Perimenopause, often referred to as the “menopausal transition,” is a natural part of aging for women, yet it remains one of the least discussed and most misunderstood phases of a woman’s life. It marks the period leading up to menopause — the point when a woman has gone 12 consecutive months without a menstrual period. Perimenopause can start as early as the mid-30s but more commonly begins in the 40s, and it typically lasts for several years. During this time, hormone levels, particularly estrogen and progesterone, fluctuate significantly, leading to a wide range of physical and emotional symptoms. This post will explore the common — and some lesser-known — symptoms of perimenopause, the reasons behind them, and how women can manage this transitional phase of life more comfortably.
Note: This article is for informational purposes only. If you are experiencing symptoms that concern you, it is important to consult your GP or a qualified healthcare provider.
What Causes Perimenopause?
Perimenopause is driven by changes in reproductive hormones. Estrogen and progesterone, which regulate menstruation and support fertility, begin to fluctuate and eventually decline. This hormonal shift can create significant changes in the body and brain. Unlike menopause, which has a defined endpoint, perimenopause is characterised by unpredictable patterns, making it more difficult to recognise and manage without guidance.
Common Symptoms of Perimenopause
While every woman’s experience is unique, certain symptoms are widely reported during perimenopause. These symptoms may vary in intensity and duration and can come and go unpredictably.
1. Irregular Periods
One of the earliest signs of perimenopause is a change in menstrual patterns. This can include:
- Heavier or lighter flow than usual
- Longer or shorter cycles
- Skipped periods
- Spotting between periods
These changes occur due to the erratic nature of ovulation during this time. Eventually, periods become more spaced out and less frequent before stopping entirely.
2. Hot Flashes and Night Sweats
Hot flashes — sudden sensations of heat, often accompanied by sweating and a red, flushed face — are hallmark symptoms of the menopausal transition. Night sweats, the nocturnal counterpart of hot flashes, can disrupt sleep and lead to fatigue and mood issues.
Hot flashes may last from a few seconds to several minutes and can occur several times a day or just occasionally.
3. Sleep Disturbances
Many women experience sleep issues during perimenopause, even if they’ve never had trouble sleeping before. Causes include:
- Night sweats
- Hormonal imbalances
- Increased anxiety or stress
Insomnia, frequent waking, and difficulty falling back asleep are all common complaints.
4. Mood Changes
Mood swings, irritability, anxiety, and depression may intensify during perimenopause. This is due not only to fluctuating hormones but also to life stressors that often coincide with this stage, such as caring for aging parents, career changes, or empty nest syndrome.
Some women report experiencing panic attacks for the first time during perimenopause, while others notice a reappearance of depression or anxiety from earlier in life.
5. Decreased Libido and Sexual Changes
Hormonal changes can impact sexual desire and arousal. Many women report a decrease in libido, but this varies widely. Vaginal dryness, thinning vaginal walls (vaginal atrophy), and discomfort during sex are also common, making intimacy more challenging.
These symptoms are linked to declining estrogen levels and can often be treated effectively with lubricants, vaginal moisturizers, or hormone therapy under a doctor’s guidance.
6. Weight Gain and Metabolism Changes
Weight gain, particularly around the abdomen, becomes more common during perimenopause. This is partly due to hormonal changes, but also linked to ageing, muscle loss, and changes in activity levels or sleep patterns.
Even with the same diet and exercise routine, many women find it harder to maintain their previous weight.
7. Fatigue and Low Energy
Persistent fatigue and low energy levels are frequent complaints. This can stem from poor sleep, mood changes, or the body’s increased effort to adjust to hormonal fluctuations.
Fatigue in perimenopause is not just feeling tired — it can be an all-encompassing exhaustion that affects concentration, memory, and motivation.
8. Cognitive Changes: Brain Fog and Forgetfulness
Many women describe “brain fog” during perimenopause. Symptoms include:
- Forgetfulness
- Difficulty concentrating
- Losing track of thoughts mid-sentence
- Slower mental recall
These cognitive symptoms can be unsettling but are generally temporary. They’re believed to be related to declining estrogen levels, which influence brain function.
Less Common Symptoms
Beyond the well-known signs, perimenopause can also cause:
– Breast Tenderness: Hormonal fluctuations can cause the breasts to feel sore or swollen, similar to premenstrual symptoms.
– Headaches and Migraines: Women who are prone to headaches may find they become more frequent or intense due to hormonal shifts.
– Joint and Muscle Pain: Some experience increased stiffness or aches, which may mimic arthritis.
– Hair Thinning and Skin Changes: Declining estrogen can affect collagen production, leading to drier, thinner skin and hair shedding.
– Urinary Issues: Increased urgency, frequency, or urinary tract infections may arise due to thinning of the bladder and urethral lining.
When Does Perimenopause End?
Perimenopause officially ends when a woman has gone 12 months without a period — this marks the beginning of menopause. The average age of menopause in the UK and most Western countries is around 51, but the timing varies widely.
The transition through perimenopause can last anywhere from 2 to 10 years, depending on the individual.
How to Manage Perimenopausal Symptoms
While perimenopause is a natural process, the symptoms can be disruptive. Fortunately, there are many strategies to ease the transition:
1. Lifestyle Modifications
- Diet: Focus on a balanced diet rich in calcium, vitamin D, healthy fats, and whole grains.
- Exercise: Regular physical activity helps manage weight, improves mood, and strengthens bones.
- Sleep Hygiene: Create a sleep-friendly environment and practice good sleep habits, such as limiting screen time before bed.
2. Stress Reduction
Mindfulness practices, yoga, breathing exercises, and counselling can help reduce stress and stabilise mood swings.
3. Medical Treatments
For moderate to severe symptoms, consult your GP. Treatments may include:
- Hormone Replacement Therapy (HRT): Replaces estrogen and/or progesterone to relieve hot flashes, mood swings, and vaginal dryness.
- Antidepressants: Can help with mood regulation and sometimes reduce hot flashes.
- Non-hormonal Medications: Certain blood pressure or seizure medications are used off-label to treat hot flashes.
4. Supplements and Natural Remedies
Some women find relief with natural remedies, such as:
- Black cohosh
- Soy isoflavones
- Evening primrose oil
However, evidence for their effectiveness varies, and supplements should be used with caution. Always consult your GP before starting new supplements.
Emotional and Social Support
Navigating perimenopause can feel isolating, but it doesn’t have to be. Talking to others who are going through similar changes, joining support groups, or seeking help from a therapist can make a big difference.
Women benefit greatly from accurate information and open conversations about their bodies. Unfortunately, perimenopause has long been surrounded by stigma and silence. Changing that narrative is essential for better health outcomes and personal empowerment.
Perimenopause is a complex, personal journey that involves much more than the cessation of periods. The symptoms can touch every aspect of life — physical, mental, and emotional. While it’s a natural part of ageing, that doesn’t mean women should have to endure it without support.
If you’re experiencing symptoms that are affecting your quality of life, speak to your GP. With the right knowledge, support, and treatment, it’s possible to navigate perimenopause with confidence and well-being.
Featured Image by Silvia from Pixabay
Last updated on November 5th, 2025 at 06:51 pm
