Category: Perimenopause

Do you fall asleep easily, only to wake at 3 AM wide awake, too hot or with your mind racing? You’re far from alone. Sleep problems are one of the most common complaints during perimenopause and menopause.

In short: hormonal changes, night sweats and stress can all disturb sleep in midlife. A cool bedroom, a regular sleep schedule, less caffeine and alcohol, and getting up if you can’t sleep all help. If night sweats or insomnia continue, talk to your doctor, as effective treatments are available.

Why menopause affects your sleep

• Night sweats: sudden heat can wake you, often several times a night. Read more about hot flashes and how to find relief.
• Falling progesterone: progesterone has a calming effect, so lower levels can make sleep lighter.
• Anxiety and racing thoughts: common in perimenopause. See perimenopause anxiety: what helps.
• Needing the toilet more often at night.
• Snoring and sleep apnoea, which become more common after menopause.

Why 3 AM?

Sleep naturally gets lighter in the second half of the night. If you’re also dealing with night sweats, stress or a busy mind, it’s much easier to wake fully at this point and struggle to drift off again.

10 ways to sleep better

Make your bedroom work for you

• Keep it cool: around 16–19°C (60–67°F), with a fan near the bed.
• Use light, layered bedding and breathable cotton or bamboo pyjamas.
• Make it dark and quiet: blackout curtains or an eye mask can help.

Build a calm routine

• Go to bed and get up at the same time every day, even at weekends.
• Wind down for 30–60 minutes: dim the lights, read, stretch or take a warm (not hot) shower.
• Put your phone away or out of reach.

Watch what you eat and drink

• No caffeine after midday.
• Skip the evening wine: alcohol can trigger night sweats and wakes you later in the night.
• Avoid big, spicy meals close to bedtime.

If you wake in the night

• Don’t lie there for hours. If you’re awake for more than about 20 minutes, get up, sit somewhere dim and do something calm until you feel sleepy again.
• Try slow breathing: in for 4 counts, out for 6.
• Keep a notebook by the bed to write down worries or to-do lists.

Move during the day

Daily walks, especially in morning daylight, and regular strength training can help you sleep more deeply. Try our 30-day walking plan and 4-week weight training plan. Finish intense workouts a few hours before bed.

What about supplements?

Magnesium is popular for sleep. The evidence is limited, but it’s generally safe at normal doses. Read our honest guide to menopause supplements before you buy.

When to see your doctor

Talk to your doctor if poor sleep is affecting your days, or if you snore loudly, stop breathing during sleep or wake gasping. Treatments that can help include:

• HRT, which is very effective for night sweats and can improve sleep.
• CBT for insomnia (CBT-I), the recommended first treatment for long-term insomnia.
• Checking for sleep apnoea and other conditions.

Frequently asked questions

Why do I wake up hot at night in my 40s?

Night sweats are a common perimenopause symptom caused by hormonal changes affecting your body’s temperature control.

Does menopause insomnia go away?

For many women sleep improves after the menopause transition, but it doesn’t have to wait. The habits above and medical treatment can help now.

Is it OK to take sleeping pills?

Sleeping pills are usually only recommended for short periods. Talk to your doctor about longer-term options such as CBT-I or treating night sweats.

The bottom line

Better sleep in menopause usually comes from small changes added together: a cool room, a steady routine, less caffeine and alcohol, daily movement and the right medical support when you need it. For simple habit tracking, 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 ongoing sleep problems.

If you’ve never been an anxious person and suddenly feel on edge, wake with a racing heart or worry about things that never bothered you before, you’re not imagining it. Anxiety is a common, and often overlooked, symptom of perimenopause.

In short: falling and fluctuating hormones can affect the brain chemicals that regulate mood. Simple daily habits like slow breathing, exercise, good sleep and less caffeine and alcohol can help, and so can treatment. Talk to your doctor if anxiety is affecting your life.

Why perimenopause can cause anxiety

During perimenopause, oestrogen and progesterone rise and fall unpredictably. These hormones influence brain chemicals such as serotonin and GABA, which help keep your mood steady and calm. When they fluctuate, many women feel more anxious, irritable or low.

Other perimenopause symptoms can add to it: poor sleep, hot flashes, night sweats and a busy midlife full of work, family and caring responsibilities.

