10 Perimenopause Symptoms: Signs You’re Entering and What to Expect
Perimenopause, also known as the menopausal transition, is the phase leading up to menopause, usually starting in your 40s, though it can begin earlier for some women. This stage can last anywhere from a few years to over a decade, with the average duration being around 4-5 years. Recognising the early signs is essential for managing symptoms and taking steps to support your body. Understanding what’s happening can make this transition smoother, empowering you to make informed choices about your health and well-being.
Although the variety of symptoms you may experience is quite broad, below are the top 10 signs most commonly associated with perimenopause, along with tips on how to manage them.
Understanding Perimenopause
Perimenopause is a natural transition that women experience as they approach menopause. It is a time of hormonal changes that can cause a range of physical and emotional symptoms. During perimenopause, the body starts to produce less estrogen, leading to irregular menstrual cycles, hot flashes, and other symptoms. Perimenopause can start as early as the mid-30s or as late as the mid-50s, and its duration varies from woman to woman. Some women may experience mild symptoms, while others may experience severe symptoms that disrupt their daily lives.
1. Irregular Periods
While period changes are often considered one of the first signs of perimenopause, it’s important to note that this isn’t always the case for every woman. Perimenopause begins with irregular menstrual cycles and concludes a year after the last menstrual period. For many, symptoms like anxiety, mood swings, or sleep disturbances may appear long before any noticeable change in their cycle. However, as estrogen and progesterone levels begin to fluctuate, the ovaries become less predictable, causing shifts in your menstrual cycle. You might notice your periods becoming shorter, longer, heavier, or lighter, and sometimes more unpredictable. For some women, these hormonal changes occur even while their periods remain regular, making it harder to recognise that perimenopause has begun.
These changes are a direct result of your body’s shifting hormonal balance as the ovaries gradually prepare to stop releasing eggs. Every woman’s experience is unique—some may notice dramatic changes in their cycle, while others may continue having regular periods but start experiencing other symptoms like mood swings, anxiety, or sleep disturbances as perimenopause progresses.
2. Hot Flushes
Hot flushes, also known as vasomotor symptoms, are one of the most common signs of perimenopause. While the exact cause is still being researched, it’s widely understood that they occur due to changes in the body’s thermoregulation. As estrogen levels drop, the hypothalamus—the part of your brain responsible for regulating body temperature—becomes more sensitive to even slight changes in body heat. This sensitivity can trigger sudden and intense feelings of warmth, typically in the face, neck, and chest.
These episodes can last anywhere from 30 seconds to several minutes and may be accompanied by sweating, a rapid heartbeat, and a flushed appearance. Hot flushes can vary in frequency, sometimes occurring multiple times a day or even waking you during the night (referred to as night sweats).
3. Night Sweats
Night sweats are similar to hot flushes but occur while you’re sleeping, often disrupting your rest. As with hot flushes, hormonal fluctuations—particularly declining estrogen—cause the hypothalamus, the body’s thermostat, to misfire and perceive a need to cool down. This triggers an intense surge of heat, followed by excessive sweating as your body tries to regulate its temperature.
Many women wake up drenched in sweat, often needing to change clothes or bedding. This sudden temperature drop can leave you feeling cold or even shivering afterward. Repeated episodes throughout the night can significantly disrupt sleep, contributing to fatigue, irritability, and even mood swings the following day. Night sweats are considered one of the most disruptive symptoms of perimenopause because of their impact on sleep quality, which is crucial for our overall well-being.
4. Mood Swings
Mood swings are a common experience during perimenopause, often linked to fluctuations in estrogen and progesterone. These hormonal changes can affect neurotransmitters like serotonin, which helps regulate mood and emotions. When estrogen dips, serotonin levels may drop, leading to feelings of irritability, anger, low mood, or anxiety. Women with a history of depression may feel particularly sensitive to these hormonal shifts. Women with a history of major depressive disorder are particularly vulnerable to developing depressive symptoms during perimenopause.
5. Fatigue
Persistent tiredness and feeling sluggish are common hallmarks of perimenopause. This fatigue often results from a combination of disrupted sleep—due to night sweats, frequent waking, insomnia, or hormonal changes—along with declining estrogen levels that affect energy regulation. Many women report feeling constantly tired, even after a full night’s sleep, making it harder to stay active and energised throughout the day.
Managing menopausal symptoms through lifestyle changes and treatments can help alleviate fatigue.
6. Vaginal Dryness
Estrogen plays a crucial role in maintaining vaginal health by keeping the tissue lubricated, elastic, and resilient. As estrogen levels drop during perimenopause, the vaginal walls can become thinner and less lubricated, leading to dryness and discomfort. For some women, this can cause pain during sex, as well as irritation or sensitivity during basic daily activities such as walking, sitting, or exercising.
While this symptom can be uncomfortable, it's important to know that effective treatments are available. Options such as vaginal moisturisers, lubricants, and prescribed medications can help relieve dryness and improve comfort.
7. Weight Gain
During perimenopause, many women notice weight gain, particularly around the abdomen. This occurs because declining estrogen levels affect how fat is distributed in the body, leading to an increase in abdominal fat. Estrogen also plays a role in regulating metabolism, and as its levels drop, the body's ability to burn calories efficiently decreases. Additionally, reduced muscle mass and changes in insulin sensitivity can further contribute to weight gain, making it harder to maintain or lose weight during this stage.
