Last Updated on 10 July 2025 by Brisbane Livewell Clinic
There is a good chance that you are already entering the Very Early phase of Perimenopause if you’re over 35 and only just beginning to experience stronger symptoms associated with your period for the first time. Last month we looked at issues associated with Menopause and natural ways to support a smooth transition. This month we look at the decade or so before it’s official – sometimes referred to as ‘second puberty’ – and what to be aware of.
The Periods of Perimenopause
Perimenopause averages around 7 years but can range anywhere from 2-10 years and can be divided into 4 phases: (1)
- ‘Very Early Perimenopause’ averages around 2-5 years
- ‘Early Menopause transition’ for another 2-3 years
- ‘Late Menopause transition’ for about 4 years of typical perimenopause symptoms
- ‘Late Perimenopause’ which is confirmed after 1 year of no menses
In the Earlier phases, menstrual cycles still occur frequently but the regularity may change. In the Late phases, menses occur much less frequently (60 days or longer) until periods stop completely. Many women typically perceive the onset of perimenopause as the Late phases, when symptoms become much more obvious (think hot flushes) but the earlier stages can also be significant.
There could be up to 8 years of these Early phases with findings showing that women who have more variable hormone levels over time are also more likely to have a symptomatic menopause transition. (2) The average age of menopause is 51, with the normal age considered to be anywhere between age 40 to 55 years of age, (3) meaning it’s anyone’s guess how long you may experience the effects of perimenopause. If hormonal imbalances are becoming apparent in your mid to late ’30s there could be a whole decade in your 40’s of symptoms associated with your period.
Very Early Perimenopause
The transition from the late reproductive phase to early perimenopause can be confronting for many women, especially if they are trying to conceive in their late 30’s or early 40’s. The normal cessation of fertility can occur up to 10 years before menopause while regular menses can still be occurring. (3) Lower progesterone production means more anovulatory cycles can occur, which impairs the ability to conceive. Despite this, don’t be fooled because in younger women under the age of 45, if it appears that menopause is occurring it is important to exclude other diagnoses that could cause cessation of menses – including the most common reason – the possibility of pregnancy. (4)
Erratic ovulation aside, as hormones begin to fluctuate akin to a ‘second puberty’, oestrogen can spike up to 3 times higher which makes for heavier periods, increased period pain, migraines and sleep disturbance. (1) Working with a Naturopath to address menstrual issues and arrange testing to identify oestrogen excess is a good idea to ensure an effective treatment plan. Better managed symptoms earlier on has the potential to equate to a better transition through to menopause.
The Perils of Perimenopause
Each woman’s experience of their journey to menopause will be unique(3) and many women seek out natural medicine during this phase of life. Poor sleep and weight gain are 2 of the top complaints we see at clinics in women of perimenopausal age.
Poor sleep
Long before night sweats occur, women can begin to experience changes to their sleep patterns in their 40’s, and these tend to worsen with menopausal transition. (5) Approximately 45% of perimenopausal women experience the kind of symptoms you might expect to see in someone experiencing sleep disturbance including anger/irritability, anxiety/tension, depression and loss of concentration. (4) Potent botanical medicine can be an effective way to recover restorative sleep and a balanced mood. Acupuncture has also been found to significantly reduce sleep disturbances in perimenopausal women. (3)
Weight gain
Known as the dreaded ‘middle-aged spread’, the body often lays down extra adipose tissue in the abdominal region during perimenopause. (3) Managing changes to body composition with supportive strategies may include an in-depth assessment of metabolic health, thyroid testing, dietary and exercise advice and appropriate prescription to help combat excessive weight gain.
Pace Yourself, Know Yourself
Perimenopause takes time and body awareness and preparedness may serve you well through the 4 phases. Keeping a menstrual symptom diary (mobile phone apps are handy for this) can be worth the effort to help to identify symptoms that coincide with your cycle. When hormonal change is afoot, Natural medicine can help to bolster the hormonal shift and address issues as they arise. Knowing a little more about the process and recognising the signs makes it a little less confronting. Chat with one of our Naturopaths if you feel your period health need some attention.
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