Signs it might be perimenopause anxiety

• New or stronger feelings of worry or dread, often without a clear reason
• A racing or pounding heart
• Feeling irritable, tense or on edge
• Trouble switching off at night, or waking at 3 or 4am with your mind racing
• Anxiety that gets worse before your period
• Changes in your cycle at the same time

Always get new heart palpitations or chest symptoms checked by a doctor, to rule out other causes.

7 things that help

1. Slow, deep breathing

When anxiety rises, breathe in slowly through your nose for 4 counts and out for 6. A few minutes can calm your nervous system and ease a racing heart.

2. Move every day

Regular exercise is one of the best natural mood lifters. A brisk daily walk is a great start. Try our 30-day walking plan.

3. Strength training

Lifting weights two or three times a week supports your mood, sleep and confidence, as well as your muscles and bones. Our 4-week weight training plan keeps it simple.

4. Cut back on caffeine

Caffeine can trigger a racing heart and jittery feelings, especially when hormones are fluctuating. Try switching to decaf after your first cup and avoid caffeine after midday.

5. Go easy on alcohol

A glass of wine may feel relaxing, but alcohol can worsen anxiety the next day and disrupt sleep.

6. Protect your sleep

Poor sleep and anxiety feed each other. A cool bedroom, a regular bedtime and a wind-down routine can help. Read our guide to sleeping better in menopause.

7. Talk to your doctor

You don’t have to cope alone. Treatment options include HRT, which can help mood symptoms in perimenopause for some women, cognitive behavioural therapy (CBT) and other medicines. Your doctor can help you decide what’s right for you.

Eat to support your mood

Regular meals with protein, fibre and healthy fats help keep your blood sugar, and your energy, steady. Skipping meals can make anxiety worse. Our menopause diet guide shows you how.

When to get help urgently

If you feel overwhelmed, can’t cope with daily life, or have thoughts of harming yourself, please reach out for help straight away. Contact your doctor, call your local emergency number, or contact a crisis line: in the US, call or text 988; in the UK, call Samaritans on 116 123.

Frequently asked questions

Can perimenopause cause anxiety even if I’ve never had it before?

Yes. Many women experience anxiety for the first time in their 40s, and hormonal changes are often part of the reason.

Does perimenopause anxiety go away?

For many women it eases after menopause, when hormones settle. In the meantime, lifestyle changes and treatment can make a big difference.

Can HRT help with anxiety?

It can help some women with mood symptoms during perimenopause, especially when they come with hot flashes and poor sleep. Talk through the options with your doctor.

The bottom line

Perimenopause anxiety is real, common and treatable. Be gentle with yourself, build small calming habits into your day and don’t hesitate to ask for support. For simple daily habits, 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 symptoms.

One minute you’re fine, the next a wave of heat rushes up your chest and face, your heart races and you’re desperate to open a window. Hot flashes (also called hot flushes) are the most common symptom of perimenopause and menopause, and they can be exhausting, especially at night.

In short: hot flashes are caused by hormonal changes that make your body’s “thermostat” more sensitive. Simple changes like keeping cool, avoiding your triggers and slow breathing can help, and there are effective medical treatments, including HRT and newer non-hormonal medicines. You don’t have to just put up with them.

What is a hot flash?

A hot flash is a sudden feeling of intense heat, usually in your face, neck and chest. It often comes with flushed skin, sweating and a fast heartbeat, and can be followed by chills as your body cools down. Most last from 30 seconds to a few minutes. When they happen during sleep, they’re called night sweats.

What causes hot flashes?

As oestrogen levels fall and fluctuate during perimenopause, the part of your brain that controls body temperature (the hypothalamus) becomes more sensitive. Even a tiny rise in temperature can make it think you’re overheating, so it rapidly tries to cool you down by widening blood vessels and making you sweat.

How long do hot flashes last?

Most women experience hot flashes at some point around menopause. They usually start in perimenopause and, for many women, continue for several years. Research suggests the average is around seven years, and some women have them for longer. Everyone is different, which is why it’s worth finding relief rather than waiting it out.

