on average at their last period. So perimenopause often begins in the mid-40s, and for some women in their early 40s. If your symptoms start before 40, have them checked by a doctor.
Perimenopause in numbers
Studies show values for groups. Your personal situation may differ.
What becomes noticeable in perimenopause.
From hot flushes to brain fog, from sleep problems to weight gain. One symptom alone says little, the interplay is what matters.
How often midlife women report these symptoms
In a worldwide analysis of 321 studies, midlife women most often reported joint and muscle discomfort (65.4%) and exhaustion (64.1%), followed by memory problems and irritability (54.4% each).6
| Symptom | Share of women |
|---|---|
| Joint and muscle discomfort | 65.4% |
| Physical and mental exhaustion | 64.1% |
| Memory problems | 54.4% |
| Irritability | 54.4% |
| Sleep problems | 51.9% |
| Mood swings | 49.0% |
| Difficulty concentrating | 44.9% |
A selection of 7 of 19 symptoms. 482,067 midlife women worldwide, 2000 to 2023. Women before, during and after the transition combined. The studies differ widely, so the figures show an order of magnitude. Hot flushes and night sweats are not part of this selection.
The hormone biology behind it.
Oestrogen regulates far more than the cycle: sleep, mood, metabolism, bone health and the moisture of the mucous membranes. When oestrogen swings and falls, those effects show up throughout the body.
Oestrogen regulates sleep, mood, metabolism, bone and mucous membranes. When it swings and falls, it shows up throughout the body.
Progesterone often falls first, because ovulation is skipped more often. That can contribute to irregular or heavier bleeding.
FSH rises in response to falling oestrogen levels. A lab value that fluctuates widely and is not decisive on its own.
There are good weeks and bad weeks. A single lab value is rarely conclusive, the assessment needs symptoms and course over time.
Often missed: exhaustion, low mood and poor sleep are easily put down to burnout or depression first, and hormones only come up later. Sometimes the two are connected. An underactive thyroid can cause similar symptoms and is therefore assessed alongside.
What helps during perimenopause?
That depends on which symptoms are bothering you, how old you are and what your medical history shows. There are approaches with and without hormones, on their own or combined.
Exercise and everyday habits
Regular exercise, especially strength training, helps you maintain muscle and bone. If you smoke, you have hot flushes more often, so stopping is always worth it.
Sleep and mood
Poor sleep is often linked to hot flushes at night, but it also happens without them. Cognitive behavioural therapy adapted for menopause can help with sleep problems and low mood, and can make hot flushes less of a burden. More on sleep problems (in German).
Without hormones
If hormones are not an option for you, or you would rather not take them, there are non-hormonal prescription medicines for hot flushes. These have side effects too. For herbal remedies the evidence is mixed and products vary widely, so talk to your physician before you take them, especially if you take any medication. More on hot flushes (in German).
Hormone therapy, if medically suitable
For troublesome hot flushes and night sweats, the guidelines recommend offering hormone therapy, unless there is a reason not to. Whether it is an option for you depends on your age, your medical history and your risks. It is not risk-free: depending on the form and duration, it can, for example, slightly increase the risk of thrombosis, stroke or breast cancer. After breast cancer or a thrombosis, and with some other pre-existing conditions, it is either ruled out or only an option after careful consideration. It is not a contraceptive, so contraception belongs in the same conversation. More in our HRT overview (in German).
When to see a doctor
Have new, severe or persistent symptoms checked by a doctor. If you have sudden chest pain, shortness of breath, fainting, paralysis or difficulty speaking, call the emergency number 144 immediately. Have very heavy bleeding, recurrent bleeding between periods and bleeding after sex checked in person by your gynaecologist. Your physician will clarify whether lab tests would help. More on hormone levels and blood tests (in German).
What is medically possible in perimenopause, step by step.
It always starts with a medical consultation. What follows depends on your phase and your findings.
Medical history questionnaire beforehand, then a 1:1 video consultation. Your physician works out whether your symptoms fit perimenopause or have another cause.
Oestradiol and FSH swing widely in this phase, a single value decides nothing. Lab values are used where they change the plan, and the thyroid is assessed alongside.
A dedicated video consultation: what connects, what is treatable and what is watched.
Closely guided during the setup phase, then on a quarterly rhythm. Dosage and tolerability are reviewed continuously.
Treatment decisions are made by your physician, not an algorithm.
To treatmentYour medical consultation
Your consultation brings clarity about your next medical step. Where medically indicated, targeted diagnostics complete the assessment. During treatment you are supported by a physician throughout.
Preparation in your patient area, a review by your physician before the appointment, 30 minutes by video with her, then your report with treatment plan in writing.
Follow-up with your physician every month, for phases in which effect, tolerability or dosage need to be guided closely. You can stop at any time, and the current monthly period runs to its end.
Follow-up with your physician every three months, once your treatment is well established. You pay for three months in advance. You can cancel at any time, and the quarterly period you have already paid for runs to its end.
Where medically indicated: targeted diagnostics. Your physician discusses the scope and cost with you beforehand.
Your medical consultation
A fixed price for your consultation. Then you decide whether ongoing care makes sense.
Included in both
When your body changes, your next step should be clear.
In your medical consultation, your physician already knows your medical history and any existing results before you speak. You use the 30-minute video call to look ahead, and afterwards you receive your report with treatment plan in writing.
- Between 38 and 65 years old
- Typical perimenopausal or menopausal symptoms
- Also with hormone therapy already underway
When your body changes, your next step should be clear.
