Perimenopause is often reduced to a handful of well-known symptoms, however, there are many related signs and symptoms – and it’s not just about hot flushes. From changes in mood and sleep to shifts in menstrual cycles and energy levels, the experience can be wide-ranging and, at times, confusing and frustrating.
In the UK, it’s estimated that around 80% of women will experience menopausal symptoms, many of which begin during perimenopause (some earlier than you may realise). Despite this, awareness of the full spectrum of symptoms remains low, meaning many women don’t immediately recognise what’s happening in their bodies.
As Dr Tang, Consultant Gynaecologist at The Gynae Centre, explains: “Perimenopause can present differently in individuals, and symptoms are not always obvious or consistent. It’s important that women feel informed and empowered so they can recognise changes early and feel supported when accessing care.”
What is perimenopause?
Perimenopause is the transitional phase leading up to menopause, when hormone levels – particularly oestrogen – begin to fluctuate.
Unlike menopause, which is defined as 12 consecutive months without a period, perimenopause can last for several years. During this time, hormone levels rise and fall unpredictably, which is why symptoms can feel inconsistent or difficult to pinpoint.
When does perimenopause occur?
Perimenopause typically begins in a woman’s forties, although it can start earlier for some. For many it lasts anywhere from four to eight years, though this can vary significantly.
It’s important to note that symptoms can begin even when periods are still regular, which is why perimenopause is sometimes overlooked in its earlier stages. Even when women notice these symptoms, they could be uncertain as they may present differently to how “menopause” has been described by healthcare professionals, friends and family and the media.
Misdiagnosis of perimenopause and why it happens
For some women, perimenopause is not just challenging because of the symptoms themselves, but because those symptoms are often overlooked, misunderstood or dismissed when they first seek help.
Because perimenopause can affect so many areas of the body, it doesn’t always present in a clear or obvious way. Mood changes may be labelled as anxiety or depression. Sleep problems are often attributed to stress or a busy lifestyle. Irregular periods can be brushed off as a natural fluctuation rather than part of a wider hormonal change.
In some cases, women find themselves going back and forth to their GP, trying to explain that something doesn’t feel quite right, only to leave without clear answers. While GPs provide essential care, they may not have specialist training in menopause. This can sometimes make it harder to recognise the full picture, particularly when symptoms are less commonly associated with perimenopause.
There are also clinical challenges. Hormone levels fluctuate significantly during this stage, meaning blood tests are not always reliable or definitive. A diagnosis often relies on recognising patterns in symptoms over time, alongside a detailed medical history – something that can be difficult to piece together without specialist insight.
This can result in women feeling unheard, frustrated or even beginning to doubt their own experience. Over time, this can take a toll, not just physically, but emotionally and mentally. It can affect confidence, relationships, work and overall enjoyment of life. At the same time, perimenopause can coincide with when women have to adjust to life changes such as job promotions and changes in interpersonal relationships.
This is why access to specialist women’s health support is so important. Being listened to, understood and properly assessed can make a meaningful difference to your experience of perimenopause, helping you make sense of what’s happening in your body and find the right approach to managing it.
Symptoms of perimenopause
Perimenopause can present differently for every woman, but common gynaecological issues in perimenopause can include:
Irregular periods
Cycles may become shorter, longer, heavier or lighter, and you may skip periods altogether. Some women experience flooding or spotting between periods. This is often the earliest sign of perimenopause, though it’s sometimes mistaken for stress, changes in weight, or underlying gynaecological conditions.
Reduced libido
A decrease in sexual desire is common and can be influenced by both physical and emotional factors, including hormonal changes, vaginal dryness, fatigue and mood.
Vaginal dryness or discomfort
Lower oestrogen levels can lead to thinning and dryness of vaginal tissues, causing discomfort during sex or even day-to-day irritation. This is sometimes mistaken for recurrent genitourinary tract infections. Some women may feel hesitant to talk to healthcare professionals about sexual difficulties and vaginal dryness.
Genitourinary Syndrome of Menopause (GSM)
This is a common condition linked to the decline in oestrogen during and after menopause, affecting the vaginal and urinary tissues. It can cause symptoms such as vaginal dryness, irritation, discomfort during sex, and urinary issues like urgency or recurrent infections. Unlike some perimenopausal symptoms that come and go, GSM is often persistent and may worsen over time if left untreated.
Other signs of perimenopause
- Hot flushes and night sweats: A sudden feeling of intense heat, often starting in the chest or face and spreading through the body. This can be accompanied by sweating, flushing and a rapid heartbeat. Night sweats can disrupt sleep significantly and may be mistaken for anxiety or illness.
- Sleep disturbances or insomnia: You may find it harder to fall asleep, wake frequently during the night, or wake very early and struggle to get back to sleep. While night sweats can play a role, hormonal fluctuations alone can affect sleep quality. This is often attributed to stress or lifestyle rather than hormonal change.
- Mood changes (anxiety, low mood irritability): Fluctuating hormones can impact neurotransmitters in the brain, leading to increased anxiety, irritability or feelings of low mood. Some women describe feeling “not like themselves”. These symptoms are frequently misdiagnosed as depression or generalised anxiety disorder.
- Fatigue and low energy levels: Persistent tiredness that doesn’t improve with rest is common. This may be linked to poor sleep, hormonal changes or both. It can feel similar to burnout or chronic fatigue, making it easy to overlook the hormonal connection.
- Brain fog or difficulty concentrating: You might notice forgetfulness, difficulty focusing, or struggling to find the right words. This can be frustrating and, for some, worrying, occasionally leading to concerns about cognitive decline.
- Headaches or migraines: Hormonal fluctuations can trigger new headaches or worsen existing migraines, particularly around the time of your cycle. These may be mistaken for tension headaches or stress-related symptoms.
- Weight changes: Weight may increase, particularly around the abdomen, even without significant lifestyle changes. This is linked to hormonal shifts affecting metabolism and fat distribution. Bloating, changes in appetite or altered digestion can also occur. These symptoms are often mistaken for dietary intolerances or gut health issues, but hormones can play a significant role.
Managing perimenopause symptoms
There are a range of effective treatment options available to help manage perimenopause and menopause symptoms, and the right approach will depend on your individual needs.
Simple lifestyle changes, such as improving sleep habits, managing stress, and supporting your body with well-rounded nutrition and regular movement, can make a significant difference to your wellbeing.
Vaginal health treatments, including locally applied oestrogen, can be particularly helpful for symptoms such as dryness and discomfort, while certain supplements may support overall hormonal balance and wellbeing.
For many women, Hormone Replacement Therapy (HRT) remains one of the most effective options, helping to restore hormone levels and relieve a wide range of symptoms. At The Gynae Centre, we believe no woman should struggle in silence. We are here to listen to your concerns and support you in choosing treatment options that may improve your day to day wellbeing. If you’re experiencing symptoms, booking a consultation with one of our specialist gynaecologists can help you understand your options and decide whether HRT – or an alternative approach – is right for you.
To make an appointment, call 020 7580 8090 or book an appointment online.
