What to Expect During Perimenopause

By Julie Dargan | Blog Posting

Sep 19

Not quite Menopause. Perhaps it is the Perimenopause.


At first I found myself throwing off the blankets at night. Initially I put it down to the warm nights. Then I wondered if I was coming down with something. Due to the interruptions to my sleep, I was tired and irritable during the day. I did not think to tell anyone about how I was feeling as I thought it was a passing phase. I was 46 years of age and menopause was the last thing that entered my mind.  Sarah-Jane V.


Many women refuse to acknowledge that they are entering the menopause when symptoms start emerging.

Ask most women what the menopause means to them, and the first thing that comes to mind is “hot flushes”. They may have seen a women experiencing a hot flush when they were younger, but did not pay much attention to what was going on at the time. Hence, when they experience the hot flushes they have trouble comprehending the next chapter in their life.

Women will actually start their menopausal journey months, or even years, prior to the actual day of reaching menopause. This journey is referred to as Perimenopause. (Click here to see a pictorial on the differences between menopause and perimenopause)


During this phase, the body has higher ratios of oestrogen to progesterone compared to a woman’s younger years.

This may not mean that she has too much oestrogen (which can be possible with blood tests) but simply the oestrogen action is stronger than progesterone.

What was once a harmonious relationship is now a coup.

Initial loss of Ovary Function

Typically around the age of 45, a woman’s ovaries will start to produce more oestrogen. This is due to the fact that she is starting to run out of ripe eggs. The number of eggs left in the ovaries is insufficient to continue the normal ovulation process.

The ovaries are trying to counter-balance the situation by releasing more oestrogen but this can only occur for a short time. After a short while, oestrogen levels drop.

Symptoms begin to surface when the oestrogen levels are higher than progesterone levels.

Too much oestrogen can make you irritable and anxious, while too little can make you depressed and confused. It is the rise and falls in oestrogen, as well as oestrogen being out of harmony with progesterone, that affects your mood. The more erratic your hormonal fluctuations, the more unsettling symptoms you will experience, particularly during peri-menopause.

Oestrogen & Progesterone: Hormonal Disharmony

Oestrogen and progesterone need to be in balance with each other as they both enhance the action of the other as well as offset the action of the other.

Oestrogen dominance is a term you may have seen. This is not a reflection of having too much oestrogen, but simply where oestrogen action is greater than progesterone.This can be the case whether oestrogen and progesterone levels are both high, low or normal.

Oestrogen dominance/high oestrogen levels symptoms:

  • heart palpitations
  • hot flushes
  • night sweats

While the oestrogen levels are making changes, so too is the progesterone levels.


Progesterone levels start decreasing (without an initial increase). It is when the oestrogen levels are too high in comparison to progesterone that menopause symptoms start to erupt.

Progesterone is the calming and sedating hormone.

Whereas oestrogen role is to store energy as fat and increase weight by increasing water retention; progesterone turns fat into energy and relieves excess fluid.

Progesterone is a natural diuretic and helps relieve excess fluids in the body.

If oestrogen levels are disproportionately high in relation to progesterone, a woman can become bloated and retain fluid. Ankles swell and rings may become tight on your fingers.

Other symptoms include tender & painful breasts, and headaches. This loss of hormonal balance can also lead to fibroids and heavy bleeding.

If you are progesterone deficient you will most likely be irritable, agitated, tired, depressed and experience unpredictable behaviour and anger outbursts.

Typical Symptoms experienced in the Peri-menopause

  1. Irregular and heavy bleeding initially. Up to 25% of women may experience heavy bleeding due to the initial increase in oestrogen. Oestrogen stimulates a thickening of the lining of the womb. With an increase in oestrogen, the thicker the lining becomes. Without the occurrence of pregnancy, the uterine lining is shed, hence a heavy period. As the oestrogen levels decrease, so does the lining of the womb, with the result of scanty periods.
  2. Night sweats and hot flushes
  3. Insomnia
  4. Loss of libido.
  5. Abrupt and intermittent mood swings
  6. Anger/temperamental outbursts
  7. General episodes of abnormal behaviour

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About the Author

Julie Dargan RN, ND, BHSc works with Successful, Busy, Menopausal Women find relief from hot flushes and night sweats, & lose weight gained in their middle years, through diet and lifestyle changes.

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