Is this perimenopause?

You’re tired, irritable, hungry, lacking motivation, can’t concentrate and are trying to survive on yet another terrible night’s sleep.

Is it work stress keeping you up at night? Maybe running around after the kids all the time is what’s making you tired. Could PMS be fuelling your urge to eat everything in sight? Your husband leaving his dirty dishes by the sink (again!) is enough to make anyone irritable surely?

Or is it perimenopause?

This is the question many women start asking themselves once they hit their 40s (and for some, their late 30s).

One of the biggest hurdles in recognising perimenopause is that many of its symptoms overlap with what we put down to being busy and stressed out. We’re juggling kids, careers, households, relationships, ageing parents and if we’re lucky, some sort of social life. No wonder we’re exhausted.

When we’re left feeling anxious, wired-but-tired and generally a bit tetchy, it’s not always obvious whether hormones or life are to blame.

To complicate matters further, blood tests are unreliable when it comes to diagnosing perimenopause. Hormone levels, particularly estrogen and follicle-stimulating hormone (FSH), fluctuate unpredictably from day to day (even hour to hour), during this transition. A single blood test only captures a "snapshot in time," which may not reflect your overall hormonal status. 

That said, your doctor will rightly so send you for full blood tests to rule out other causes such as vitamin deficiencies or thyroid issues. These can mimic perimenopausal symptoms so it’s important they’re checked.

Providing your blood tests have all come back normal, what now?

Perimenopause versus life stress

If you’re trying to figure out what’s behind your symptoms, there are a few questions you can ask yourself.

Is there a pattern to your symptoms?

If your symptoms reliably show up before your period and disappear once it starts, PMS is probably playing a role. But if your symptoms feel random, like they appear out of nowhere, with no connection to your cycle, it might be perimenopause.

PMS tends to follow the luteal phase (the 1-2 weeks before your period). Perimenopause on the other hand, often feels like chaos. While you may have been able to predict how you would feel at the different stages of your cycle before, you may now find there’s no connection between the two.

How long have you been getting symptoms?

Stress-related symptoms usually come and go depending on what’s happening in your life. Perimenopausal symptoms tend to persist, evolve or gradually intensify.

If your “bad days” have become your new normal, that’s a clue worth paying attention to.

Have your periods changed?

I cannot stress enough the importance of tracking your menstrual cycle. We all have off months where our period may belate or heavier than usual, but consistent changes are a core symptom of perimenopause.

You might notice:

• Your cycle has become longer or shorter

• Heavier or lighter bleeding

• Spotting between periods

• Missed periods (this becomes more common the closer to menopause we get)

If your cycle hasn’t changed at all, it’s less likely to be hormonal (though not impossible).

Telltale signs of perimenopause

Here are some of the more common signs that may suggest perimenopause.

Sleep disturbances

With up to 90% of women reporting problems falling or staying asleep, sleep disturbances are one of the most common symptoms of perimenopause. Night sweats and hot flushes can contribute to this but even without them, hormonal shifts can affect your body’s ability to fall asleep, stay asleep and get the deep, restorative rest you need to function.

You might find yourself:

• Waking at 2-4am for no reason

• Tossing and turning all night

• Feeling wired late into the evening

• Waking up exhausted despite a full night in bed

Brain fog

Forgetfulness goes from occasionally misplacing your keys to genuinely wondering why you walked into a room or completely forgetting words.

Hormonal changes have a big impact on the brain and many women struggle with:

• Slower thinking

• Difficulty focusing

• Losing your train of thought mid-sentence

• Struggling to multitask like you used to

Mood changes

Hormonal fluctuations can leave you feeling like you’re on an emotional rollercoaster.

Common mood symptoms include:

• Irritability

• Sudden tearfulness

• Feeling overwhelmed by things that never used to bother you

• Anxiety that appears out of nowhere

• General feelings of “I’m not myself”

Hormones affect neurotransmitters like serotonin, so these shifts are extremely common (and you’re not going crazy!)

Fatigue

This isn’t “I stayed up too late” tired. This is exhaustion that doesn’t shift no matter how much you sleep or how well you’re eating.

Fatigue may show up as:

• Low physical energy

• Mental burnout

• Feeling unmotivated

• Hitting a wall by mid-afternoon

• Struggling to get going in the morning

  
  

If rest doesn’t seem to solve it, hormones may be involved.

Weight changes

Weight gain, especially around the belly, is common during perimenopause thanks to declining estrogen. Even if your diet and exercise haven’t changed at all, your body starts to redistribute fat differently.

You may also notice:

• Your usual routines suddenly stop working

• Increased bloating

• Feeling puffy or inflamed

Hot flushes and night sweats

The most famous symptom of them all! Please bear in mind however that not every woman experiences hot flushes and night sweats, some reach menopause without getting a single hot flush.

If you do experience them, you might notice:

• Sudden waves of heat that rise through your body

• Flushing in your face, neck or chest

• Sweating that seems to come out of nowhere

• Feeling shaky or anxious immediately after

• Night sweats can drench your clothes or bedding and leave you wide awake at inconvenient hours.

Vaginal changes

Declining estrogen can cause:

• Vaginal dryness

• Discomfort or pain during sex

• Increased UTIs

• Reduced libido

• Changes in natural lubrication

  
  

These are extremely common but rarely talked about and should be discussed with your doctor, because there aretreatments which can help.

A sense of losing yourself

This is the part women often struggle to articulate. It’s not always about symptoms, it’s about identity.

You might feel:

• Disconnected from your old self

• Like your confidence has dipped

• Unsure why you’re suddenly overwhelmed

• Less emotionally resilient

• Simply “not you”

  
  

This emotional shift is normal and more common than we realise.

Other symptoms of perimenopause:

As if we didn’t have enough to deal with, there are a number of other symptoms of perimenopause:

Changes to your menstrual cycle

• Heart palpitations

• Migraines and headaches

• Skin changes (dryness, itchiness and breakouts)

• Hair thinning or falling out

• Joint or muscle aches

• Bloating

• Itchy ears (yes, really!)

• Dry eyes

• Breast tenderness

• Digestive issues

• Dizziness or lightheadedness

• Gum or dental changes

• Tinnitus

  
  

Perimenopause can feel like a puzzle. If you’re not sure whether what you’re experiencing is perimenopause or something else, the best thing you can do is track your symptoms regularly. Patterns often reveal what guesswork can’t.

Importantly, speak with your doctor. You don’t have to diagnose yourself and you don’t have to struggle through it alone. With the right support, information and care, this transition can become much easier to navigate.