Perimenopause Symptoms Nobody Warned You About

By Your Health Magazine Contributor

Your Health Magazine Contributor

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Perimenopause Symptoms Nobody Warned You About

Most women know about hot flushes. What they don’t know, because nobody tells them, is that perimenopause can start in the early forties or before, that it lasts years, and that its most common symptoms are ones that look like something else entirely. Women spend years being treated for anxiety, insomnia, joint pain or low mood before anyone connects the dots. Here are the symptoms that get missed, and what to do about them.

What Perimenopause Actually Is

It’s the transition, typically lasting four to eight years, during which oestrogen and progesterone fluctuate and decline before periods stop altogether. Menopause itself is a single day, twelve months after the last period. Perimenopause is everything before that, and it’s when most of the symptoms happen. It commonly starts in the mid-forties but can begin earlier, and it often begins while periods are still regular, which is why it’s missed.

Sleep That Falls Apart

The symptom women most often describe first, and least often attribute to hormones. Waking at three or four and lying awake. Night sweats that soak the sheets. Difficulty falling asleep despite exhaustion. Hormonal changes during perimenopause can affect sleep, while night sweats, anxiety and other menopause symptoms can make sleep disruption worse.

The practical response is worth setting out because it’s the thing that makes the rest bearable. A cool bedroom, with the heating off overnight. Bedding in breathable natural fibres, in layers that can be shed at 3am: a light duvet and a cotton blanket beat one heavy duvet. Cotton or bamboo nightwear that wicks. A fan by the bed. Two separate duvets for couples, so a partner isn’t woken by the shedding. When comparing options you can
explore Simba’s bedding range, as one example, to look for breathable materials and bedding that helps prevent excess heat from becoming trapped overnight. Alcohol in the evening, which worsens night sweats and early waking, is the habit most worth reconsidering.

Anxiety That Arrives From Nowhere

Anxiety, low mood, irritability and changes in confidence can occur during perimenopause, sometimes in people who have not previously experienced these symptoms. Palpitations can also occur. However, new or significant anxiety, panic symptoms or palpitations should not automatically be assumed to be hormonal, particularly if they are severe or persistent.

Brain Fog

Losing words, forgetting why you entered a room or struggling with concentration can occur during perimenopause. Memory and concentration problems are commonly reported and may also be worsened by poor sleep or mood changes. New, severe or progressively worsening cognitive symptoms should be discussed with a healthcare professional rather than automatically attributed to hormones.

Joint And Muscle Pain

Aching hips, stiff knees, sore shoulders, frozen shoulder. Oestrogen has an anti-inflammatory effect on joints and connective tissue, and its decline shows up as pain that’s often put down to age or exercise. It’s one of the least-known perimenopausal symptoms and one of the most disruptive.

Weight and body shape changes are the symptom women most often blame on themselves. The shift of fat to the abdomen is hormonal and happens to women who’ve changed nothing about how they eat or move. It responds to strength training and protein more than to dieting, and the guilt attached to it is entirely misplaced.

The Rest Of The List

Heavier, longer or more erratic periods. Migraines that worsen or change. Palpitations. Dry eyes, dry skin, dry mouth. Vaginal dryness and discomfort during sex. Recurrent urinary infections. Itchy skin, sometimes with a crawling sensation. Tinnitus. Hair thinning. Weight redistributing to the middle regardless of diet. A loss of interest in sex. Any of these, alone, would be put down to something else. Together, in a woman in her forties, they’re a pattern.

Getting Help

The first step is a GP appointment with a list of symptoms, written down, and their timing. UK guidance no longer requires blood tests to diagnose perimenopause in women over 45 with typical symptoms; the pattern is enough. Hormone replacement therapy can be highly effective for many troublesome menopause symptoms, particularly hot flushes and night sweats, and may also improve some menopause-related sleep and mood symptoms. For many healthy women who start HRT before age 60 or around the time of menopause, the benefits are likely to outweigh the risks, but suitability depends on individual health history and risk factors. It’s not for everyone, and there are alternatives, so treatment options are worth discussing with a healthcare professional.

Cognitive behavioural therapy has good evidence for the sleep and mood symptoms. Exercise, particularly strength training, helps with joints, mood and the weight shift. And knowing what’s happening is itself a treatment, because a symptom with a name is easier to live with than one without.

Telling The People Around You

Partners, children, managers. Perimenopause is easier with people who understand what’s going on, and the conversation is easier than it used to be. Workplaces increasingly have menopause policies. Partners who know why the duvet’s on the floor at 3am are partners who can help.

Closing Thoughts

Perimenopause is longer, earlier and stranger than most women expect, and its most common symptoms, poor sleep, anxiety, brain fog and joint pain, are the ones least often connected to it. Recognising the pattern is the first step. Cooling the bedroom and changing the bedding makes the nights manageable. And a GP appointment with a written list opens the door to treatment that works for most women and that far too many go without.