Perimenopause: taking care of yourself as change begins

Menopause is the name for your last period. The few years before it, perimenopause, are the time of greatest change for many women. Symptoms can creep in quietly and are often brushed off as stress, tiredness or "getting older". Yet recognising this phase is the first step to protecting your quality of life.

When does it start?

• Changes before menopause start on average around age 40. Perimenopause usually begins in your mid-forties, sometimes earlier. Periods become irregular, and the first hot flushes can appear while you are still bleeding.
• The average age of menopause is around 51.
• Menopause is determined in hindsight: if you have had no period for 12 months, you are considered to be in menopause.
• If before age 40 your periods become irregular or stop, be sure to see a doctor. This can be a sign of early menopause and needs to be looked at separately.

What might you feel?

• Changes in your cycle: first shorter or longer cycles, then periods becoming less frequent
• Hot flushes and night sweats
• Sleep problems
• Mood swings, anxiety, irritability
• Difficulty concentrating ("brain fog")
• Joint pain
• Vaginal dryness, changes in sexual desire

You won't necessarily have all of these. More than two thirds of women experience menopausal symptoms, and half of them experience them severely.

Important: You can still get pregnant during perimenopause. Talk to your doctor before stopping contraception.

Do you need a hormone test?

Many women ask for a hormone test to find out "am I in menopause?". But according to the current German guideline, an FSH test is only needed in special cases. Because hormones fluctuate a lot from day to day in perimenopause, a single test doesn't tell you much; the diagnosis is mostly based on symptoms. These tests are often self-pay services (IGeL). Ask about the price in advance.

Treatment options

• Lifestyle: Regular movement, a sleep routine, managing stress. Caffeine and stress can trigger hot flushes.
• Hormone therapy (HRT): When and which treatment to start depends largely on your wishes and symptoms. You need to weigh the benefits and risks together with your doctor.
• Herbal products: Some women find them helpful, especially early on. Some herbal products are not recommended if you have had breast cancer; don't use them without asking your doctor.
• Vaginal dryness: Local treatments can be used for as long as needed.

At work

According to research by Berlin's HWR, there is almost no support for women going through menopause in German workplaces. Yet workplaces that recognise this phase and offer flexibility are very important for women to continue their careers without interruption.

• If symptoms stop you from working, your doctor can give you a sick note (Krankschreibung). The note does not state a diagnosis.
• If your company has an occupational doctor (Betriebsarzt), you can talk to them about things like flexible working or office temperature.

Where to go in Berlin

• Your gynaecologist (Frauenärztin): The first place to go. Not every practice offers in-depth menopause counselling, and statutory health insurance doesn't cover it. According to one gynaecologist, such counselling can cost between 200 and 800 euros. Ask what you will have to pay for when booking.
• FFGZ (Feministisches FrauenGesundheitsZentrum): Has offered independent advice on menopause and women's health afterwards for many years.
• Feministisches Netzwerk für Gesundheit Berlin (pro familia): Works on the topic of menopause in Berlin.
• Deutsche Menopause Gesellschaft: Lists dates for information events on its website.

Practical tips from women

• Note your symptoms. Before seeing a doctor, write down your symptoms and periods for 2–3 months.
• Dress in layers. During a hot flush you can take off the top layer and feel better.
• Talk to close friends. Many women go through the same things, but it's rarely talked about.

This section will grow with the experiences of women in the BACIM community. If something has worked for you, you're welcome to share it.

Sources

• German Menopause Society press kit (PDF)
• Basic information on menopause (Apotheken Umschau)
• Treatment in perimenopause (Gynäkologie 2024, PDF)
• MenoSupport: research on menopause in the workplace (HWR Berlin, PDF)
• Menopause and working life (Berlin House of Representatives, PDF)

This guide is not a substitute for medical advice. Information checked as of October 2026.

Wish I'd known this in German

At the gynaecologist's