Perimenopause Symptoms: What It Is, When It Starts, and What to Expect
Maybe you’re 39, 42, or 44. You’re not sleeping well. You find yourself snapping at loved ones for reasons you can’t explain. Your period is acting differently. Some days you feel like yourself, and other days you barely recognise your own body.
You search for answers online late at night, first at 11 pm, then again at 2 am when sleep still won’t come.
Maybe you come across the word perimenopause. Or perhaps a doctor mentions it in passing, but moves on before you get a chance to ask what it really means.
I wrote this post because it’s what I wish I'd found when I first started looking for answers.
What perimenopause actually is
Perimenopause is the stage before menopause. It can last for several years, during which your hormones start to change, and your body gradually slows down its reproductive cycle.
Perimenopause isn’t the same as menopause. Menopause is defined as the moment you’ve gone 12 months in a row without a period. Everything leading up to that point is considered perimenopause.
I remember thinking I was losing my mind, before I realised that "peri" was what was happening to me.
For most women, perimenopause lasts between four and ten years. Some go through it in just two or three years, while others experience it for a decade. There’s no set timeline, and it’s impossible to predict exactly how long it will last for you.
During perimenopause, estrogen and progesterone, the hormones that have managed your cycle for years, start to fluctuate instead of following a steady pattern. They don’t decrease smoothly. Instead, they rise and fall unpredictably. Some months, your estrogen might be high; other times, it’s much lower. This unpredictability causes many of the symptoms women notice, which is why perimenopause can feel so confusing.
I hear so many women taking years before they are able to identify that the reason why they "don't feel like themselves anymore" is perimenopause.
When Perimenopause Actually Starts
Many women think perimenopause will start in their early 50s, since that’s when their mothers went through it, if it was discussed at all. So when symptoms show up at 38, 40, or 43, it’s common to look for other reasons first.
In Australia, menopause happens on average at age 51. This means perimenopause usually starts in the mid to late 40s. But it can begin much earlier. Many women notice changes in their late 30s, and some even as early as 35. I began noticing changes around 39, though I didn’t realise what they were for a long time.
If you’re in your late 30s and notice changes and your doctor hasn’t brought up perimenopause, it’s worth asking about. You don’t need to diagnose yourself, but it’s a conversation worth starting.
The Symptoms You Can Expect In Perimenopause.
There’s a long list of clinical symptoms for perimenopause, and most people would rather not see them all on a checklist. What those lists miss is how these symptoms actually feel, often happening together and without warning.
Sleep is often the first thing to change. It’s not the usual kind of insomnia where you can’t fall asleep. Instead, you fall asleep easily but wake up at 2 or 3 a.m., wide awake with your mind racing, unable to fall back asleep. Sometimes you wake up drenched in sweat, not knowing why, and spend the rest of the night feeling too hot or too cold. Lack of sleep makes everything else harder, and I believe this is one of the most overlooked parts of perimenopause.
Your period changes, too. It might become heavier or lighter, shorter or longer, or unpredictable in ways that make planning difficult. You might skip a month, then have two periods close together, or start spotting between cycles. The regular pattern you’ve counted on for years just stops being reliable.
Mood changes can show up suddenly. You might feel anxious for no clear reason, or overwhelmed by everyday tasks. Irritability can appear out of nowhere and leave you feeling guilty. Many women, myself included, nearly get diagnosed with anxiety or depression before anyone mentions hormones. I almost started antidepressants before I realised what was really going on.
Brain fog is real, and it doesn’t mean you’re losing your mind, even if it feels that way. You might forget words mid-sentence or walk into a room and forget why you’re there. It’s like a mental haze that clouds your thinking. If you’ve always depended on your mind to be sharp, this can be unsettling and even scary until you know what’s causing it.
Desire changes as well, often in subtle ways. It’s not a sudden shift, but more like a signal that becomes harder to reach. This is a very common part of perimenopause, but it’s rarely discussed. I’ve written more about it in other posts because it deserves more attention than just a paragraph.
You might also notice joint pain, headaches, heart palpitations, dry skin, digestive changes, different reactions to alcohol, or more sensitivity to temperature. The list is long, and many of these symptoms seem unrelated, which is why perimenopause often goes unnoticed for so long. Most people don’t expect sore knees, poor sleep, and low mood to all be connected.
Why Is Perimenopause Often Missed
Perimenopause doesn’t make itself obvious. It often shows up through symptoms that could have other explanations. Sleep problems might be blamed on stress. Mood changes could be linked to work, relationships, or aging. Irregular periods might just seem like your cycle is unpredictable. Brain fog might be chalked up to exhaustion.
Doctors, partners, and even women themselves often suggest these explanations before anyone connects the symptoms.
Perimenopause looks different for everyone. Some women have strong symptoms from the start, while others barely notice any changes. There’s no single ‘normal’ to compare yourself to, which makes it harder to recognise what’s going on.
If I could share one piece of advice, it would be this: trust yourself if you feel something has changed. You know your own body. If things feel different for a while and you can’t explain why, it’s worth looking into.
What helps Dealing with Perimenopausal Symptoms
There isn’t a single simple answer, and I want to be honest about that rather than give you a neat list that suggests otherwise.
What helps depends on which symptoms are affecting you.
What will help depends on which symptoms affect you most, how severe they are, your health history, and what you can manage right now. Some women find that hormone replacement therapy (HRT) makes a big difference. Others do well with changes to sleep, exercise, and support. Many use a mix of approaches. The research on HRT has changed a lot in the past decade, so if you’ve heard it isn’t safe, it’s worth talking to a doctor who understands menopause. Conversations I've had with women in the same season: community and honesty matter more than any single intervention. Finding out that other women are experiencing exactly what you are, that this is not you falling apart but your body in transition, changes something.
You’re not too young for this. You’re not overreacting. You’re not losing who you are.
You’re going through something that was never explained to you, but now you know what it is. That’s a starting point.
If any of this feels familiar, you might want to read more about why desire changes during perimenopause, why sleep is often affected first, and what current research says about HRT. If you’d like to connect with other women going through the same thing, the Perimenopause Inner Circle is available.
Martina Baroncelli
Founder of Arousi. Background in pharmaceutical sales and product development. Writing from her own experience of perimenopause.