What is perimenopause?
Why is there so much talk about perimenopause/premenopause and what is it? Is there such a phase – and why is it so important to pay attention to it?
Perimenopause – a controversial concept
The concept of premenopause have become popular in recent times. But the concept has also been questioned. Some would like to talk more about premenopause, but others say it’s not even a clinically recognized term and claim that it just confuses women by talking about menopause starting already for women in their forties.
For Swedes, perhaps the problem lies in the Swedish language. In Swedish, the entire hormonal process a woman undergoes is called klimakteriet – often simply translated to menopause. This includes the period before and during a woman’s final menstruation; the time of the actual final menstruation, menopause; as well as the time afterwards, post-menopause.
But in English, these are actually divided up with different names for the different phases. The term premenopause – the prefix pre- means before – is often used for the time period when the hormone cycle starts to change, but before a woman has any real symptoms. The term perimenopause – the prefix peri– means around – is used for the time just before and around the final menstruation. The term menopause is for the time of the final menstruation. And the term post-menopause is for the period starting one year after final menstruation. In other words, English has stopped using one word to describe it and instead describes it as different phases.
Complicated? Yes, a bit. But whatever you call it and its different phases, the fact is that many women do not understand that they are approaching menopause (the time of final menstruation), and they are caught off guard by the different things happening with their health and well-being.
Read more about everything you need to know about the phases of menopause.
The word menopause comes from the French word menepausi, which in turn is derived from Latin. Menes means monthly, while pausi means expiration or end.
I couldn’t find any comprehensive information about perimenopause when I started to experience changes, and I didn’t understand what they were about. Katarina Wilk, author
Actual experience of perimenopause led to a book
Someone who began writing about perimenopause early on – and about the confusion of terms that has occurred in Swedish – is Katarina Wilk, author and writer on medicine and health.
“I believe that part off the problem lies in the choice of the word förklimakteriet,” says Katarina Wilk. “The term förklimakteriet [which translates more or less directly as premenopause] – instead actually should be förmenopaus [perimenopause]. We could have avoided this debate completely. The Swedish word förklimakteriet refers to the phases before menopause.”
Katarina Wilk’s book Perimenopower was published in 2018 and since then has been translated into seven languages. The book was published in a new edition in 2022, with a completely new chapter on the latest research and what happens to the brain during menopause, an area that Katarina Wilk thinks needs much more focus. And the new edition also has a new and descriptive title: På väg in I väggen – eller bara i förklimakteriet? – which translates to About to crash or just perimenopausal?
“I wrote the book because I couldn’t find any comprehensive information myself about perimenopause when I started to experience changes, and I didn’t understand what they were about,” says Katarina Wilk.
Burnt out – or just entering perimenopause?
Katarina was in her forties when she started experiencing significant problems with sleep, sudden episodes of sweating and pressure on her chest, which culminated in panic attacks. She jumped into work mode, put on her writer’s hat and started researching what happens in the years before menstruation stops.
“I saw the clear connection between mental health and fluctuating hormones – and I decided to write a book about this turbulent time.”
Photo: Magnus Rangvid
Katarina Wilk is clear that awareness and knowledge about what happens during perimenopause needs to increase, both within healthcare and among women who are approaching menopause. There is a clear knowledge gap that can lead to unfortunate misdiagnoses, she says.
“Many who enter perimenopause are unaware of it, since they are still menstruating,” says Katarina Wilk. “And if you don’t know enough, it’s easy to believe that you are feeling bad because of something else.
“So instead of going to your gynecologist, you go to your general practitioner, who may not understand that fluctuating hormones are the reason behind the insomnia, anxiety or depression.”
Poor awareness of menopausal symptoms
In Sweden alone, 1.3 million women between ages 45-65 are either approaching or undergoing menopause. In 2022, RFSU started a comprehensive survey on the awareness of menopause and the most common symptoms.
