Perimenopause is the transitional phase into menopause, which can last several years. It ends after 12 consecutive months without a menstrual period, marking the official onset of menopause. This transition comes with hormonal fluctuations, including a natural decline in reproductive hormones such as oestrogen and progesterone. This natural progression can result in a range of physiological and psychological symptoms.

Everyone experiences perimenopause differently and will have different signs and symptoms. Typically, one of the first signs of perimenopause is changes to your menstrual cycle. Periods may become heavier, lighter, or more irregular due to hormonal fluctuations. If you typically have a 28-day cycle, during perimenopause your period might arrive as early as 20 days or as late as 35. It’s also common to skip periods entirely.

Irregular periods are very common during perimenopause, most of the time there is nothing to be concerned about, however if your experience extremely heavy bleeding, periods that last longer than seven days, bleeding between periods, or cycles that are less than 21 days, you should contact your doctor.

Your body needs to adjust to your fluctuating hormone levels during perimenopause, this adjustment is different for everyone, and no two women will have the same experience. According to a recent survey of perimenopausal women from Active Iron¹, some of the most common symptoms include;

• Anxiety, mood swings, irritability & depression (64%)
• Tiredness & Fatigue (63%)
• Heavier periods (58%)
• Irregular periods (57%)
• Weight gain (56%)
• Hot Flushes (51%)
• Bloating (48%)
• Loss of Sleep or Insomnia (43%)

Women typically start perimenopause in their mid-40s, but some women notice changes as earlier as their mid-30s. Perimenopause usually lasts about 8-10 years and ends after 12 consecutive months without a period – marking the onset of menopause².

While perimenopause is a natural process and there are no treatments to stop it from happening, there are things you can do to ease some uncomfortable symptoms.

Many people don’t need any medication to treat symptoms of perimenopause, and simple lifestyle changes may be enough to ease symptoms. However, some people find that taking medication can ease symptoms. You should always consult your healthcare provider before starting medical treatments.

Your healthcare provider may recommend some of the following medications²:

• Hormone therapy using oestrogen or oestrogen and progesterone to balance your hormone levels.
• Antidepressants can help with mood swings, anxiety, and hot flashes.
• Gabapentin can be taken to ease hot flashes.

Many women successfully manage perimenopause symptoms at home, without treatment from a healthcare provider. Here are some tips for treating your symptoms at home:

• Eating a healthy and balanced diet, with lots of fruits, vegetables, whole grains, and protein.
• Exercising regularly.
• Find out what triggers your hot flashes by keeping a record, for example alcohol or caffeine may be a trigger.
• Taking supplements that support your hormonal balance, bone health, or energy levels can play an important role in managing perimenopause symptoms.
  • Iron – helps fight tiredness and fatigue, particularly if you’re experiencing heavy periods³.
  • B Vitamins (Particularly B6 and B12) – Support hormone balance, reduce tiredness and fatigue & support the nervous system and immune system⁴.
  • Selenium – Contributes to normal thyroid function, which is key during hormonal changes⁵.
  • Vitamin D – Is important for the health and strength of your bones during perimenopause⁶.

During perimenopause, menstrual cycles can become unpredictable, with many women experiencing heavier and longer periods. A recent survey from Active Iron¹ revealed that 58% of perimenopausal women reported having heavy periods, and 80% of these women say they feel tired all the time. This exhaustion is often linked to low iron caused by increased blood loss during heavy periods.

Oestrogen plays a role in iron absorption in the intestines, as oestrogen levels decline during perimenopause, the body may become less efficient at absorbing iron from the diet. This can result in low iron levels during perimenopause. Oestrogen also influences the production of ferritin, a protein that stores iron in the body’s tissues. Lower oestrogen levels can lead to reduced ferritin, reducing the body’s iron reserves⁷.

Many women experience symptoms of low iron, such as feeling tired all the time, having no energy, feeling weak, and having trouble concentrating. These symptoms can easily overlap with typical perimenopausal symptoms, making it essential to monitor and manage iron levels to support overall health and well-being during this transitional stage.

Iron is essential for producing haemoglobin, which carries oxygen through the body. Without enough iron, energy levels drop, and overall well-being suffers. Ensuring adequate iron intake through diet or supplements can help, and Active Iron is designed to be gentle on the stomach while providing the iron needed during perimenopause.

Recent research highlights the significant impact of perimenopause on women’s health and daily lives. With nearly one in three (31%) women over 35 currently going through perimenopause or menopause, over half (55%) of them describe their perimenopause or menopause experience as negative⁸. Among women aged 30-49, 72% report experiencing symptoms of perimenopause⁹.

According to a survey by Active Iron¹, the most common symptoms reported during perimenopause include anxiety, mood swings, irritability, and depression, affecting 64% of women. Fatigue and tiredness follow closely, impacting 63% of women, while 58% report experiencing heavier periods. Notably, 69% of perimenopausal women said that tiredness and fatigue during heavy menstrual bleeding left them without the energy or motivation to carry out everyday tasks. Additionally, 45% of women found their methods for managing fatigue during their menstrual cycle to be ineffective.

These statistics highlight the significant challenges many women face during perimenopause and menopause, and the importance of addressing the physiological and psychological symptoms.