Perimenopause: the years before your last period

Perimenopause vs menopause

Perimenopause is the transition phase, when oestrogen and progesterone rise and fall unpredictably. Menopause is a single point in time — confirmed once you have gone 12 months without a period. Everything after that is postmenopause. Many Indian women reach menopause in their mid-to-late 40s, which means perimenopausal symptoms can start in the early 40s or even the late 30s.

Common symptoms

• Periods becoming irregular, heavier, lighter, closer together or further apart
• Hot flushes and night sweats
• Difficulty falling or staying asleep
• Anxiety, irritability, low mood or feeling "not like yourself"
• Brain fog and poor concentration
• Joint and muscle aches
• Vaginal dryness, discomfort during sex and bladder changes
• Changes in weight distribution and body composition

What actually helps

• Menopausal hormone therapy (MHT) — the most effective treatment for hot flushes and night sweats for many women. Whether it is right for you depends on your age, symptoms and personal and family history; your gynaecologist will explain benefits and risks individually.
• Non-hormonal medicines — options exist for women who cannot or prefer not to use hormones.
• Vaginal treatments — for dryness and discomfort.
• Strength training — helps protect bone density and muscle mass, which decline after menopause.
• Nutrition — adequate protein, calcium and vitamin D, and heart-healthy eating.
• Sleep and mood support — structured psychological approaches can reduce the impact of hot flushes, poor sleep and anxiety.

Protecting your long-term health

Falling oestrogen affects more than symptoms: bone density and cardiovascular risk change after menopause. Midlife is the right time to review blood pressure, cholesterol, blood sugar and bone health, and to build habits that protect your independence for decades. Our Menopause Care Plan brings together a gynaecologist, dietician, physiotherapist and psychologist to do exactly that.

Written by the Narika clinical team. Last reviewed 28 September 2026. This guide is general education; your Narika doctor will tailor advice to you. If you have severe or sudden symptoms, go to the nearest emergency department first — our team will support your follow-up care.