10 Signs You're in Perimenopause

AskAwayHealth

10 Signs You’re Already in Perimenopause — And What to Do Next

May 21, 2026

Your periods have gone rogue. You can’t sleep. You keep losing your train of thought mid-sentence. You’ve put weight on around your middle even though nothing has changed about your diet — and nobody, not your GP, not Google, not your friends, has given you a satisfying explanation.

NHS GP & Women’s Health Specialist

Dr Sylvia Kama-Kieghe

lady in a cream hijab contemplative about early perimenopause signs

What if every single one of those things has one name? And what if most women are living inside it for four to ten years before anyone says that word out loud?

That word is perimenopause — and today, we’re saying it.

Watch First: 10 Signs You’re in Perimenopause — A GP Explains What to Do Next

What Is Perimenopause — And Why Does It Get Missed So Often?

Perimenopause is the hormonal transition phase that happens before your final period. It is not menopause itself — it is the runway leading up to it. And it can begin as early as your mid-to-late thirties.

Out of all the hormonal conditions I see in women’s health, perimenopause is the one most frequently missed, most frequently mistaken for something else — anxiety, depression, thyroid problems, burnout — and the one women most often suffer through alone, convinced they’re falling apart, when actually their hormones are simply shifting.

The reason it gets missed? The symptoms are wildly varied, they tend to build gradually, and they look like a lot of other things. So women get passed around — sometimes for years — before anyone joins the dots.

This post joins those dots. Here are the 10 signs your body may already be in perimenopause, what’s happening clinically at each stage, and exactly what to say to your GP.

The 10 Signs of Perimenopause — Explained

Sign 1: Your Periods Have Become Unpredictable

Your cycle used to be something you could set a clock by. Now it’s shorter. Or longer. Heavier one month, barely there the next — or disappearing entirely for a month and then reappearing as though nothing happened.

This is one of the earliest and most telling signs of perimenopause. Fluctuating oestrogen affects both ovulation and the womb lining, so the regularity you’ve always known starts to unravel.

What to do:

Track your cycle for at least three months — dates, flow, duration
Bring that written log to your GP appointment and connect it to any other symptoms you’re experiencing

Irregular does not always mean just hormones. If you are experiencing very heavy bleeding — flooding, clots the size of your palm, soaking through a pad in under an hour — that needs a separate assessment. Conditions like fibroids or endometrial changes need to be ruled out. Don’t let anyone brush this off as “just perimenopause” without checking.

Sign 2: Hot Flashes and Night Sweats

A sudden wave of heat — face, neck, chest — sometimes followed by chills. Or waking at night drenched in sweat, stripping the covers, changing your sheets at 3am.

Fluctuating oestrogen tricks your brain’s thermostat (the hypothalamus) into registering a fake temperature spike. Your body responds by trying to cool itself down. Fast. That’s the flush.

What to watch for: Most hot flashes in perimenopause are uncomfortable but harmless. But if you have night sweats alongside unexplained weight loss, a persistent fever, or new lumps anywhere in your body — see your GP urgently. These combinations can signal conditions that need to be ruled out before hormones are assumed to be the cause.

Sign 3: You Can’t Sleep — and When You Do, It Doesn’t Feel Restful

You can’t fall asleep. You wake at 3am and your brain simply will not stop. Or you wake up drenched and can’t settle again.

This is not just “getting older.” Progesterone has a natural, gentle sedating effect on the brain. As progesterone levels begin to drop in perimenopause, that natural sleep support disappears — and your sleep pattern changes as a direct result. Poor sleep then amplifies every other symptom on this list, which is why it can feel like everything is falling apart at once.

Quick practical tip: Cool bedroom, no screens or devices for 30 minutes before bed. Small changes, but they matter when your sleep is already fragile.

If disturbed sleep is affecting your ability to function day to day — work, relationships, concentration — that is a conversation to have with your GP explicitly. Don’t minimise it.

Sign 4: Brain Fog, Lost Words, and Walking Into Rooms For No Reason

That tip-of-the-tongue moment that used to happen occasionally is now happening constantly. Words hang in mid-sentence. You walk into a room and have absolutely no idea why. You’re struggling to focus on tasks you used to handle without thinking.

Oestrogen plays a direct role in memory and cognitive sharpness. When oestrogen fluctuates, so does mental clarity. Perimenopausal brain fog is a real, clinically recognised phenomenon — and importantly, it improves as hormones stabilise.

This is the sign most women spend years blaming on stress, on being too busy, on “just not being as sharp as I used to be.” It’s not that. It’s hormonal.

When to escalate: If the memory changes feel more severe than forgetting words mid-sentence — if it feels more like significant gaps or disorientation — that warrants a separate assessment from your GP, not a blanket assumption that it’s perimenopause.

Sign 5: Mood Changes — Anxiety, Low Mood, Irritability That Feels Out of Nowhere

You feel on edge. You’ve cried without being able to explain why. You’ve snapped at people you love and felt terrible about it afterwards. You just don’t feel like yourself — and there is no clear life reason for it.

Oestrogen regulates serotonin — the brain chemical responsible for mood stability. When oestrogen fluctuates, so does your ability to regulate your emotions. This is a biochemical problem, not a character flaw and not a sign you’re struggling to cope.

This is the sign that leads to the most misdiagnoses. Many women are prescribed antidepressants during perimenopause when the underlying driver is hormonal. Both depression and perimenopausal emotional fluctuation can coexist — but the distinction matters for treatment.