In your medical consultation, your physician already knows your medical history and any existing results before you speak. You use the 30-minute video call to look ahead, and afterwards you receive your report with treatment plan in writing.
Common questions about perimenopause.
The most common questions about perimenopause. Anything further you clarify directly with your physician.
All questions and answersWhat is perimenopause?
Perimenopause is the transition before menopause, in which the ovaries gradually wind down their hormone production. Ovulation is skipped more often, progesterone declines and oestrogen swings widely. It usually begins in the mid to late 40s and ends with menopause, which is confirmed in hindsight once the last period was twelve months ago.
What are the first signs of perimenopause?
Typical first signs are a change in your cycle and hot flushes or night sweats. The gaps between periods get shorter or longer, bleeding gets heavier or lighter, and hot flushes can start while your periods are still regular. Poorer sleep, mood changes or difficulty concentrating often come with them. A single sign says little, it is the overall picture that counts. Have very heavy bleeding or recurrent bleeding between periods checked in person by your gynaecologist.
When does perimenopause begin?
Perimenopause usually begins in the mid to late 40s, but it can start earlier. If your symptoms start before 40, have them checked by a doctor.
Can perimenopause start at 40 or earlier?
Yes, for some women it begins in their early 40s, and rarely even earlier. If menopause comes before 45, it is called an early menopause, before 40 premature ovarian insufficiency (POI). Before 40, menopausal symptoms, or periods that have stopped for months or become very irregular, should always be checked by a doctor, partly because an early lack of hormones can put a strain on your bones and heart.
How long does perimenopause last?
Perimenopause typically lasts several years, just under four on average, and much longer for some women. When it has ended only becomes clear in hindsight, once the last period was twelve months ago.
Is perimenopause the same as menopause?
No. Perimenopause is the transition, the phase of hormonal change. Menopause is confirmed in hindsight, once the last period was twelve months ago.
Perimenopause, burnout or thyroid: how can I tell them apart?
Perimenopause, burnout and thyroid disorders often cannot be told apart from the symptoms alone, and sometimes they occur together. Exhaustion, sleep problems, low mood and difficulty concentrating occur with all of them, and with depression too, which is more common in perimenopause. From around 45, a change in your cycle together with hot flushes points more towards perimenopause. The thyroid can also change your cycle and cause sweating, and it can be checked with a blood test. Iron deficiency, for example after heavy bleeding, can make you similarly tired. Your physician works out whether your symptoms fit perimenopause or have another cause.
Can perimenopause be detected with a blood test?
Usually not. From around 45, your physician assesses perimenopause from your symptoms and your cycle, because hormone levels fluctuate too much. A blood test helps mainly in younger women or when another cause such as the thyroid is possible.
What helps during perimenopause?
Depending on your symptoms, options include cognitive behavioural therapy adapted for menopause, non-hormonal medicines and, if medically suitable, hormone therapy, along with exercise and strength training for muscles and bones. Which approach suits you depends on your age, your medical history and your risks. Your physician weighs this up with you.
Does hormone therapy help with perimenopausal symptoms?
According to the guidelines, hormone therapy relieves hot flushes and night sweats effectively, and for many women sleep and mood improve too, often because the hot flushes ease. It is not suitable for every woman, though, and it is not free of risks. Whether it is right for you depends on your age, your medical history and your risks, and your physician assesses this.
Can I still get pregnant during perimenopause?
Yes, pregnancy is possible until menopause, even if your cycle is irregular. So if your period does not come, a pregnancy test is the first step. Hormone therapy is not a contraceptive. If you use non-hormonal contraception, the rule of thumb is to keep using it until you have gone two years without a period, or one year if you are 50 or older. From 55, contraception is usually no longer needed. On hormonal contraception or hormone therapy, you cannot tell this from your bleeding, so your physician will clarify it with you.
Written by the gynxtra editorial team for general information. It does not replace medical advice.
Sources
- McKinlay 1992: McKinlay SM, Brambilla DJ, Posner JG. The normal menopause transition. Maturitas 1992;14(2):103-115. doi:10.1016/0378-5122(92)90003-M, own illustration europepmc.org ↩︎
- STRAW+10, Harlow 2012: Harlow SD, Gass M, Hall JE, et al. Executive summary of the Stages of Reproductive Aging Workshop + 10. Menopause 2012;19(4):387-395, own illustration pmc.ncbi.nlm.nih.gov ↩︎
- WHO 2024: World Health Organization (WHO). Menopause. Fact sheet, 16 October 2024 who.int ↩︎
- USZ: University Hospital Zurich, patient information on menopause symptoms («Wechseljahresbeschwerden»), updated 31.07.2026, accessed 07.10.2026 usz.ch ↩︎
- Paramsothy, SWAN 2017: Paramsothy P, Harlow SD, Nan B, et al. Duration of the menopausal transition is longer in women with young age at onset. Menopause 2017;24(2):142-149. doi:10.1097/GME.0000000000000736 (SWAN) pmc.ncbi.nlm.nih.gov ↩︎
- Fang 2024: Fang Y, Liu F, Zhang X, et al. Mapping global prevalence of menopausal symptoms among middle-aged women: a systematic review and meta-analysis. BMC Public Health 2024;24:1767. doi:10.1186/s12889-024-19280-5. Licence CC BY 4.0 (creativecommons.org/licenses/by/4.0), own illustration, selection doi.org ↩︎