Perimenopause Symptoms: What’s Normal, What’s Not, and When to Seek Help

Perimenopause, the transition phase leading up to menopause, can feel unpredictable, confusing, and often overwhelming.

One month everything seems fine. The next, your cycle shifts, your mood changes, and your sleep feels disrupted for no clear reason.

For many women, it’s hard to tell what’s a “normal” part of this phase and what might need further attention. If you’re unsure whether what you’re experiencing is related to perimenopause, you’re not alone.

This article outlines the most common symptoms, what to expect, and when it’s a good idea to speak to a healthcare professional.

What Is Perimenopause, Exactly?

Perimenopause refers to the time when your ovaries begin producing less estrogen, typically starting in your 40s — though for some women, it can begin earlier.

This stage can last anywhere from a few months to up to 10 years before periods stop completely and menopause is reached (defined as 12 months with no menstrual period).

During this time, hormone levels fluctuate significantly, and those shifts can affect almost every system in the body — not just the reproductive system.

Read More: Perimenopause and Changing Periods

Common Perimenopause Symptoms: What’s Usually Considered Normal

Not every woman will experience all of these symptoms, but many will notice at least a few. They can come and go, change in intensity, and sometimes overlap in unexpected ways.

1. Changes in Your Menstrual Cycle

• Periods may become heavier, lighter, shorter, or longer

• You might skip cycles or have unpredictable timing

2. Hot Flushes and Night Sweats

• Sudden feelings of heat, often in the face, neck, or chest

• Can last from 30 seconds to several minutes

• May disrupt sleep

3. Sleep Disturbance

• Difficulty falling asleep or staying asleep

• Waking up feeling unrested, even after a full night

4. Mood Changes

• Increased irritability, sadness, anxiety, or emotional sensitivity

• Feelings of overwhelm without a clear cause

5. Reduced Libido or Changes in Sexual Function

• Vaginal dryness or discomfort

• Decreased interest in sex or changes in sensation

6. Cognitive Symptoms

• Difficulty concentrating (“brain fog”)

• Forgetfulness or feeling mentally slower than usual

7. Physical Changes

• Weight gain (especially around the middle)

• Breast tenderness

• Joint or muscle aches

• Thinning hair or dry skin

These symptoms are often part of the natural transition, but that doesn’t mean they should be ignored. If they’re affecting your day-to-day life or mental wellbeing, support is available.

What’s Not “Normal”, and Shouldn’t be Ignored

While hormonal changes can explain a lot, not everything should be attributed to perimenopause.

Here are some signs that might indicate another issue, or at least warrant a check-up:

• Very heavy bleeding (soaking through pads or tampons every hour)

• Bleeding between periods or after sex

• Periods that last longer than 10 days

• Severe mood swings that interfere with work, relationships, or daily functioning

• Sudden or severe depression or anxiety

• Rapid or unexplained weight loss

• Persistent pelvic pain

• Heart palpitations or dizziness that don’t improve with rest

These symptoms may not be serious, but they should be assessed to rule out underlying conditions such as thyroid issues, fibroids, or other medical concerns.

When to Speak to a Healthcare Professional

If you’re experiencing symptoms that are disruptive, confusing, or concerning — even if you think they’re “normal” — it’s worth having a conversation with your GP or a menopause specialist.

Don’t wait for things to become unmanageable. Early intervention can help improve your quality of life and give you options you may not have known were available.

Some questions to ask at your appointment:

• Could these symptoms be related to perimenopause?

• Should I consider hormone testing?

• What treatment options (e.g. lifestyle changes, HRT, non-hormonal therapies) are available?

• Are there any further tests I should consider based on my symptoms?

You Don’t Have to Manage This Alone

Perimenopause is a natural part of life, but that doesn’t mean it’s easy. It’s perfectly reasonable to want guidance, reassurance, and effective support. Whether you’re in the early stages or further along in the transition, understanding what your body is going through can make a significant difference.

By recognising the signs, asking the right questions, and seeking appropriate help, you can move through this stage with more clarity and confidence.