Perimenopause is the stage leading up to menopause, when the ovaries gradually start to produce fewer eggs and levels of oestrogen and progesterone (hormones) start to decline. It's a natural part of ageing, but is nonetheless misunderstood by many.
Often, perimenopause is characterised by certain symptoms. Most commonly, doctors see irregular periods, hot flushes, sleep disturbances, and mood swings. However, what perimenopause feels like can be different for everyone.
"Other common perimenopause symptoms include night sweats, heavy periods, anxiety, irritability, brain fog, difficulty concentrating, fatigue, sleep disturbances, and vaginal dryness or discomfort during sex," says Dr Nikki Ramskill, a GP and women’s health expert verified on Doctify.
Perimenopause isn't just about symptoms either. "It's also about long-term heart, bone, vaginal, vulval, and urinary health," says the doctor. That's why it's essential to speak to your doctor if you feel like you may be experiencing the symptoms of perimenopause.
When do symptoms of perimenopause start?
For many women, perimenopause will start in the mid-40s, but it can be earlier or later, depending on lifestyle factors, genetics, ethnicity, and medical history.
For example, some women go through an early perimenopause due to surgery and other medical conditions, while those from an African and Caribbean descent and Hispanic women have fewer ovulation cycles in the last year before the final period compared to other women, according to a report by the British Menopause Society.
How long does perimenopause last?
The stage of perimenopause lasts until you haven't had a period for 12 months in a row. At this point, it's said that you are in menopause or even postmenopausal, a stage that lasts for the rest of your life.
However, it's important to note that not all of the symptoms associated with perimenopause only indicate this life stage. "These symptoms could also have other underlying causes, so it's worth having a full check-up to ensure nothing is being missed before blaming it all on perimenopause," says Dr Ramskill.
As words, perimenopause and menopause are often used interchangeably. However, perimenopause technically refers to the period up until menopause. Strictly speaking, menopause is the time when you haven't had a period for 12 consecutive months.
What are the common symptoms of perimenopause?
1. Hot flushes
Not every woman will experience hot flushes, but according to Harvard Health, as many as 80% do. Known as a vasomotor symptom, hot flushes tend to feel like a sudden rush of heat around the face, neck, and chest, resulting in sweating, a flushed look, and a racing heartbeat.
2. Irregular periods
Changes to periods are one of the most commonly reported symptoms of perimenopause, with the British Menopause Society reporting that 50% of women find their periods become more irregular or report changes in the length and heaviness of the bleeding.
This happens as the ovaries may occasionally stop releasing an egg as oestrogen levels drop.
Gaps between periods can be less than 21 days or more than 35, with the breaks happening occasionally in the early stages of perimenopause and then more frequently as you approach menopause.
3. Heavy periods
Equally, as periods can become more spaced apart, they can get heavier. "Menorrhagia, or heavy periods, is a common side effect of fluctuating hormone levels," explains Emma Bardwell, a registered nutritionist, menopause specialist, and women's health expert for Active Iron. "It's often due to unopposed oestrogen building up in the uterine lining, and it frequently happens alongside anovulatory cycles [when no egg is released] and irregular menstrual bleeding."
Having heavy periods after 40 can be disruptive to your regular life, painful, and could result in iron loss, leading to low iron levels over time, so it's very important to speak to your doctor if you're experiencing this issue.
4. Disrupted sleep
Around 12% of women experience issues with sleep, but this number rises to 40% during perimenopause, so it's another one of the most common perimenopause symptoms.
"Low levels of progesterone can make it harder to fall asleep or stay asleep as progesterone has a calming, sleep-promoting effect," says Dr Lindsay Browning, a sleep specialist and expert at And So To Bed.
"Since oestrogen affects temperature regulation, when oestrogen levels decrease, night sweats and hot flashes are more likely," she says. "Additionally, mood changes and anxiety can be related to fluctuating oestrogen levels, which can contribute to insomnia."
So, as much as the fall hormone levels can impact our ability to get enough core sleep, other perimenopause symptoms can cause problems with our shut-eye.
5. Hair loss or changes
It's also very common to experience hair loss in perimenopause as "falling oestrogen and shifting androgens can change the texture and thickness of your hair and lashes," says Dr Ramskill.
"Some women find their hair becomes thinner or more brittle, while others notice surprising new curliness, frizz, or coarseness," she says. "Eyelashes may also become sparser or shorter, and can even become curly too."
6. Mood swings
People joke about mood swings in perimenopause, but for many, it's no laughing matter.
"Dropping progesterone levels and wildly fluctuating, and ultimately declining, oestrogen levels lead to increased anxiety and depressive symptoms in the perimenopause stage, along with worsening premenstrual syndrome, mood swings, brain fog, and early subjective cognitive decline,” Dr Sara Szal, a precision medicine practitioner and author of Women, Food, and Hormones, wrote in the OURA Perimenopause Report.
"These changes contribute to less sleep and declining health, which may diminish a woman’s resiliency in relationships and at work," she wrote.
The Oura ring is one of the most accurate skin temperature, sleep, and wellbeing trackers on the market in 2025. In the app, users can report changes to their mental and physical health and emotional wellbeing. The report reveals that members tagged many changes to their mood in perimenopause, with 33% increases in anger and 28% increases in sadness tags from premenopause to perimenopause.
Always speak to your doctor if you are struggling with your mental health at any time in perimenopause.
