As the world observes World Menopause Day on October 18, experts stress the need to talk about a stage that often goes unnoticed, which is the perimenopause phase, the transition that begins years before menopause itself. While menopause is when a woman stops menstruating for 12 consecutive months, perimenopause is the phase that leads up to it, marked by fluctuating hormones and significant changes that happen in the body.
According to Dr Padmavathi Kapila, chief consultant obstetrician & gynaecologist at Renova Hospitals, Langar House, perimenopause is a transition phase where the ovaries produce less oestrogen. “Perimenopause is that in-between phase when the ovaries start producing less oestrogen. It usually begins in a woman’s 40s and can last for several years before menopause sets in. Menopause, on the other hand, is when you’ve gone 12 months without a menstrual cycle, which typically happens around the age of 51,” Dr Padmavathi explains.
While many women expect changes in their late 40s, some begin much earlier. Dr Arjumand Shafi, senior consultant obstetrician and gynaecologist at CARE Hospitals, Nampally, points out that, “Some women may notice changes as early as their mid-30s, but it’s more common in the early to mid-40s. The first signs are usually irregular periods — they may become shorter, longer, or unpredictable. Other symptoms include disturbed sleep, tiredness, mood changes, anxiety, and lower interest in sex. These are early signals that hormone levels are changing.”
What often complicates this phase is how easily these symptoms are mistaken for stress or depression. “The most frustrating part about perimenopause is that our bodies start producing less of the major hormones like oestrogen, progesterone, and testosterone. Because of that, we go through anxiety, hot flushes, irregular periods, sleeplessness, and fatigue. The sad part is that these symptoms are often mistaken for stress or depression, even though these hormones play such an important role in regulating how we feel,” says Dr Padmavathi.
Dr Arjumand adds that this confusion is understandable. “Because these symptoms are very common in everyday life, many women think they are caused by work pressure or emotional stress. In reality, fluctuating hormone levels during perimenopause can affect brain chemicals that control mood and sleep. Without awareness, both women and doctors may miss the hormonal cause and treat only the emotional side,” she explains.
When it comes to diagnosis, both doctors agree that there isn’t a single test to confirm perimenopause. Instead, doctors rely on a woman’s symptoms and medical history. Dr Padmavathi says, “Symptoms such as irregular periods, fatigue, anxiety, depression, and sleep disturbances often signal underlying hormonal changes. To understand these better, tests like FSH, oestrogen, progesterone, thyroid, iron, and vitamin B12 levels are usually recommended.”
Lifestyle choices also play a major role in managing symptoms. “Poor diet, stress, and lack of sleep can make symptoms worse. A balanced diet with fruits, vegetables, and whole grains, regular exercise, and stress management can reduce discomfort and improve sleep and mood. These simple steps often work better than medicines in the early stage,” says Dr Arjumand.
Adding to that, Dr Padmavathi recommends that, “Avoid processed foods, refined carbs, caffeine, and alcohol, and include more plant-based foods like vegetables, fruits, nuts, seeds, and omega-3 fats. Manage stress through yoga, meditation, walking, or sports, stay socially active, and cut down on screen time for overall well-being.”
For some women, despite these changes, symptoms may persist. In such cases, hormone therapy may be an option. “It depends on the severity of symptoms. For many women, lifestyle changes and natural remedies bring relief. But if symptoms like hot flashes, mood swings, or sleep loss are severe and affecting daily life, hormone therapy can be considered under medical supervision. The treatment plan should always be personalised,” shares Dr Arjumand.
Beyond treatment, awareness remains the key. “Yes, awareness is crucial because women experience significant hormonal and physical changes. It’s essential to integrate mental and hormonal health into regular care, with routine screenings and counselling sessions, as these play a vital role in supporting women’s overall well-being,” concludes Dr Padmavathi.
