What I notice in my conversations with women is how much confusion there is over what is menopause and what is perimenopause and how do you know the difference?

Indeed they can be very similar, but perimenopause is when your body is beginning the very natural transition to menopause itself.

Normally women start menopause in the UK at around 52 years of age, but perimenopause can be noticed long before that and definitely I am hearing about symptoms in women as young as mid-thirties.

It is the changing hormone levels of course that are behind the changes and women are generally the best judges of what is happening in their own bodies, so if you are starting to notice changes it is worth paying attention. It may be perimenopause or something else entirely so knowing what to look for is key.

Key symptom 1 – Irregular periods

These are often the first sign women notice as the hormone changes affect your ovaries: periods can be longer or shorter, or you may miss a few and then go back to your normal pattern for a couple of months, or can become heavier than usual.

If you have no periods for three months or more as well as very heavy periods, particularly if associated with feelings of tiredness or breathlessness, and you are under 40, then discuss this with your doctor.

Key symptom 2 – Putting on weight

This is immediately noticeable, and often the most irritating symptom, particularly if you have not changed anything in your diet or exercise routine.

There are several contributory factors and the main one is the changing balance of our hormones and metabolism as our ability to build muscle slows down and our body starts to shift oestrogen production away from the ovaries and into the fat cells of the stomach, hips and thighs.

Increased stress can increase weight as elevated levels of the stress hormone cortisol can lead to weight gain – unfortunately it goes straight onto your stomach.

Key symptom 3 – Hot flushes

These can come on suddenly and are very common not only at menopause, but also during pregnancy and it’s the same cause – unstable hormone levels.

This is common in perimenopause and they can vary in duration and intensity throughout the day and at night. Triggers can relate to being overweight, alcohol, excess caffeine, certain foods or allergies as well as stress and hormonal fluctuations.

They can be different for every woman so make a note of what sets you off so you can try to reduce that factor, or eliminate it if possible as women can experience flushes from 2-10 years, and even post menopause.

Most flushes respond well to bioidentical progesterone, but if they are severe you may need a combination cream of both progesterone and oestrogen.

Key symptom 4 – Changes in your sleep pattern

This can also indicate perimenopause as sleep is affected by your hormone levels. Progesterone can help relax you if you are having difficulty getting off to sleep, or waking up earlier than usual and are unable to nod off again.

A lack of sleep is also associated with mood swings, anxiety and irritability so find a good bedtime routine that you can maintain as that seems to be a key element in tackling sleeplessness.

Key symptom 5 – Loss of libido

This is very distressing for women, and their partners, and can be a tricky one to get right as so many factors, both physical and emotional, can be involved such as mood changes and lack of sleep.

Progesterone can increase sex drive in women but if you also have vaginal dryness you may find a combination cream of both progesterone and oestrogen more effective.

Key symptom 6 – Muscle and joint aches and pains

Not necessarily an obvious symptom of perimenopause but one you may put down to strain, over exercise or just general tiredness.

Arthritis is associated with these aches and pains as well as to declining hormone levels at perimenopause and menopause. Following an anti-inflammatory diet is very helpful, as is supplementing with progesterone, as that has those properties as well.