Perimenopause: 7 symptoms to look for and what you can do.
There is a phase that most women go through — often for years — before they ever hear the word perimenopause.
During this time, sleep gets worse. Moods feel harder to manage. Periods become unpredictable. And most of the time, no one connects the dots.
Perimenopause can begin up to eight years before your last period. It comes with a specific set of signs — seven of them — that are almost always missed or misattributed to stress, age or something else entirely.
In this article I will walk you through all seven. I will also cover what the evidence says about treatment — because there are real, effective options, and you deserve to know about them.
Always consult your doctor for personalised medical advice.
What is perimenopause?
Let me explain it simply.
The menopause is the point at which your periods have stopped completely — for twelve months in a row. Perimenopause is everything that leads up to it. The years when your body is gradually shifting from its reproductive phase into a new normal.
During this time, your ovaries start producing less oestrogen and progesterone. But this does not happen in a straight line. The levels go up and down — sometimes quite sharply — before they eventually settle lower. Those fluctuations are what cause almost everything we are about to discuss.
Most women enter this phase in their early to mid-forties. Some begin in their late thirties. The average length is four to eight years. So by the time your periods actually stop, your body has often been sending these signals for a long time.
The 7 signs of perimenopause
Sign 1 — Changes in your menstrual cycle
The first sign is a change in your periods. Not that they disappear — just that they become different from what you know.
Your cycle might get shorter. Or it stretches out to 35 or 40 days. Your flow might be heavier one month and much lighter the next. You might occasionally skip a period entirely.
This kind of unpredictability is one of the earliest and most reliable signs that your hormones are no longer running on the schedule they used to. If your cycle has shifted noticeably and you are in your late thirties or forties, it is worth mentioning to your doctor.
Sign 2 — Sleep that does not work anymore
The second sign is sleep that just does not work the way it used to.
You might struggle to fall asleep. You might wake up at two or three in the morning and lie there for an hour. Or you sleep a full night and still feel exhausted when you get up.
Some of this is caused by night sweats — which we will get to in a moment. But sleep can be disrupted during perimenopause even without the sweating. The hormonal fluctuations themselves affect how deeply you sleep and how well you stay asleep. If your sleep quality has quietly gotten worse over the past year or two, that pattern is worth paying attention to.
Sign 3 — Mood changes that feel out of place
The third sign is mood changes that do not quite make sense.
When oestrogen fluctuates, it directly affects the chemicals in your brain that control how you feel. That is why many women suddenly feel more anxious, more irritable or just off — even when nothing in their life has actually changed.
This gets misread all the time. Many women are treated for anxiety or depression during this phase, without anyone asking whether hormones might be part of the picture. It is an important distinction — and one your doctor should explore before drawing any conclusions.
Sign 4 — Hot flushes and night sweats
The fourth sign is hot flushes and night sweats.
A sudden wave of heat — usually from the chest up. It lasts a few minutes. Sometimes it comes with flushing and sweating. At night, it can wake you up drenched.
What drives this is the effect oestrogen has on the part of your brain that controls your body temperature. Think of it as a thermostat. When oestrogen swings, that thermostat becomes unreliable — it fires when it should not.
Not every woman gets hot flushes. But if you are getting them — particularly alongside the other signs we are discussing — they are telling you something.
Sign 5 — Brain fog
The fifth sign is what many women describe as brain fog.
You go to say a word and it is just not there. You walk into a room and forget why. You sit down to focus on something and find it much harder than it used to be.
This is real, and it has a hormonal basis. Oestrogen has a direct effect on how the brain works — on memory and on the speed at which you process things. Add disrupted sleep on top, and the effect is worse. If your mental clarity has quietly shifted over the past year or two, do not automatically put it down to stress or getting older.
Sign 6 — Heart palpitations
The sixth sign is heart palpitations — and this one surprises most women.
You suddenly become aware of your own heartbeat. A flutter. A thump. A brief racing feeling that comes out of nowhere.
In perimenopause, this is often connected to how oestrogen affects your nervous system and the way your heart rate is regulated. When oestrogen is fluctuating, that regulation becomes less steady. That said, palpitations should always be checked by a doctor — they can have causes unrelated to hormones, and those need to be ruled out first.
