Perimenopause symptoms: How to know if you’re in perimenopause

Perimenopause can leave you feeling unlike yourself - whether it’s disrupted sleep, mood swings, brain fog or a dip in libido.

Here’s how to recognise the early signs of perimenopause, understand what’s happening in your body, and find the support you need.

Key takeaways

• Perimenopause is the transition before menopause, caused by fluctuating hormone levels.
• Symptoms include changes in periods and sleep disruption, mood swings, hot flushes, brain fog, and low libido.
• Perimenopause often begins in your mid to late 40s, but can start earlier.
• There isn’t a single test for perimenopause. A diagnosis is based on age, symptoms, and menstrual history.
• Support is available: lifestyle changes, nutritional support, non-hormonal treatments, and HRT can all help.

What is perimenopause?

Perimenopause is the transition phase before menopause (when your periods stop). It’s when your ovaries start producing less oestrogen and progesterone, leading to hormonal ups and downs that can cause a wide range of symptoms, aka signs like hot flushes, anxiety and sleep problems.

Perimenopause can vary from person to person. This phase lasts on average 4–8 years (sometimes shorter, sometimes up to 10).

The terminology can be confusing. Menopause itself is just one day - when you’ve gone 12 months without a period. Everything before that? That’s perimenopause.

What age does perimenopause start?

Most women begin perimenopause in their mid to late forties, around age 47 on average. But it can start earlier, even in your late thirties. Factors like smoking, chemotherapy, being underweight, or a family history of early menopause can bring it on sooner.

Signs of perimenopause: early symptoms to look out for

The early signs of perimenopause might be so subtle that they’re easy to dismiss, or they might feel like a complete system shake-up. Here are some of the most common:

Changes to your periods

Your cycles (the time between the first day of your last period and when your next period begins) may shorten or lengthen, and bleeding may become heavier or lighter. That said, some women don’t notice any changes to their periods at all during perimenopause.

Sleep disruption

You might struggle to fall asleep or stay asleep, even when you’re not feeling stressed.

Mood changes

Increased anxiety, low mood, irritability, or feeling emotionally out of control are common symptoms during perimenopause.

Hot flushes and night sweats

Doctors call these “vasomotor symptoms”, and they happen due to hormonal fluctuations.

Brain fog

Forgetfulness, difficulty concentrating, or a sense of mental fuzziness is sometimes reported by women going through perimenopause.

Physical changes

Breast tenderness, bloating, joint pain, dry skin and vaginal dryness can all arise due to fluctuating hormone levels.

Reduced libido

Some people experience a noticeable drop in interest in or enjoyment of sex.

These symptoms are very real - but too often brushed off as “just stress” or the demands of busy life. But luckily help is available.

Is there a test for perimenopause?

Unfortunately, there isn’t one clear test for perimenopause. Hormone levels (such as FSH and oestrogen) fluctuate too much at this stage to provide reliable answers. Instead, healthcare professionals focus on:

• Your age and menstrual history
• The pattern and severity of your symptoms
• Any relevant medical or family history

Your doctor might consider testing for perimenopause if you are aged 40 to 45 with symptoms and have noticed period changes, or if you are under 40 with suspected premature ovarian insufficiency (when your ovaries stop working as they should before age 40).

Support for perimenopause symptoms

Perimenopause can feel overwhelming at times, but the good news is there are lots of ways to make this stage of life easier. What works best will depend on your symptoms, your health, and your preferences.

Some women find that simple lifestyle tweaks, like improving sleep routines, cutting back on caffeine or alcohol, and making space for stress relief, make a real difference.

Adding in the right nutrients, such as calcium and vitamin D, can also support your bones and overall health.

For specific symptoms, there are both non-hormonal options (such as cognitive behavioural therapy for mood changes or vaginal moisturisers for dryness) and hormonal options like HRT (including testosterone therapy in some cases), which can ease many symptoms and protect long-term health. Browse our menopause treatments page to find out more.

Personalised perimenopause care at Voy

Perimenopause can feel confusing and challenging at first, but this transition is also a chance to tune into your body and take charge of your health.

You deserve care that helps you thrive, not just cope. And you don’t have to figure it out alone. At Voy, our clinicians combine evidence-based treatments with personalised support, so you have expert guidance every step of the way.

Still wondering “am I perimenopausal?” Take our short quiz to get personalised insight into your symptoms and explore the support that’s right for you.