Common hot flash triggers

Keeping a simple diary for a couple of weeks can help you spot your personal triggers. The most common ones are:

• Alcohol, especially red wine
• Caffeine
• Spicy food and hot drinks
• Warm rooms, hot showers and heavy bedding
• Stress and anxiety
• Smoking
• Tight or synthetic clothing

12 ways to find relief

Everyday cooling tricks

• 1. Dress in layers of breathable cotton, linen or bamboo so you can quickly take one off.
• 2. Keep cool water close and sip it when you feel a flash starting.
• 3. Carry a small fan or a cooling face mist in your bag.
• 4. Lower the temperature at home and at work where you can.

Natural remedies for hot flashes at night

• 5. Keep your bedroom cool, around 16–19°C (60–67°F), with a fan near your bed.
• 6. Choose light, layered bedding and moisture-wicking pyjamas so you can adjust quickly.
• 7. Try a cooling pillow or flip your pillow to the cool side.
• 8. Avoid alcohol, caffeine and big, spicy meals in the evening.

Mind and body

• 9. Paced breathing: when a flash starts, breathe slowly and deeply, about six breaths a minute. Many women find it helps them feel calmer and more in control.
• 10. Cognitive behavioural therapy (CBT): there is good evidence that CBT can reduce how much hot flashes bother you and improve sleep.
• 11. Move your body: regular exercise supports sleep, mood and a healthy weight, and many women find hot flashes easier to cope with when they’re fitter. Try our 30-day walking plan.

Medical treatment

• 12. Talk to your doctor: hormone replacement therapy (HRT) is the most effective treatment for hot flashes and night sweats. If HRT isn’t right for you, there are non-hormonal prescription options, including certain antidepressants in low doses, gabapentin and newer medicines designed specifically for hot flashes. Your doctor can help you weigh the benefits and risks.

What about supplements?

Many supplements are marketed for hot flashes, such as black cohosh, evening primrose oil and red clover, but the evidence that they work is weak or mixed. Some foods containing soy may help a little for some women. Always check with your doctor or pharmacist before taking a supplement, because some can interact with medicines.

When to see a doctor

Book an appointment if hot flashes are affecting your sleep, work or wellbeing, or if you have night sweats along with unexplained weight loss, fever or other new symptoms, as these can have other causes.

Frequently asked questions

Why are hot flashes worse at night?

Your body temperature naturally changes during sleep, and warm bedding or a warm room can easily push you over your new, more sensitive threshold.

Can you have hot flashes before your periods stop?

Yes. Many women start having them in perimenopause, while they still have periods.

Does losing weight help hot flashes?

For some women who are carrying extra weight, losing some of it may reduce hot flashes. Combining walking, strength training and enough protein is a healthy way to start.

The bottom line

Hot flashes are common, but they’re not something you have to suffer through. Learn your triggers, keep cool, look after your sleep and talk to your doctor about treatment if they’re affecting your life. For simple daily habits that help, 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 symptoms and treatment options.

“Am I too young for this?” It’s one of the most common questions women ask when their body starts to feel different. Here’s what you need to know about when perimenopause starts, the very first signs and how long it usually lasts.

Quick answer: perimenopause usually starts in your 40s, most often in your mid-40s, but it can begin in your late 30s. It lasts about four years on average, and ends at menopause, which most women reach at around 51.

What age does perimenopause usually start?

Most women notice the first changes somewhere between 40 and 47. For some, it begins in the late 30s; for others, not until about 50. There’s no exact age, because every woman’s body follows its own timeline.

What affects when it starts?

• Your family: women often go through menopause at a similar age to their mother and sisters.
• Smoking: smokers tend to reach menopause one to two years earlier.
• Medical treatments: surgery to remove the ovaries, some cancer treatments and certain other conditions can bring it on earlier.
• Hysterectomy: if your womb has been removed but not your ovaries, you won’t have periods to track, so other symptoms may be the first clue.

The first signs of perimenopause

The earliest signs are often subtle and easy to put down to stress or a busy life:

• Periods that become a few days shorter, longer, heavier or less predictable
• Worse PMS, sore breasts or bloating
• Waking in the night, often around 3 or 4am
• New anxiety, irritability or low mood
• Feeling warm at night or having the odd hot flush
• Feeling more tired than usual, or noticing brain fog

For the full list, see our guide to 17 perimenopause symptoms.

How long does perimenopause last?

