What is Perimenopause? Symptoms and What to Expect
Article written by Dr Emma Ginns, 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.
Perimenopause is the stage leading up to menopause, when hormone levels begin to fluctuate and symptoms may start to appear. It can begin earlier than many women expect, often in the late 30s or early 40s.
In this guide, we explain the common symptoms of perimenopause, why they happen, and what can help.
What is perimenopause?
Perimenopause is the natural transition leading up to menopause, when ovarian hormone levels begin to fluctuate.
During this time, oestrogen and progesterone levels rise and fall unpredictably, which can lead to a wide range of symptoms.
Perimenopause can last for several years and ends when periods stop completely.
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 do periods change in 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 does perimenopause affect mood and wellbeing?
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 feel forgetful or have brain fog?
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 can feel worrying, but are very rarely a sign of dementia.
Why does sleep change during 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.
Hot flushes and night sweats
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.
Vaginal and urinary symptoms (GSM)
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
Reduced clitoral sensation.
If this is something you’re suffering with, have a look at our resource specifically on Genitourinary Syndrome of Menopause (GSM).
Changes in 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.
Weight changes in perimenopause
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.
Migraine and headaches in perimenopause
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.
Joint pain and muscle aches
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)
Hair, skin and body changes
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
Other symptoms
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.
Have a look at our guides on oestrogen, progesterone and testosterone replacement.
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
Consider supplements, especially vitamin D. Have a look at our supplement guide.
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
Communicate with your partner
Life is always better when you are supported. Share our guides with your partner to enable those conversations: for male/ female couples and for same-sex couples.
Summary
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 Checker which you may find helpful to print off and complete.
If you are struggling with your perimenopausal symptoms, we can offer a personalised, holistic review of your symptoms and support you with a tailored plan.