Perimenopause means "around menopause" and refers to the time during which your body makes the natural transition to menopause, marking the end of the reproductive years. Perimenopause is also called the menopausal transition.
Women start perimenopause at different ages. You may notice signs of progression toward menopause, such as menstrual irregularity, sometime in your 40s. But some women notice changes as early as their mid-30s.
The level of oestrogen — the main female hormone — in your body rises and falls unevenly during perimenopause. Your menstrual cycles may lengthen or shorten, and you may begin having menstrual cycles in which your ovaries don't release an egg (ovulate). You may also experience menopause-like symptoms, such as hot flashes, sleep problems and vaginal dryness. Treatments are available to help ease these symptoms.
Once you've gone through 12 consecutive months without a menstrual period, you've officially reached menopause, and the perimenopause period is over.
Menopause is when periods stop for good. It's diagnosed after 12 months without a menstrual period, vaginal bleeding or spotting. Menopause can happen in the 40s or 50s.
Menopause is natural. But the physical symptoms, such as hot flashes, and emotional symptoms of menopause may disrupt sleep, lower energy or affect mood.
Some of the symptoms associated with perimenopause carry on into menopause.
Symptoms
Throughout the menopausal transition, some subtle — and some not-so-subtle — changes in your body may take place. You might experience:
- Irregular periods. As ovulation becomes more unpredictable, the length of time between periods may be longer or shorter, your flow may be light to heavy, and you may skip some periods. If you have a persistent change of seven days or more in the length of your menstrual cycle, you may be in early perimenopause. If you have a space of 60 days or more between periods, you're likely in late perimenopause.
- Hot flashes and sleep problems. Hot flashes are common during perimenopause. The intensity, length and frequency vary. Sleep problems are often due to hot flashes or night sweats, but sometimes sleep becomes unpredictable even without them.
- Mood changes. Mood swings, irritability or increased risk of depression may happen during perimenopause. The cause of these symptoms may be sleep disruption associated with hot flashes. Mood changes may also be caused by factors not related to the hormonal changes of perimenopause.
- Vaginal and bladder problems. When oestrogen levels diminish, your vaginal tissues may lose lubrication and elasticity, making intercourse painful. Low oestrogen may also leave you more vulnerable to urinary or vaginal infections. Loss of tissue tone may contribute to urinary incontinence.
- Decreasing fertility.As ovulation becomes irregular, your ability to conceive decreases. However, as long as you're having periods, pregnancy is still possible. If you wish to avoid pregnancy, use birth control until you've had no periods for 12 months.
- Changes in sexual function.During perimenopause, sexual arousal and desire may change. But if you had satisfactory sexual intimacy before menopause, this will likely continue through perimenopause and beyond.
- Loss of bone. With declining oestrogen levels, you start to lose bone more quickly than you replace it, increasing your risk of osteoporosis — a disease that causes fragile bones.
- Changing cholesterol levels. Declining oestrogen levels may lead to unfavourable changes in your blood cholesterol levels, including an increase in low-density lipoprotein (LDL) cholesterol — the "bad" cholesterol — which contributes to an increased risk of heart disease. At the same time, high-density lipoprotein (HDL) cholesterol — the "good" cholesterol — decreases in many women as they age, which also increases the risk of heart disease.
If your symptoms are causing you extreme discomfort, you may consider talking to your doctor or healthcare provider. There are many treatments, from lifestyle changes to hormone therapy that may benefit you.
If your symptoms are mild however, two of the most important nutrients that have been shown in repeated studies to be of benefit are Magnesium and Vitamin B6. Taken together they have been shown to alleviate symptoms commonly associated with Perimenopause as well as menopause.
Magnesium
Best for: sleep, mood, brain fog and hot flushes
Magnesium can help with many women’s health issues including PCOS, PMS and Menopause, especially for those who have taken oral contraceptives which have been proven to affect magnesium levels (1).
This essential micronutrient contributes to many of the body’s processes including bone health, organ function and mood. But the most common reason people take magnesium is to help with poor sleep. This is because magnesium can help to regulate melatonin, which naturally decreases during perimenopause.
Magnesium can also help with anxiety and hot flushes which both impact sleep quality. Studies (1) have shown that women with depressive symptoms had lower magnesium levels compared to those without. Whilst others have also shown it can be beneficial for brain health (2).
You can take magnesium supplements before bed, or increase your intake of magnesium-rich foods such as nuts, bananas, seeds and spinach.
B vitamins
Best for: energy levels, mood, brain function and bone health
B vitamins play a key role in energy production, brain function, and overall well-being - areas that are often impacted during menopause. They help regulate mood, support cognitive function and maintain bone health, making them essential during this stage of life.
Vitamin B6 is particularly beneficial for anxiety, stress and depression (3). It helps produce serotonin, a neurotransmitter that regulates mood, which can fluctuate during menopause. It also supports melatonin production, which has a direct impact on sleep quality (4).
Another important vitamin to consider during menopause is B12, which is vital for red blood cell formation, bone health and nerve function. As we age, our bodies naturally lose some of the ability to absorb B12 and so we become at risk of deficiency, which can lead to anaemia (5). This can cause fatigue, memory issues, depression and cognitive decline, all of which can worsen during menopause.
Boost your B vitamin intake by adding foods like poultry, fish, eggs, dairy, whole grains and fortified cereals in your diet. Those following a plant-based diet may also need to consider supplementation with B12 which is mostly found in meat.
Calcium and Vitamin D
Women going through the perimenopause and menopause, have very often already had one or more pregnancies, often breastfed their babies. Both of these cause enormous drains on a woman’s body stores of calcium. With declining oestrogen levels, you start to lose bone more quickly than you replace it, increasing your risk of osteoporosis — a disease that causes fragile bones.
Make sure you take a suitable Calcium with Vitamin D supplement to give your body the chance to replenish some of your body stores of calcium. See Sona Calcium with Vitamin D3 tablets
Bottom Line
Several studies have shown that a combination of magnesium and vitamin B6 may be useful for alleviating symptoms of premenstrual syndrome. (6)
Magnesium may also be useful for menopause associated headache, anxiety and depression although there is limited evidence from clinical studies. (7) See Sona Magnesium 300 - Magnesium and Vitamin B6 Tablets
Alternatively, you may prefer an easier to take Effervescent tablet – See Sona Magnesium 300mg with Vitamin B6 Effervescent Tablets
References
- Effect of magnesium supplementation on women's health and well-being - ScienceDirect June 2021
- The Effect of Magnesium Deficiency on Neurological Disorders: A Narrative Review Article - PubMed March 2019#
- Vitamin B6: A new approach to lowering anxiety, and depression? - PMC September 2022
- A combination of melatonin, vitamin B6 and medicinal plants in the treatment of mild-to-moderate insomnia: A prospective pilot study - PubMed May 2019
- Vitamin B12 or folate deficiency anaemia - Symptoms - NHS February 2023
- McCabe D, Lisy K, Lockwood C, Colbeck M. The impact of essential fatty acid, B vitamins, vitamin C, magnesium and zinc supplementation on stress levels in women: a systematic review. JBI database of systematic reviews and implementation reports. 2017;15(2):402-53.
- Parazzini F, Di Martino M, Pellegrino P. Magnesium in the gynecological practice: a literature review. Magnesium research. 2017;30(1):1-7.