Perimenopause Symptoms: An Introduction to Menopause and What to Expect

What is perimenopause?

Perimenopause is the transition leading up to menopause. During this time, your ovaries’ hormone production changes, ovulation becomes less predictable, and you may begin to notice changes in your periods and how you feel.

These changes don’t happen in a neat, steady pattern. Hormone levels can fluctuate, which helps explain why symptoms may come and go.

Every woman’s experience is different. Some have few symptoms, while others find that their physical health, emotional wellbeing and everyday life are significantly affected.

What age does perimenopause start?

Perimenopause often begins in your 40s, although some women notice changes in their late 30s. Menopause itself usually happens between 45 and 55.

If you think you’re experiencing menopause symptoms before 45, speak to your GP rather than assuming they are simply something to put up with.

How long does perimenopause last?

Perimenopause can last several years, but there is no fixed timetable. Symptoms may change along the way, and reaching menopause doesn’t necessarily mean they stop straight away — some women find symptoms continue post menopause for a while.

Try not to measure your experience against someone else’s. Your friend’s symptoms, timing and support needs may be very different from yours.

What is the difference between perimenopause and menopause?

The terms are often used interchangeably, but they describe different stages:

• Perimenopause: the transition before menopause, when symptoms and menstrual changes can begin.
• Menopause: the milestone confirmed after 12 consecutive months without a natural period, when there is no other explanation.
• Postmenopause: the stage after menopause.

Hormonal contraception can change or stop your bleeding, so periods alone may not tell you which stage you’re at. A healthcare professional can help you understand your situation.

What are the most common perimenopause symptoms?

There is much more to perimenopause than hot flushes. Symptoms can affect your sleep, concentration, mood, confidence and physical comfort.

Changes to your periods, temperature and sleep

Some early signs of perimenopause include periods becoming less predictable, with changes in timing or flow. You may also notice hot flushes, migraines, night sweats or difficulty sleeping, as well as worsening PMS.

Poor sleep can then leave you feeling exhausted during the day, making everyday tasks harder to manage.

Brain fog, anxiety and changes in mood

Losing your train of thought, struggling to concentrate or feeling more anxious can also be part of the picture. These symptoms can be unsettling, particularly when they affect your confidence at work or at home.

In its October 2026 report, Menopause Mandate shared the symptoms women said affected them most in its 2025 survey:

1. Brain fog
2. Weight gain
3. Fatigue
4. Low mood
5. Reduced concentration
6. Muscle or joint pain
7. Reduced motivation
8. Lack of confidence
9. Low libido
10. Anxiety or panic attacks

This reflects the experiences of survey respondents, rather than a universal ranking for every woman. But it highlights just how varied menopause symptoms can be.

Other common menopause symptoms

Vaginal dryness, discomfort during sex, bladder symptoms, headaches/migraines and changes to your skin can also occur.

You don’t need to experience every symptom for perimenopause to be worth discussing with your GP. Equally, these symptoms can have other causes, so getting the right assessment matters.

Why do hormones affect how you feel?

Hormones are chemical messengers. They help different parts of the body communicate and influence functions including reproduction, sleep and mood.

Oestrogen and progesterone are central to the menopause transition, but their roles are different.

Oestrogen: more than a reproductive hormone

Oestrogen helps support bone health and vaginal tissues, as well as playing a role in brain function and temperature regulation.

During perimenopause, levels can fluctuate before becoming consistently lower after menopause. These changes can contribute to symptoms including hot flushes, vaginal dryness and changes in how you feel.

Progesterone: an important part of your menstrual cycle

Progesterone is mainly produced after ovulation. It helps prepare and maintain the womb lining for a possible pregnancy.

As ovulation becomes less regular during perimenopause, progesterone production also changes. This forms part of the hormonal picture behind changes to your menstrual cycle. Calling it simply a “calming hormone” doesn’t capture its full role — or the fact that women respond differently to hormonal changes.

What about other hormones?

Other hormones are involved too. FSH, or follicle-stimulating hormone, generally rises as the ovaries become less responsive. Testosterone also plays a role in sexual desire.

However, a symptom on its own cannot tell you which hormone is responsible. Understanding the overall picture is more useful than trying to diagnose a particular hormone imbalance yourself.

What should you do if you recognise these symptoms?

Start by making a simple note of what has changed: your periods, sleep, mood, concentration and any physical symptoms. Include how these changes affect your everyday life.

Then arrange a conversation with your GP. You don’t have to wait until your periods stop before asking for support, and treatment options can include HRT and non-hormonal approaches, depending on your needs.

Any vaginal bleeding after menopause should be checked by a GP, even if it only happens once or is just spotting.

This article provides general information and does not replace personalised medical advice.

Your Essential Menopause Handbook

Recognising the symptoms is a useful first step. Knowing what to ask, where to turn and how to explain what you’re experiencing can make the next step feel less overwhelming.

That’s why I created Your Essential Menopause Handbook, my 53-page digital guide bringing practical information together in one easy-to-follow place.

Inside, you’ll find an in-depth guide to HRT, preparing for your GP appointment, a printable perimenopause symptom tracker for 70+ symptoms, a dedicated chapter on menopause at work — including reasonable adjustments, flexible working and menopause and disability — and lots more. I like to think of it as a reference manual for perimenopause that you can dip in and out of whenever you need the info.

This introduction covers the basics. The handbook helps you build on them, feel better prepared for important conversations and understand the support you can ask for.

Buy Your Essential Menopause Handbook here →