Perimenopause is a process leading up to the menopause when a woman's sex hormone levels begin to decline and fluctuate and menopausal symptoms can be experienced before periods stop altogether. Women have actually gone through their menopause when they have not had a period for 12 months, so it is a retrospective diagnosis. During perimenopause, ovarian output of oestrogen and progesterone begins to decline. However, the levels of these hormones, (as well as testosterone), can fluctuate in quite an erratic manner rather than in a smooth and gradual descent and can become out of balance relative to one another. This means that symptoms can vary from month to month and every woman's experience will be different depending on factors such as genetics, nutritional deficiencies, stress, gut health and lifestyle. There are some women who can continue to have regular periods even though they experience numerous symptoms of the menopause. However for some, periods may become a little shorter, longer, heavier or lighter than they have in the past. The average age of the menopause – when periods have stopped for a year – is 51, and the perimenopause can last for a number of years. So it often starts in the early or mid 40s. However, 1 in a 100 women will have the menopause before the age of 40 so it could start in the 30s for a few. Some women make all the hormones they need from their own adrenals and ovaries and they can sail through the process. However many women enter perimenopause exhausted from stressful lives, careers, over-giving to children and/or parents, chronic sleep deprivation, and nutritional deficiencies. Their bodies can often lack the raw materials required to produce adequate hormones. The one size fits all approach does not work as every woman is different - for some focusing on personalised nutritional therapy, lifestyle changes and support can have a huge impact. For others, in addition to looking after their health, they may need extra hormonal support in the form of body-identical HRT. Speaking to a menopause specialist is key so that you can be informed of all options available and suitable for you.