What to say at your GP appointment: If you are in your late thirties or early-to-mid forties and your mood has shifted suddenly without a clear life trigger, name perimenopause specifically. Don’t wait for your GP to bring it up.

Download the free Perimenopause Clarity Tool — know exactly which symptoms to track and what to say at your next appointment

Sign 6: Heart Palpitations — Racing, Fluttering, or Skipping

A racing, fluttering, or skipping sensation in your chest. Often when you’re doing nothing — resting, lying in bed at night. It arrives without warning and then goes.

Normal oestrogen levels help keep heart rhythm stable. As levels fluctuate in perimenopause, these on-and-off episodes can occur. Perimenopausal palpitations are usually short-lived and benign — but that word “usually” carries important weight.

Symptom	Action
Brief flutter or racing, resolves quickly, no other symptoms	Monitor and mention to GP at next appointment
Palpitations + chest pain	Go to A&E today
Palpitations + shortness of breath	Go to A&E today
Palpitations + feeling faint or lightheaded	Go to A&E today
Palpitations that don’t stop after a few seconds	Go to A&E today

Do not assume palpitations are hormonal until cardiac causes have been ruled out. This is not a “watch and wait” situation when those red flags are present.

Sign 7: Joint Pain and Muscle Aches — Out of Nowhere

Aching knees. Stiff hips. Sore hands and wrists in the morning. Back pain that appeared without any injury or obvious cause.

Oestrogen has anti-inflammatory properties. As levels drop, inflammation in joints can develop or increase. This is one of the most overlooked signs of perimenopause — largely because it doesn’t look hormonal. Many women are referred to rheumatology for joint problems before anyone thinks to ask about their hormonal history.

If you are in your early-to-mid forties with new joint pain and other symptoms from this list, connect those dots explicitly when you see your GP. They are not separate problems. They may be one.

Sign 8: Vaginal Dryness and Changes in Libido

Dryness. Discomfort during sex. A significant drop in sexual desire that came from nowhere and doesn’t seem connected to how you feel about your relationship.

Vaginal and vulval tissues rely on oestrogen. As levels drop, those tissues become thinner and less moist — a condition called Genitourinary Syndrome of Menopause (GSM). It affects 50% of women going through menopause and perimenopause. That is one in two. And it is almost never talked about.

This is not something you need to put up with. It does not resolve on its own the way some other symptoms can.

Practical tip: Vaginal moisturisers used two to three times a week can significantly improve day-to-day comfort. This is not the same as lubricant — a moisturiser works consistently over time, not just in the moment. Speak to your GP about additional treatment options.

Watch next: Vaginal Dryness in Perimenopause — What Actually Helps

Sign 9: Skin and Hair Changes

Your skin feels thinner, drier, less elastic. Your hair is finer — or you’re noticing more of it in the shower drain or on your brush than you ever have before.

Oestrogen stimulates collagen production and supports hair follicle health. Both decline as oestrogen fluctuates. These changes can feel cosmetic, but they are clinical — they are direct evidence of shifting hormone levels.

One important overlap: The thyroid gland can also cause significant hair and skin changes, and thyroid dysfunction frequently coexists with perimenopause. They can look identical.

Ask your GP for: A hormone profile and a thyroid function test at the same appointment — so you know which is driving the change, or whether it’s both.

Sign 10: Weight Gain Around the Middle

You haven’t changed what you eat. You haven’t changed how much you move. And yet weight is gathering around your belly in a way it never did before — in a place it never went before.

This is not a willpower problem. Fat distribution shifts during perimenopause from hips and thighs to the abdominal area. At the same time, the body’s sensitivity to insulin changes — meaning it becomes harder to manage blood sugar levels efficiently, which promotes fat storage around the middle.

What to ask your GP:

Fasting glucose test
HbA1c (a measure of blood sugar over time)

Practical action: Strength training twice a week and reducing refined carbohydrates are two of the most evidence-supported strategies for this specific type of weight change. This is not generic diet advice — this targets the hormonal mechanism driving the shift.

Red Flags: When to Act Now, Not Later

Not every perimenopause symptom needs a routine appointment. Some need faster action.

Symptom Combination	Action
Night sweats + unexplained weight loss + fever + new lumps	See GP urgently this week
Heart palpitations + chest pain or breathlessness or feeling faint	Go to A&E today
Very heavy bleeding — flooding, large clots, soaking through a pad in under 1 hour	GP appointment within 1–2 weeks — needs assessment
Mood changes so severe you are struggling to function	GP appointment this week
Memory changes that feel more like significant gaps than forgetting words	GP appointment for separate assessment
Joint pain so severe it limits your daily movement	GP appointment — mention hormonal history explicitly

Your GP Checklist — What to Say at Your Next Appointment

If you recognise three or more of these signs, you have enough to have a meaningful conversation with your GP. Here is exactly what to ask:

“Can we check my hormone profile?”
“Could this be perimenopause — given my age and the pattern of symptoms?”
“Can we also check my thyroid and fasting glucose?”

Write those three questions down before you go in. Don’t leave without answers to all three.

The Bottom Line

Perimenopause is not a diagnosis of decline. It is a hormonal transition — one that is often invisible, frequently misunderstood, and almost always under-discussed. If you have been told you’re “fine” when you know something has shifted, trust that instinct. Your body is not falling to pieces. It is changing. And change, when it is understood and supported, is manageable.

The first step is naming it. The second is walking into your GP appointment armed with the right questions. You now have both.

Which of these 10 signs hit home for you? Share it below — and know that you are not alone in this. → Join the free AskAwayHealth community

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