Perimenopause 101: When? Why? What? The? Fuck?
What’s behind the sulks, the silence and the slammed doors - and how to save your relationship (and your sanity)
Let’s be honest: if you’re confused about perimenopause, you’re not alone. Most men are. And a lot of women are too. Research from University College London found that just 2% of women felt well-informed about the menopause before their symptoms began - and nearly two-thirds said they hadn’t been informed at all.
It’s little wonder. Quick quiz question: when was menopause education first taught in British secondary schools?
A) 1985
B) 1995
C) 2005
Trick question. It was September 2020. That’s not a typo. Until just five years ago, the menopause didn’t even get a mention.
So for women approaching midlife today, there’s an alarming lack of information and support. And what little advice is out there is usually whispered, sugar-coated, or discovered ten years too late.
But I’m going to get you up to speed - so you can start to make a real difference.
First up, and it’s a big one: perimenopause isn’t a switch that flicks one day. It’s a process - sometimes slow and barely noticeable, sometimes slow and utterly brutal - and it can start years before her periods stop. Think of it less as a milestone, more as a maze of symptoms, second-guessing, and what the hell is happening moments.
This is the part most men don’t understand - and most women aren’t warned about.
So if she’s acting differently, sleeping badly, snapping over nothing, or simply saying she doesn’t feel like herself, there’s a good chance her hormones are at the wheel – just as they start swerving out of control. Let’s break it down.
What exactly is perimenopause?
It’s the hormonal build-up to menopause. Her main sex hormones - oestrogen and progesterone - stop following a predictable monthly rhythm and start going rogue. One day they’re sky-high, the next they crash. These hormonal swings affect her brain, body, sleep, sex drive, mood - everything. You’ll probably have heard of hot flushes, night sweats or brain fog. But there are some truly bizarre ones too: tinnitus, electric shock sensations, burning mouth syndrome, even the feeling of insects crawling under her skin. The list is long - and weird.
When does perimenopause start?
Usually in her forties, though it can begin as early as her late thirties. It often sneaks in with subtle changes that don’t seem linked - patchy sleep, low mood, brain fog, irritability, irregular periods. That’s what makes it so hard to pin down - and why so many women get brushed off by their GP. Before 45, blood tests aren’t reliable, because hormone levels can swing wildly day to day.
How long does perimenopause last?
Buckle up. On average, four to eight years. Yes, years. For some women, it’s shorter. For others, it drags on for a decade.
How is it different from menopause?
Menopause is the official moment her periods stop - 12 consecutive months without one, to be precise. It’s a milestone, not a phase. Everything before that is perimenopause. Everything after is postmenopause. But in reality, the symptoms often blur across all three stages - so it rarely feels as tidy as the (rarely read) textbooks suggest.
What are the most common symptoms?
There’s no set checklist - every woman’s experience is different (and a key reason it’s so hard to diagnose). But here are some of the most frequently reported issues:
Mental muddle: She forgets what she was saying mid-sentence. And the car keys? Missing again.
Sudden anxiety: She’s withdrawn, dodging plans and losing interest in stuff she normally enjoys.
Sleep struggles: She can’t fall asleep, wakes up constantly, or is wide awake at 4am.
Short fuse: She snaps over the tiniest thing - sometimes just the sound of you breathing.
Aching body: Her joints and muscles are suddenly sore, with no clear cause.
Low libido: Sex has fallen off the radar - and she’s more physically distant with you too.
Does every woman get symptoms?
No. Around one in four women sail through perimenopause with barely a blip. But another one in four struggle with severe, life-disrupting symptoms - including anxiety and depression. Some even report suicidal thoughts. It’s that serious.
How do I know if she’s going through it?
You might not - and neither might she. Symptoms are often subtle and easily mistaken for stress, overwork or just life. But if she’s saying she doesn’t feel like herself, or seems flat, frazzled or furious with no clear reason, hormones could be playing a big part.
Can she still get pregnant?
Yes. Until she reaches menopause - 12 consecutive months without a period - she can still conceive, even if her cycles are chaotic. That’s why contraception still matters during perimenopause.
What can I do to help?
Start by listening - and taking it seriously. Don’t brush it off as stress or moodiness. Don’t try to fix it. Encourage her to track her symptoms, speak to her GP and explore lifestyle changes like sleeping better, eating well, exercising more and lowering stress.
And if she - or you - feels overwhelmed? That’s normal. There’s plenty both of you can do to take back control of health, hormones and happiness. We’ll get into all of that next time.
Thanks for reading. Got any question, comments or thoughts? Let me know!
Joe