Perimenopause .

Perimenopause is a natural transition phase that occurs before menopause, marking the time when your body begins to undergo significant hormonal changes. You start experiencing menopausal symptoms before your periods have fully stopped; these symptoms often begin years before your periods completely stop and can continue after menopause.

In this guide, we will explore early signs, symptoms, and tips for managing perimenopause, with expert insights from Emma Bardwell, registered nutritionist and menopause specialist.

What is Perimenopause .

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 brings along hormonal fluctuations, including a natural decline in reproductive hormones, including oestrogen and progesterone.

This natural progression can result in a range of physiological and psychological symptoms.

When Perimenopause Starts .

Perimenopause typically begins for women in their mid-40s. However, some notice changes as early as their mid-30s. According to the Cleveland Clinic, perimenopause usually lasts about 8-10 years and ends after 12 consecutive months without a period, marking the onset of menopause¹.

Early Signs of Perimenopause .

Each woman’s journey through perimenopause is unique to them. 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 days. It is also common for periods to
skip entirely.

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

Perimenopause Symptoms

Your body will need time to adjust to your fluctuating hormone levels during perimenopause. This adjustment is different for everyone, and no two people will have the same experience. According to a recent survey of perimenopausal women from Active Iron², some of the most common symptoms include:

Anxiety, Mood Swings, Irritability & Depression

A very common symptom during perimenopause, caused by hormonal fluctuations, especially a drop in oestrogen and progesterone.

Tiredness & Fatigue

Changes in hormones can disrupt sleep and cause a dip in your energy levels. Active Iron is formulated to increase iron levels by 94% in 6 weeks, helping to increase energy levels³ and fight tiredness & fatigue⁴.

Heavier Periods

According to the NHS, if you’re losing 80ml or more in each period, having periods that last longer than seven days, or both, you have heavy menstrual bleeding. Changing your sanitary products every hour or two, passing clots larger than 2.5cm, bleeding through your clothes or bedding, or using two types of sanitary products at once are also reasonable indications that your periods are heavy⁵.

Irregular Periods

Periods may become more irregular due to the hormonal fluctuations occurring in your body. If you typically have a 28-day cycle, during perimenopause, your period might arrive as early as day 20 or as late as day 35 of your cycle. It is also common for periods to skip entirely.

Weight Gain

Changes in metabolism, hormones, and lifestyle make weight management more challenging.

Hot Flashes

Sudden waves of heat, sweating, and flushing, typically affecting the neck, face, and chest.

Bloating

Changing levels of oestrogen and progesterone can cause digestion to slow down and water retention to increase⁶.

Loss of Sleep/ Insomnia

Difficulty falling asleep and/or staying asleep. Disturbed sleep can lead to tiredness and fatigue.

Medical Treatments for Perimenopause .

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. Medication is not needed for some women to treat symptoms of perimenopause, and simple lifestyle changes may be enough to ease symptoms. However, some find that taking medication can help improve 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.

Managing Perimenopause Symptoms at Home 

Many women can 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 proteins, can help reduce your symptoms during perimenopause.

Regular exercise can also make a big difference. Even a short walk can be highly beneficial, supporting both your physical and mental well-being!

Find out what triggers your hot flashes by keeping a record, for example, alcohol or caffeine can be a big trigger for many women.

Taking supplements that support your hormonal balance, bone health, or energy levels can play an important role in managing perimenopause symptoms⁴.

- Iron can help fight tiredness and fatigue, particularly if you’re experiencing heavy periods

- B Vitamins (particularly B6 and B12) support hormone balance, reduce tiredness and fatigue & support the nervous system and immune system

- Selenium contributes to normal thyroid function, which is key during hormonal changes

- Vitamin D is important for the health and strength of your bones during perimenopause⁴.

The Impact of Low Iron on Perimenopause .

During perimenopause, menstrual cycles can become unpredictable, with many women experiencing heavier and longer periods. A recent survey from Active Iron² 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 your 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, including 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 body⁴. 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.

According to Active Iron's survey², 69% of perimenopausal women are left without energy or motivation to carry out everyday tasks, caused by tiredness and fatigue during heavy menstrual bleeding. 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.

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References

  1. ¹Cleveland Clinic - Perimenopause https://my.clevelandclinic.org/health/diseases/21608-perimenopause. Accessed 16/10/2025
  2. ²Active Iron survey 2024. N=1500
  3. ³Ledwidge, M. et al. PRECISION Study. Int J Clin Pharm (2023)
  4. ⁴Iron contributes to normal energy-yielding metabolism and the reduction of tiredness and fatigue. Iron contributes to normal formation of red blood cells and haemoglobin and oxygen transport around the body. Vitamin B6 & B12 contribute to the reduction of tiredness and fatigue, normal function of the immune system, normal functioning of the nervous system, and vitamin B6 also contributes to the regulation of hormonal activity. Selenium contributes to the normal thyroid function. Vitamin D contributes to the maintenance of normal bones and muscle function.
  5. ⁵NHS - Heavy Periods https://www.nhs.uk/conditions/heavy-periods/. Accessed 16/10/2025
  6. ⁶My Menopause Centre - Understanding Hormonal Changes During Perimenopause https://www.mymenopausecentre.com/hormonal-changes/hormonal-changes-tracking/understanding-hormonal-changes-during-perimenopause/#fc-common-symptoms-of-perimenopause. Accessed 16/10/2025
  7. ⁷Qian et al. Oestrogen contributes to regulating iron metabolism through governing ferroprotein signalling via an oestrogen response element. Cell Signal. 2015; DOI: 10.1016/j.cellsig.2015.01.017