On average, perimenopause lasts around four years, but it varies a lot. For some women it’s a few months; for others it’s eight to ten years. It’s usually split into two stages:

• Early perimenopause: your periods are still fairly regular, but your cycle length starts to change by a week or more.
• Late perimenopause: you start to skip periods, with gaps of two months or more between them. Hot flushes and night sweats are often strongest at this stage.

Perimenopause vs menopause: what’s the difference?

Perimenopause is the transition, when hormones fluctuate and you still have periods, even if they’re irregular. Menopause is a single point in time: 12 months in a row without a period. After that, you’re postmenopausal.

• Average age of menopause: around 51
• Early menopause: between 40 and 45
• Premature menopause (premature ovarian insufficiency): before 40. If you think this could be you, see your doctor, because treatment is important for your long-term health.

Is there a test for perimenopause?

For women over 45 with typical symptoms, a diagnosis is usually based on your symptoms and periods, without a blood test. Hormone levels go up and down so much during perimenopause that a single test often isn’t reliable. If you’re younger, your doctor may suggest tests to rule out other causes, such as thyroid problems.

What can you do now?

You can’t change when perimenopause starts, but you can make it a much easier ride:

• Track your cycle and symptoms for a few months, so you can spot patterns and talk to your doctor with confidence.
• Start strength training to protect your muscles and bones. Our beginner’s guide shows you how.
• Eat enough protein, roughly 25–35 g per meal. Start with these high-protein breakfasts.
• Walk daily and protect your sleep. Try our 30-day walking plan.
• Talk to your doctor about treatment options, including HRT, if your symptoms are affecting your life.

Frequently asked questions

Can perimenopause start at 35?

It’s less common, but yes, some women notice changes in their mid to late 30s. If you’re under 40 and your periods stop or become very irregular, see your doctor.

What’s the youngest age for perimenopause?

Most women start in their 40s. When periods stop before 40, doctors call it premature ovarian insufficiency, which needs medical support.

How do I know when perimenopause is over?

Once you’ve gone 12 months without a period, you’ve reached menopause, and perimenopause is over.

The bottom line

If you’re in your 40s and your body feels different, you’re not imagining it, and you’re definitely not alone. Learn the signs, look after your strength and sleep, and get support early. For simple first steps, download our free Fit After 40 Starter Kit.

This article is for general information only and isn’t medical advice.

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.

You’re eating the same, moving the same, and yet the scale is creeping up, especially around your middle. If that sounds familiar, you’re not imagining it, and it’s not a lack of willpower.

What’s happening in your body

Perimenopause is the transition before menopause, and it often begins in your 40s. As hormone levels, especially oestrogen, rise and fall less predictably, several things can change at once:

• Where you store fat: lower oestrogen tends to shift fat storage towards the tummy.
• Muscle: we naturally lose muscle with age, and less muscle means your body uses a little less energy each day.
• Sleep: night sweats and broken sleep are common, and poor sleep can increase appetite and cravings.
• Stress and energy: busy lives, low energy and mood changes can make old routines harder to keep.

What actually helps

The answer usually isn’t eating less and less or doing hours of cardio. That often leaves you tired, hungry and losing muscle. These habits tend to work better:

1. Strength train twice a week

Keeping and building muscle is one of the most helpful things you can do. Two short full-body sessions a week are enough to start.

2. Eat enough protein

Protein helps protect muscle and keeps you fuller for longer. Aim for a good source at every meal, roughly 25–35 g.

3. Walk most days

Walking is gentle, easy to fit in and great for your heart, mood and blood sugar. Build up gradually to a daily step count that feels achievable for you.

4. Protect your sleep

Keep a regular bedtime and a cool bedroom, and limit caffeine after midday. If night sweats are keeping you awake, talk to your doctor.

5. Fill up on fibre and colour

Vegetables, fruit, beans, lentils and whole grains support digestion and help you feel satisfied.

6. Go easy on alcohol

Alcohol can disrupt sleep, trigger hot flushes and add calories without making you feel full.

When to talk to your doctor

If your symptoms are affecting your daily life, or you’d like to talk about options such as hormone therapy, book an appointment with your GP. A doctor can also check for other causes of weight change, such as thyroid problems.

The bottom line

Your body is changing, so your approach can change too. Focus on strength, protein, movement and rest, and judge your progress over weeks, not days. Be patient and kind with yourself. This chapter can be a strong one.