Feeling hot at night, anxious for no reason, or like your periods have a mind of their own? You might be in perimenopause. It’s one of the most searched health topics for women in their 40s, and yet so many of us are never told what to expect.
In short: perimenopause is the transition before menopause, when your hormones start to fluctuate. It usually begins in your 40s and can bring changes to your periods, sleep, mood, body temperature, weight and energy. Symptoms are common and very treatable, so you don’t have to just put up with them.
What is perimenopause?
Perimenopause means “around menopause”. It’s the stage when your ovaries gradually produce less oestrogen and progesterone, and levels rise and fall unpredictably from month to month. It ends at menopause, which is defined as 12 months in a row without a period. Read more in our guide: When does perimenopause start?
The 17 most common perimenopause symptoms
Every woman’s experience is different. You may notice just one or two of these, or many of them.
Changes to your periods
- 1. Irregular periods: cycles that get shorter, longer or unpredictable are often the first sign.
- 2. Heavier or lighter bleeding: some months may be much heavier than you’re used to.
- 3. Worse PMS: breast tenderness, bloating and mood swings before a period can become more noticeable.
Body temperature and sleep
- 4. Hot flushes: sudden waves of heat in your face, neck and chest, sometimes with redness and sweating.
- 5. Night sweats: waking up hot and damp, sometimes needing to change your clothes.
- 6. Trouble sleeping: difficulty falling asleep or waking at 3 or 4am, even without night sweats.
- 7. Tiredness: poor sleep and hormonal changes can leave you exhausted.
Mood and mind
- 8. Anxiety: new or stronger feelings of worry, sometimes with a racing heart.
- 9. Low mood and irritability: feeling flat, tearful or short-tempered.
- 10. Brain fog: forgetting words, losing your train of thought or finding it harder to concentrate.
Body changes
- 11. Weight gain around the middle: fat storage tends to shift towards the tummy. See what helps with perimenopause weight gain.
- 12. Loss of muscle and strength: everyday tasks can start to feel harder.
- 13. Joint and muscle aches: stiffness, especially in the morning.
- 14. Headaches: some women notice more frequent or stronger headaches or migraines.
- 15. Heart palpitations: an awareness of your heartbeat. Always get new palpitations checked by a doctor.
Intimate and bladder health
- 16. Vaginal dryness and lower libido: discomfort during sex and less interest in it.
- 17. Bladder changes: needing to pee more often, or more urinary infections.
Other symptoms women often report include dry or itchy skin, thinning hair, dizziness and tingling in the hands or feet.
How do you know it’s perimenopause?
If you’re over 45 and have typical symptoms, a doctor can usually tell you’re in perimenopause from your symptoms and your periods alone. Hormone blood tests aren’t always helpful, because levels change so much from day to day. If you’re under 45, your doctor may suggest tests to rule out other causes, such as thyroid problems or anaemia.
A simple trick: keep a symptom diary for two or three months. Note your periods, sleep, mood and hot flushes. It makes the conversation with your doctor much easier.
What helps with perimenopause symptoms?
Talk to your doctor about treatment
Hormone replacement therapy (HRT), also called menopausal hormone therapy, is the most effective treatment for hot flushes and night sweats, and it can help with sleep, mood and joint aches too. It isn’t right for everyone, so talk through the benefits and risks with your doctor. There are also non-hormonal medicines and local treatments for vaginal dryness.
Strength train twice a week
Strength training helps protect muscle and bone, supports a healthy weight and is great for mood and sleep. Start with our gentle beginner’s guide.
Eat enough protein
Aim for roughly 25–35 g of protein at each meal to protect your muscles. Here’s how much protein women over 40 need, plus high-protein breakfast ideas.
Walk every day
Daily walks support your heart, mood, sleep and weight. Our 30-day walking plan is a gentle place to start.
Protect your sleep
Keep your bedroom cool, wear light layers, keep a regular bedtime and limit caffeine after midday and alcohol in the evening.
Look after your mind
Cognitive behavioural therapy (CBT) has good evidence for helping with hot flushes, sleep and low mood during this stage. Talking to friends who are going through the same thing helps, too.
When to see a doctor
See your doctor if your symptoms are affecting your daily life, and always get checked if you have:
- Very heavy periods, or bleeding that lasts much longer than usual
- Periods closer together than every three weeks
- Bleeding between periods or after sex
- New heart palpitations, chest pain or shortness of breath
- Low mood that won’t lift, or any thoughts of harming yourself
Frequently asked questions
Can perimenopause start in your 30s?
Yes. For most women it starts in their 40s, but some notice changes in their late 30s.
How long do perimenopause symptoms last?
Perimenopause lasts about four years on average, but it can be shorter or as long as ten years. Some symptoms, such as hot flushes, can continue for a few years after menopause.
Can I still get pregnant during perimenopause?
Yes. You can still ovulate, so use contraception until your doctor says it’s safe to stop.
The bottom line
Perimenopause is a normal stage of life, but that doesn’t mean you have to struggle through it. Track your symptoms, talk to your doctor and build simple habits around strength, protein, movement and rest. If you’d like a gentle place to start, download our free Fit After 40 Starter Kit.
This article is for general information only and isn’t medical advice. Please speak to your doctor about your own symptoms.
