What is the Perimenopause?
Article written by Dr Mari Walling, British Menopause Society Registered Specialist, GP, Co-founder of Lemala Health, November 2025
This information is not a substitute for professional medical advice, diagnosis, or treatment. Always consult your healthcare provider for personal guidance.
This guide explores the many symptoms of the perimenopause, and covers the wide range of options available to help women, as they navigate this transition.
Perimenopause is the natural transition leading up to menopause, and it may begin earlier than you expect - in your late 30s or early 40s.
It is a normal part of female biology but the hormonal changes can be challenging. As oestrogen and progesterone fluctuate, you may notice a variety of symptoms affecting your menstrual cycle, sleep, mood, cognition and overall wellbeing.
Understanding what is happening and knowing which symptoms are related to perimenopause can make this stage far easier to navigate.
What are the common symptoms of Perimenopause?
Every woman’s experience is different, but the symptoms most frequently reported include:
Irregular or changing periods
Hot flushes and night sweats
Vaginal dryness and urinary symptoms
Weight gain or changes in body shape
Migraine or hormonal headaches
Mood swings, anxiety or low mood
Cognitive changes (often described as “brain fog”)
These symptoms are linked to fluctuating hormone levels and may come and go over several years.
How might my periods change with perimenopause?
Irregular periods are often one of the earliest signs of perimenopause, although some women notice other symptoms first. If you have a hormonal coil or take oral contraception, your cycles may already be lighter, irregular or absent.
You may find that your cycles become:
Shorter or longer
Heavier or lighter
Occasional gaps of several months
Tracking your menstrual cycle can help you recognise changes and patterns. If you experience heavy bleeding or concerning changes, speak to your GP or menopause specialist.
How might my mood and general wellbeing change with perimenopause?
Hormonal fluctuations can significantly influence emotional health. Many women notice mood swings, irritability, increased anxiety or, in some cases, depression. Women with a history of mental health conditions may be more sensitive to these changes.
Why do I keep forgetting things in perimenopause?
Brain fog is a very common symptom and may include
Difficulty concentrating
Struggling to find words or names
Forgetfulness, losing keys etc
These changes are usually temporary and linked to hormonal fluctuations - they are very rarely a sign of early dementia.
Why can I not sleep like I used to? Is that perimenopause?
Sleep difficulties are frequently reported during perimenopause. You may find yourself waking overnight and struggling to fall back to sleep, leading to fatigue during the day.
I just feel so hot!
Up to 80% of women experience hot flushes and night sweats. These occur because fluctuating hormones affect the body’s temperature regulation.
Symptoms may include sudden heat in the face, neck or chest, sweating or even the chills and feeling very cold.
Why does my vagina feels so uncomfortable?
Lower oestrogen levels can lead to vaginal dryness and discomfort as well as new urinary symptoms - collectively known as Genitourinary Syndrome of Menopause (GSM).
Common symptoms include:
Vaginal or vulval dryness or itching
Discomfort or pain during intercourse
Recurrent urinary infections
Frequency, urgency or stinging when passing urine
Why do I have NO libido?
Sexual desire often fluctuates during perimenopause. Some women notice a reduced libido, while for others it may increase. Vaginal dryness or discomfort can also influence sexual enjoyment and arousal.
Why am I gaining weight?
Hormonal changes can affect metabolism and body composition, leading to weight gain, particularly around the abdomen. This is an incredibly common symptom of perimenopause, which can be so frustrating.
Helpful strategies include focusing on the following:
A balanced diet with plenty of vegetables, lean protein and whole grains
Regular movement including strength training
Being mindful of portion sizes and reducing highly processed, sugary foods
If you have gained weight, even a small amount of weight loss can improve blood pressure, cholesterol and blood sugar levels.
My migraines are much more frequent now…
Fluctuating oestrogen can increase the frequency or severity of migraines. Keeping a record of triggers such as disrupted sleep, caffeine, alcohol or missed meals can be useful. These triggers may change in perimenopause, with many women becoming much more sensitive to sleep changes, caffeine and alcohol in particular.
I am so stiff when I wake up, and my joints really hurt after exercise.
As a result of the declining levels of oestrogen, many women experience:
Joint stiffness, often worse in the mornings
Conditions such as frozen shoulder, plantar fasciitis or tennis elbow
A general increase in muscular aches
Loss of muscle mass (sarcopenia)
Why is my hair going thin, and my skin has become so dry?
Falling oestrogen levels and reduced collagen may lead to:
Dry or watery eyes
Dry or itchy skin
Thinning or brittle nails
Hair thinning or increased shedding
Reduced skin elasticity
Anything else?!
Some women notice new or worsening digestive symptoms such as bloating, wind, constipation, diarrhoea, irritable bowel type discomfort or heartburn. With bowel symptoms in particular. any new or persistent symptoms should be reviewed by your GP and not just assumed to be perimenopause.
What will help me with my perimenopause symptoms?
Hormone Replacement Therapy (HRT), which can be helpful for many women experiencing perimenopause symptoms.
Local vaginal oestrogen, vaginal moisturisers and lubricants can really help vaginal and urinary symptoms
Prioritise good sleep habits
Keep stress levels manageable through relaxation strategies such as yoga, meditation, mindfulness and talking therapies
Stay mentally active in ways you enjoy: eg. work, reading, puzzles, creative activities.
Regular physical activity supports both brain health and hormone balance as well as your heart, muscles and bones.
Wear layers that can be removed easily
Keep your bedroom cool: helps with sleep, hot flushes and night sweats
Cognitive Behavioural Therapy (CBT) can help reduce the impact and severity of vasomotor symptoms and help improve psychological symptoms.
Antidepressants or anti-anxiety medication, when recommended by your GP
Perimenopause is a natural stage of life, but the symptoms can be unpredictable and sometimes overwhelming. With the right information, support and treatment, most women find they can manage this transition with far greater ease and confidence.
We have created a Menopause symptom tracker LINK HERE which you may find helpful to print off and complete.