The report, called Klimakteriekollen (Menopause Check), is based on interviews with 3,000 women ages 45-65 in the Nordic region. The first report found a disturbing lack of awareness for both women and the healthcare system. Only two of five (59 percent) of women who had started menopause reported that they had a good awareness about menopause before hormonal changes started occurring.
In 2024, a new Menopause Check was undertaken. The report found that four of ten (44 percent) of women said they have negative feelings connected to menopause. This is an increase from the previous year, when the comparable number was 35 percent.
The increase can be interpreted as a sign that the more aware women are of the reason behind their symptoms, the easier it is for them to connect the discomfort with menopause.
Many women seeking care, including myself, have heard that the problem is that they are burnt out and depressed, when their symptoms actually are due to sinking estrogen levels. Katarina Wilk, author
What Katarina Wilk pointing outs is that it is exactly during the most turbulent phase – right before the onset of menopause – that it is most important to understand that the difficulties one is experiencing are due to hormone fluctuations – and not something else.
But since every woman is unique, there is no “magic date” to write in the calendar to start counting down to menopause – or to take into account turbulent hormone production. And if furthermore, you don’t recognize the different symptoms that can appear related to hormone fluctuations, it’s not easy to put together the pieces.
A maze of clues – early menopause symptoms
Katarina Wilk says that healthcare should be more much more aware of women’s early menopause symptoms. But isn’t it just a matter of taking a blood test at the gynecologist to see if you have decreasing estrogen levels? Or of taking a home test?
Unfortunately, it isn’t that simple. Since estrogen levels can fluctuate, one test does not provide a correct answer.
Nina Sommerfeld, specialist in obstetrics and gynecology, in her practice meets many women who suspect they have lowered estrogen levels but continue to menstruate.
Can you experience menopause but still menstruate?
“Absolutely, you can find yourself in the phase right before your final menstruation, where estrogen levels have started to decrease and hormones can be on a rollercoaster,” says Nina Sommerfeld. “And if you don’t know which symptoms are due to hormonal imbalances, this period of time can feel particularly difficult.”
Women want to be prepared before they seek healthcare for menopause symptoms
Within the healthcare system, whether a woman is undergoing menopause is mostly determined by looking at symptoms. But many women want to be well-informed and prepared before they contact healthcare providers.
But if you want some kind of indication before you seek care, you can test yourself using a test that measures the follicle stimulating hormone (FSH) levels that increase during the time approaching menopause.
“Just remember that this provides a snapshot of a woman’s FSH levels only for that particular moment,” says Nina Summerfeld.
Which is why it is recommended to test yourself at least two times and complement that with something like RFSU’s digital self-test for menopause (in Swedish), above all to get an indication if the problems you are experiencing are related to hormones.
Photo: Noonakliniken
“It’s extremely important to include a woman’s symptoms to get the full picture,” says Nina Sommerfeld. “The more indicators, the better. It’s about putting together the pieces to understand the hormonal processes the woman in question is undergoing.”
Read more about menopause symptoms to look out for.
You should never hesitate to seek care if you feel bad. Help is available. Nina Sommerfeld, specialist in obstetrics and gynecology
In some cases, simply making a few lifestyle changes can help you feel a little better, says Nina Sommerfeld. Later down the road can come actual hormone treatment. It depends on the woman herself, if she has a medical condition where she should not take estrogen supplements, or how much difficulty she is experiencing.
Only two of three women seek care for menopause-related problems
Despite half of women (53 percent) who took part in the Menopause Check 2024 reporting that menopause symptoms had a big effect on their daily lives, more than a third (37 percent) have not sought help for their problems.
“You should never hesitate to seek care if you feel bad. Help is available,” says Nina Sommerfeld.
Read more about what happens to the body during menopause.
Nina Sommerfeld agrees with Katarina Wilk that there is confusion about the term perimenopause, but points out that what’s most important is not what you call it.
“Above all, it’s important that women feel as if they are being listened to and are heard when it comes to their problems.”