7. Changes in sex drive
Most people associate perimenopause with a low libido, and this can certainly be the case for many with the emotional symptoms of menopause having an effect. The Karolinska Institutet also reports that 50% of women say their sex drive had been negatively impacted by perimenopause or menopause thanks to physical issues like vaginal dryness, burning or itching.
However, sometimes it's the opposite. "Some are less interested and have trouble getting aroused, while others enjoy sex more as they feel freer,” says Dr Shirin Lakhani, a GP, menopause and women's intimate health specialist.
“Women shouldn’t feel pressured by society to think they need to be one way or another and should be able to choose how they want their sex life to be. If they feel they don’t want to have sex, that’s fine, but if they do, then that’s fine too and it’s important for us as medical professionals to give them the tools to be how they want to be," she says. This can include topical treatments like lubricants or vaginal oestrogen.
Importantly, though, continue to use contraception in perimenopause if you used it beforehand, as it's still possible to get pregnant. "This is the point leading up to the menopause when changes in hormones are occurring, which means that your periods are often irregular and some months an egg is released, whilst others it’s not," says Dr Lakhani.
8. Itchy or crawling skin
It's worth considering whether any itchy skin or skin changes you've been seeing recently could be a symptom of perimenopause.
As Dr Ramskill explains, "Oestrogen helps keep skin hydrated and collagen-rich. As it drops, skin becomes drier and more sensitive, with some women even describing a 'pins and needs' or crawling feeling. Others describe a feeling of brief, sudden zaps or jolts felt under the skin, thought to be due to changes in nerve conductivity from hormonal shifts."
9. Mouth changes
Yes, really. If you've noticed a burning, itchy, or sore tongue, or a metallic taste in your mouth, it could be perimenopause symptoms.
"A dry, burning, tingling sensation in the tongue, lips, or palate is linked to falling oestrogen levels affecting nerve sensitivity and saliva production," says Dr Ramskill. "The drop in oestrogen can also affect the mucous membranes, leading to inflamed gums (gingivitis) and tooth decay."
The same goes for a metallic taste in the mouth. “Oestrogen fluctuations can alter how we perceive taste and smell, leading to some women experiencing a strange metallic or bitter taste in the mouth. Previously favoured smells may change to be less desirable, and food and drink tastes can change," she says.
10. Chest pain
Around 50% of women experience palpitations during perimenopause and menopause. While it's a worrying feeling, it's down to changes in hormone levels.
“Fluctuating oestrogen can affect blood vessels and the nervous system, sometimes leading to feelings of tightness in the chest, skipped beats, or sharp pains," says Dr Ramskill.
However, "any new or severe chest pain must always be checked urgently to rule out heart disease," she says. In an emergency, always dial 999.
11. Weight changes
Many women notice that they appear to have gained weight with the onset of perimenopause symptoms. While not an exact symptom, the two are often related.
Woman&home fitness columnist Annie Deadman puts the so-called 'menopause tummy' down to changes in weight distribution, age, and lifestyle. "Where previously some women may have laid down fat on thighs and hips, the drop in oestrogen may cause it to settle more around the abdomen instead. Not only on the outside but the inside too," she says.
"Age is a factor, too," she notes. "As all of us (whatever sex) grow older, we lose muscle; anything from 1-3% a year. Muscle helps keep our metabolic rate up and this burns energy (calories) on a day-to-day basis, so as our bodies become older, less responsive and our muscle tissue starts to decline, they require fewer calories."
This is not an exhaustive list of perimenopause symptoms - just the most common ones. There are at least 34 different symptoms recognised by the Menopause Charity, so always speak to your doctor if something feels out of the ordinary for you.
Perimenopause treatment: What are your options?
Many people will recognise the symptoms of perimenopause within themselves. However, it's always a good idea to speak to a doctor before considering any treatment options. Also, as Dr Ramskill says, many symptoms coincide with signs of other conditions which may need more urgent interventions. So, make an appointment with your doctor as a first step.
"Doctors can prescribe you hormone replacement therapy (HRT) to help deal with hot flushes and vaginal dryness, and in some cases, anti depressants can also be prescribed if diagnosed with depression or anxiety," says pharmacist Sheena Bagga from Lloyds Online Pharmacy.
Other ways to ease perimenopause symptoms include:
- Eating a balanced diet: "Eating a varied balanced diet can help give your body the nutrients to help cope with changes," says Bagga. "Including calcium rich foods like yoghurt and milk, along with vitamin D, can help support bone health."
- Optimise your sleep schedule: "Struggling with sleep is a key symptom of menopause, so trying to maintain a regular sleeping pattern will help combat the difficulties sleeping," she says. However, it's also important to be patient with yourself and seek specialist help when needed. It's often not as simple as going to bed the same time every night and closing the blinds to make sure it's dark in perimenopause.
- Do regular exercise: There's plenty of research that reveals exercise to be one of the ways to ease perimenopause symptoms. Studies in the Journal of Clinical Medicine and Exercise Rehabilitation suggest resistance training (i.e. lifting weights or callisthenics) can help improve bone density, reducing the risk of conditions like osteoporosis, and Pilates home workouts can be beneficial for both mind and body wellness.
- Avoid triggers: If you suffer with hot flushes, heart palpitations, or night sweats, it's a good idea to avoid consuming caffeine, eating spicy foods, or drinking alcohol as these trigger changes that can make these symptoms worse.
