We’ve all heard about menopause, but what you can expect in the years leading up to it is less well-known.

Perimenopause, as it is commonly called, can take many women by surprise.

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Menopause refers to the time after the final menstrual cycle, but you might experience all manner of annoying, uncomfortable symptoms for up to five years before that hits.

With the average woman reaching menopause at 51, your perimenopause will likely begin at around 47.

But don’t despair, we’ve got tips on how to manage ‘the pre-change’...

What happens?

During perimenopause, the ovaries start producing less oestrogen, progesterone and testosterone. But it’s not a slow, steady decline – levels can fluctuate wildly, causing irregular periods as well as mood swings and irritability.

And that’s not all – many women get hot flushes, insomnia, forgetfulness and a loss of libido. Increased vaginal dryness can lead to discomfort during sex, and women may also notice more fat around the waist.

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Sounds like a real barrel of laughs, right? But before you sink into a deep depression, take heart – you can fight back against the perimenopause monster!

Can I delay the onset?

Although it’s a necessary part of ageing, hormone replacement therapy (HRT) can attack the problem at its cause and delay the progression of symptoms.

While it’s not a long-term solution, it is very effective.

Ask your GP to check your hormone levels – if they’re low, he or she may suggest HRT, or may even prescribe the Pill.

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The Pill limits the hormonal surges that produce symptoms such as hot flushes, night sweats and sore boobs. It also provides women with contraceptive cover – while fertility declines during this perimenopause, it’s still possible to fall pregnant. During perimenopause some women can even ovulate twice in a cycle – including during their period – so it’s essential to discuss contraception with your GP.

However, if you’re a smoker, are overweight, have high blood pressure or are deemed at risk of cardiovascular disease, then the Pill is not recommended – a safer option may be the Mirena IUD, which lasts for five to seven years and packs a lower hormone dose.

How do I manage symptoms?

If you seem in the grip of perimenopause, don’t fret – there’s a lot you can do to manage your symptoms. If vaginal dryness and painful sex are an issue, your doctor can prescribe a vaginal oestrogen ointment or you can try a lubricant. Your GP can refer you to a professional for advice on improving libido.

You should also see a doctor if you get very heavy periods during perimenopause, as it may be a red flag for a malignancy in the cervix or uterus.

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Simple lifestyle changes can also go a long way to reducing the negative impacts. As usual, try to exercise regularly and eat a balanced diet, drink sensibly and don’t smoke. Many women also find natural therapies or herbal remedies to be effective.

So don’t suffer in silence – seek help, get informed and you’re sure to see your symptoms ease.

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But many experts today contend the study is highly flawed and say the benefits of HRT greatly outweigh the risks – not only in helping with symptoms such as hot flushes, but in preventing osteoporosis and heart disease.

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of menopause and for no more than five years. However, it’s not recommended for women with a history of breast cancer.

Are you headed for early menopause?

Early menopause is defined as a complete absence of menstrual cycles before the age of 45, and it’s estimated to affect eight to 10 per cent of women. If the cycles cease before the age of 40, the diagnosis is for premature menopause.

Early menopause can occur without obvious cause, as a result of surgery (having your ovaries removed) or cancer treatment.

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The cause of spontaneous early menopause is often unknown, but you are much more likely to experience it if your mother did. Symptoms of early menopause are the same as for menopause but can be much more severe, and you are also at increased risk of a brain aneurysm, heart disease, osteoporosis and premature ageing.