Perimenopause is the transitional 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.

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. 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.

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.

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.