You are not sleeping well. Your periods have become unpredictable. You snap at your partner, then find yourself crying twenty minutes later. And you start to wonder if this is just stress or ageing, or whether it could be hormonal.
If that sounds familiar, you are not alone. Many women go months or even years feeling unlike themselves before anyone mentions the word perimenopause. This guide is here to help you recognise the signs, understand what is happening in your body, and know what support is available.
What is perimenopause, exactly?
Perimenopause is the transition phase before menopause. It’s when your ovaries start producing less oestrogen and progesterone, leading to hormonal ups and downs that can cause a wide range of symptoms. This phase can last anywhere from 4 to 8 years, and sometimes even shorter or up to 10 years[1,2,3].
Menopause itself is just one day—when you’ve gone 12 months without a period. Everything before that? That’s perimenopause[1,4].What are the first and most common signs you could be in perimenopause?The first signs of perimenopause can be subtle or feel like a complete system shake-up. Here are some of the most common:
- Changes to your periods: Your cycles may shorten or lengthen, and bleeding may become heavier or lighter—or your periods might not change at all. Hormonal fluctuations can begin even while your periods remain steady; if you’re experiencing other symptoms like hot flushes, sleep issues, or mood swings, you could still be in perimenopause[4,5].
- Sleep disruption: Difficulty falling asleep or staying asleep, even when you are not feeling stressed.
- Mood changes: Increased anxiety, low mood, irritability, or feeling emotionally out of control.
- Hot flushes and night sweats: Very common during hormonal fluctuations as oestrogen levels change.
- Brain fog: Forgetfulness, difficulty concentrating, or a sense of mental fuzziness.
- Physical changes: Breast tenderness, bloating, joint pain, dry skin, and vaginal dryness.
- Reduced libido: A noticeable drop in interest in or enjoyment of sex.
These symptoms are often overlooked or dismissed as stress or other life pressures[5,6].
When does perimenopause usually start?
Most women begin perimenopause in their mid to late forties, around age 47 on average, but it can start earlier, even in the late thirties[4,6]. Smoking, chemotherapy, being underweight, or having a family history of early menopause can contribute to earlier onset[7,8].
Is there a test for perimenopause?
There is no single definitive test. Blood tests for hormones like follicle-stimulating hormone (FSH) or oestrogen fluctuate too much during perimenopause to be reliable for diagnosis. Instead, healthcare professionals focus on:
- Your age and menstrual history
- The pattern and severity of your symptoms
- Any relevant medical or family history
Testing may be considered if you are aged 40–45 with symptoms and menstrual changes, or if you are under 40 and premature ovarian insufficiency is suspected[1,2,3].
What can help?
There is no single solution, but there is support. Depending on your symptoms, options may include:
- Lifestyle changes such as improving sleep hygiene, reducing alcohol or caffeine, and managing stress
- Nutritional support including calcium and vitamin D for bone health
- Non-hormonal treatments such as cognitive behavioural therapy for mood or vaginal moisturisers for dryness
- HRT (hormone replacement therapy) which can ease many symptoms and protect long-term health depending on your risk profile[13,14]
You are not imagining it
Many women feel confused, dismissed, or even gaslit about what they are going through. If you are reading this and thinking, "This is me," that is a sign in itself.
Perimenopause is real. You deserve care that listens, informs, and takes action. If you are not sure what you are going through, you are not alone. Our clinicians specialise in this stage of life, and we are here to help you make sense of it.
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