Sign 7 — Joint pain and stiffness
The seventh sign is probably the most overlooked one: joint pain and muscle stiffness.
Oestrogen has an anti-inflammatory effect in the body. It helps keep your joints working smoothly and your connective tissue healthy. When it starts to drop and fluctuate, some women notice a creeping stiffness — particularly in the morning, or after sitting still for a while. Hips, knees, fingers, shoulders.
This almost always gets blamed on ageing or posture. But if joint discomfort has appeared — or noticeably worsened — in your late thirties or forties without a clear physical reason, perimenopause belongs on the list of things to discuss with your doctor.
Recognize any of these? Download the free checklist — 7 Symptoms of Perimenopause. One page. Evidence-based. Free. Get the checklist →
What does the evidence say about treatment?
If several of these symptoms sound familiar, the important thing to know is this: there are effective options. You do not have to just live with it.
Hormone therapy (MHT / HRT)
The most effective treatment for hot flushes, night sweats and the sleep disruption that comes with them is hormone therapy — also called MHT (menopausal hormone therapy) or HRT (hormone replacement therapy).
It also has good evidence for mood symptoms and for protecting bone density over time. Many women carry an outdated fear about breast cancer risk. That picture is more nuanced than older headlines suggested — the level of risk varies depending on the type of hormone used, how it is taken and the individual woman. This is a conversation worth having with your doctor, based on your own history.
Non-hormonal options
For women who cannot or prefer not to use hormone therapy, there are alternatives. Certain antidepressants (SSRIs and SNRIs) and gabapentin have shown meaningful reductions in hot flush frequency in clinical trials. Cognitive behavioural therapy (CBT) has proven benefit for the experience of hot flushes, sleep and mood — not just as a talking point, but as a measured clinical outcome.
Soy isoflavones
Soy isoflavones are plant compounds with a mild oestrogen-like effect. Studies show they may help reduce the frequency of hot flushes for some women. The effect is not as strong as hormone therapy, and results vary from person to person. But for women looking for a non-prescription option to try alongside medical advice, the evidence is reasonable and the safety profile for short-term use is good.
If you want to try soy isoflavones: NOW Foods Soy Isoflavones 60mg is a well-documented product in this category. As always, speak to your doctor before starting any supplement.
NOW Foods Soy Isoflavones 60mg — view on Amazon
Affiliate link: if you purchase through this link, I receive a small commission at no extra cost to you.When should you see a doctor?
Do you recognise these symptoms? Always consult your doctor — they can assess your situation and discuss your options with you.
Hormonal changes are not a women-only story. If someone close to you is navigating similar questions in their forties, read our article on testosterone after 40 — what actually happens and what the evidence says.
Do these symptoms sound familiar?
We made a full video on perimenopause — covering all seven signs and what the evidence says about hormone therapy. Watch it on our YouTube channel.
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Medical disclaimer: The information in this article is intended for educational purposes only and does not replace personalised medical advice. Always consult your doctor for guidance on your individual situation.
References
1. National Institute for Health and Care Excellence (NICE). Menopause: diagnosis and management. NICE guideline NG23. Updated April 2026. nice.org.uk/guidance/ng23
2. Lethaby A, Marjoribanks J, Kronenberg F, et al. Phytoestrogens for menopausal vasomotor symptoms. Cochrane Database of Systematic Reviews. 2013;(12):CD001395.
3. Daley AJ, Stokes-Lampard H, Thomas A, MacArthur C. Exercise for vasomotor menopausal symptoms. Cochrane Database of Systematic Reviews. 2014;(11):CD006108.
4. Hunter MS, Chilcot J. Testing a cognitive model of menopausal hot flushes and night sweats. Journal of Psychosomatic Research. 2009;67(6):593–600.
5. Rees M, Bitzer J, Cano A, et al. Global consensus recommendations on menopause in the workplace. Maturitas. 2021;151:55–62.
6. Prior JC. Progesterone for symptomatic perimenopause treatment — Progesterone politics, physiology and potential for perimenopause. Facts, Views & Vision in ObGyn. 2011;3(2):109–120.
