Perimenopause and menopause, explained

What happens in your body

From your early forties, the ovaries slowly produce less oestrogen and progesterone. This does not happen in a straight line. For several years the levels can go up and down from month to month, which is why periods often become irregular and why symptoms can come and go.

Doctors use three terms for this stage:

• Perimenopause: the years before your last period, up to one year after it. This is when most symptoms start.
• Menopause: your very last period. You only know it afterwards, once you have had no period for 12 months.
• Postmenopause: the years from one year after your last period.

In the Netherlands, the average age at menopause is 50 to 51. About 2 in 100 women reach it before the age of 40. The transition usually takes 3 to 7 years, and for some women longer. In Dutch this whole period is called de overgang.

Common symptoms

About 80% of women notice symptoms during the transition. For some they are mild, for others they affect sleep, work and relationships. The most common:

• Changes in your periods. Often the first sign: cycles become shorter or longer, bleeding heavier or lighter, and periods are sometimes skipped.
• Hot flushes and night sweats. A sudden feeling of heat in the face, neck and chest, often with redness, sweating and a faster heartbeat. A flush usually lasts 3 to 5 minutes. Some women have a few a month, others several an hour. They are most frequent in the first year after the last period and usually continue for 3 to 7 years. At night they are called night sweats.
• Sleeping badly, sometimes because of night sweats, sometimes without a clear reason.
• Mood changes. Feeling low, irritable or anxious. The risk of depression is 2 to 5 times higher during the perimenopause and the first years after.
• Forgetfulness and trouble concentrating. About 6 in 10 women in midlife report this.
• Joint and muscle pain. Up to half of women report it around menopause.
• Vaginal dryness, itching or pain during sex. This affects about 15% of women in the perimenopause and 30% after menopause, and it tends to stay unless treated.
• Headaches, palpitations, and changes in weight and where fat is stored.

Not every symptom at this age is caused by hormones. For joint pain, low mood and forgetfulness, the Dutch GP guideline notes that the link with menopause is not fully clear. Stress, sleep, work and caring for others also play a part. That is one reason it helps to keep track of what you notice and when.

What changes in the longer term

Most symptoms pass. Two changes do not, and they are worth knowing about because you can do something about them.

• Bones. Bone density starts to decrease a few years before your last period and continues afterwards. This raises the risk of osteoporosis and fractures later in life.
• Heart and blood vessels. The risk of cardiovascular disease rises after menopause.

Most women spend at least a third of their life after menopause. Muscle- and bone-strengthening exercise, not smoking, enough vitamin D and calcium, and keeping an eye on blood pressure all matter more from this point on. The Dutch Health Council advises women aged 50 to 70 to take 10 micrograms of extra vitamin D a day, and everyone over 70 to take 20 micrograms. Read more in Vitamin D after 50 and on our page about strength, bones and balance.

What helps

Knowing your pattern

Writing down your symptoms for a few weeks shows how often they happen, how much they bother you and whether they change with your cycle, sleep or stress. It also makes a GP appointment more useful. Our symptom diary takes a minute a day and can be printed for your GP.

Hot flushes and night sweats

• Practical things many women find useful: dressing in layers, a cooler bedroom, a fan, and noticing what seems to set flushes off for you, such as alcohol, hot drinks or spicy food.
• Cognitive behavioural therapy and other stress-reducing approaches, such as mindfulness, reduce hot flushes. In studies, women who had about 8 flushes a day had about 3 fewer.
• Hormone therapy is the most effective treatment for hot flushes and night sweats. Like any medicine it has benefits and risks, and these depend on your age, your health and how long you use it. Your GP can go through them with you.
• The Dutch GP guideline does not recommend black cohosh or phytoestrogens such as soy or red clover extracts, because trials have not shown that they reduce symptoms. For black cohosh there are also reports of liver damage.

Exercise and weight

Regular exercise and a healthy weight are good for your heart, bones, muscles and mood. Research has not shown that they reduce hot flushes themselves, so do not judge an exercise routine by that. The reasons to keep moving are the longer-term ones above.

Vaginal dryness

A moisturising gel or a cream with hyaluronic acid can help, though the effect is short. If it does not help enough, your GP can prescribe a local treatment.

At work

Symptoms can affect concentration, sleep and energy at work. Dutch occupational physicians have their own guideline on menopause and work, published in 2026. If symptoms affect your work, you can make an appointment with the occupational physician (bedrijfsarts) without going through your manager.

When to see your GP

You do not need a reason beyond "this bothers me". Make an appointment if:

• symptoms affect your sleep, work, mood or relationships;
• you bleed again after 12 months without a period. Always have this checked;
• your periods are very heavy, last much longer than usual, or you bleed between periods or after sex;
• your periods stop before you are 40;
• you have felt low or anxious most days for several weeks;
• you have questions about contraception. You can still become pregnant during the perimenopause, so ask your GP how long to keep using it.

Before the appointment, write down your main symptoms, how long you have had them, the date of your last period and any medication or supplements you take. Bring your symptom diary if you keep one.

How Japan talks about it

Nami means "wave" in Japanese, and part of why we chose the name is the way Japan describes this stage. The Japanese word is kōnenki, loosely translated as a season of renewal. It covers a longer period of midlife change, much like puberty at the other end, rather than a single moment or a medical problem.

In the 1980s the anthropologist Margaret Lock compared more than 1,200 Japanese women aged 45 to 55 with large groups of women in the United States and Canada. Japanese women reported hot flushes and night sweats significantly less often. Researchers also found that language plays a role: Japanese has several words for different kinds of heat sensations, where English and Dutch have one. Diet, culture and how questions are asked all seem to contribute, and the differences are still being studied.

Read more in our journal: Kōnenki: how Japan talks about menopause and Eating the Japanese way.

Sources

• NHG-Standaard De overgang (2022), summarised in Wiersma T, Van den Donk M, De Vries C. Huisarts en Wetenschap, 2022.
• NVAB, Richtlijn Overgang en werk (2026).
• Thuisarts.nl, Overgang.
• Gezondheidsraad, advice on vitamin D (2012) and Beweegrichtlijnen (2017).
• Lock M. Menopause: lessons from anthropology. Psychosomatic Medicine, 1998;60(4):410–419.
• University of Delaware, interview with anthropologist Melissa Melby (2025).