8. Trouble Sleeping
Sleep disturbances are very common during perimenopause. Difficulty falling or staying asleep can be caused by physical symptoms like night sweats or restless legs, as well as emotional symptoms such as anxiety. Hormonal changes, particularly the decline in estrogen, also affect the production of melatonin—the hormone responsible for regulating sleep—making it harder to get a full, restful, deep night's sleep.
9. Low Libido
A decrease in sexual desire is often tied to hormonal changes, particularly lower levels of estrogen and testosterone. These hormonal shifts can influence both physical arousal and emotional well-being. In addition to physical discomfort from vaginal dryness, symptoms like low mood, anxiety, stress, and fatigue can further diminish libido. Addressing both the physical and emotional aspects—whether through treatments or lifestyle adjustments—can help manage this symptom and improve overall sexual health.
10. Memory Lapses or Brain Fog
Cognitive changes, often referred to as “brain fog,” are a common issue during perimenopause. Fluctuating estrogen levels can disrupt key brain functions, affecting memory, concentration, and overall mental clarity. Estrogen plays a vital role in regulating neurotransmitters, such as serotonin and dopamine, which support cognitive function. As estrogen levels decline, the brain may become less efficient at processing information, leading to difficulties with memory recall, focus, and mental sharpness.
This symptom can be exacerbated by other factors that are also common during perimenopause, including disrupted sleep, fatigue, and elevated stress levels. These combined effects can make it difficult for many women to stay mentally sharp, perform daily tasks, or remember details, contributing to the sense of “fog” or mental sluggishness. Recognizing perimenopausal symptoms and seeking medical attention can help manage cognitive changes.
Causes and Risk Factors
Perimenopause is caused by the decline in estrogen levels as the ovaries start to produce fewer eggs. This decline can be triggered by a range of factors, including genetics, lifestyle factors such as smoking and obesity, and medical conditions such as polycystic ovary syndrome (PCOS). Women who have a family history of early menopause or who have had a hysterectomy or pelvic surgery may also be at risk of experiencing perimenopause earlier. Additionally, women who are underweight or have a low body mass index (BMI) may experience perimenopause earlier than women who are at a healthy weight.
Complications and Health Risks
Perimenopause can increase the risk of a range of health complications, including osteoporosis, cardiovascular disease, and depression. Women who experience severe symptoms of perimenopause, such as hot flashes and night sweats, may also be at risk of sleep disturbances and fatigue. Additionally, perimenopause can increase the risk of vaginal dryness and painful sex, which can affect a woman’s quality of life. Women who experience perimenopause earlier than average may also be at risk of premature menopause, which can increase the risk of osteoporosis and cardiovascular disease.
When to Seek Medical Advice
Women who experience symptoms of perimenopause should seek medical attention if their symptoms are severe or disrupt their daily lives. Women who experience heavy bleeding, pelvic pain, or difficulty getting pregnant should also seek medical attention. Additionally, women who experience symptoms of depression or anxiety should seek medical attention, as these conditions can be treated with hormone therapy or other medications. Women who are under 45 years old and experience symptoms of perimenopause should also seek medical attention, as they may require FSH testing to confirm the diagnosis.
What You Can Do
1. Stay active
While these symptoms may seem overwhelming, there are plenty of ways to support your body through perimenopause. Staying active is key—whether it's walking, yoga, or resistance training, regular movement helps maintain a healthy metabolism, supports bone density, and boosts mood. Managing stress is also essential; try incorporating practices like meditation or deep breathing, which can work wonders for reducing anxiety and improving sleep.
2. Nourish your body
Diet plays a huge role in how you feel. Focus on nutrient-dense, whole foods rich in vitamins and minerals, such as leafy greens, lean proteins, and healthy fats like omega-3s. Omega-3-rich foods include fatty fish like salmon, mackerel, and sardines, as well as plant-based sources such as chia seeds and flaxseeds. However, even if you're incorporating these foods into your diet, an omega-3 supplement can be beneficial to ensure you're getting adequate amounts, especially during perimenopause when these fats support heart, brain, and joint health. Supplements like Vitamin D and calcium are also particularly important to support bone health and overall well-being during this phase.
3. Consider supplementing
Modern diets often lack sufficient vitamins and nutrients, especially with today’s processed foods and nutrient-depleted soil. Stress, a common companion of perimenopause and menopause, can also quickly deplete vital nutrients, making it hard to get everything you need from diet alone. This is where supplementing can make a real difference. By filling any nutritional gaps, supplements containing vitamins, minerals, nutrients, and plant actives—such as phytoestrogens, adaptogens, and antioxidants—can help ease symptoms and support healthy hormonal balance and overall vitality during perimenopause.
4. Explore treatment options
If your symptoms are significantly interfering with your quality of life, it may be time to explore treatment options with a healthcare provider or menopause specialist. Options like hormone replacement therapy (HRT) or other prescribed treatments can provide much-needed relief. Remember, you don’t have to “grin and bear it”—solutions are available, so be proactive in seeking help. Your well-being matters, and there are plenty of ways to improve how you feel during this transition.
