Is This Perimenopause? The Symptoms Women Often Don't Connect
2 days ago
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2 days ago
·Your periods are still arriving. You’re not having dramatic hot flushes, and you certainly don’t feel like the version of menopause you remember hearing about growing up. But something has changed.
Maybe you’re waking at 3 am for no obvious reason, your joints feel stiffer when you first get out of bed, or you’re forgetting words halfway through a sentence. Perhaps exercise seems to take more out of you than it used to, your patience has become noticeably shorter, or the glass of wine that was perfectly fine on Friday night now seems determined to ruin your entire Saturday.
It’s easy to blame these changes on stress, getting older, having too much going on, or simply being tired. And sometimes that is exactly what they are. But for women in their late 30s, 40s and early 50s, there’s another possibility that often isn’t considered until much later: perimenopause.
For many women, the first signs of perimenopause look nothing like the version of menopause they expected. Understanding what can change, and why, can make it much easier to recognise when your body may be entering a new stage.
What actually is perimenopause?
Perimenopause is the transition leading up to menopause. Menopause itself is technically reached once you have gone 12 consecutive months without a menstrual period, assuming there isn’t another medical reason for your periods stopping. Perimenopause is the period before that point, and it can last for several years.
During this transition, ovarian function changes and hormones, including oestrogen and progesterone, begin to fluctuate. The important word here is fluctuate. Hormones don’t simply decline neatly and predictably each month. Levels can rise and fall considerably, which helps explain why symptoms can seem inconsistent and why you might feel completely fine for several weeks before suddenly feeling as though something has shifted again.
It also means perimenopause isn’t necessarily something you can identify from one symptom or one particularly bad month. The pattern of changes over time usually tells the story.
What age does perimenopause start?
For many women, perimenopause begins sometime during their 40s, although it can begin earlier. Some women notice changes in their late 30s, while others won’t notice symptoms until much later.
There isn’t one birthday when perimenopause begins, and there isn’t one standard sequence of symptoms that every woman follows. This can make recognising it particularly difficult when someone feels “too young for menopause” and therefore doesn’t consider hormonal change as a possible explanation for what they’re experiencing.
The average age of menopause in Australia is around 51, but the transition towards it begins before that. Perimenopause is therefore much more relevant to women in their 40s than many of us were ever taught to expect.
Can you be in perimenopause if your periods are still regular?
Yes, and this is one misconception that can delay women from recognising what is happening.
Changes to menstrual cycles are common during perimenopause, but they don’t necessarily happen first. Your periods may initially remain relatively predictable while changes in sleep, mood, headaches, concentration, or other symptoms begin to appear. Over time, cycles may become shorter, longer, heavier, lighter or increasingly irregular.
Waiting for your period to disappear before considering perimenopause can therefore mean missing several years of the transition. Menopause is the point at which periods have stopped for 12 months. Perimenopause is everything that happens before this point.
What are the first signs of perimenopause?
There’s no single first symptom that signals the start of menopause. While changes in menstrual cycles, hot flushes and night sweats are the classic symptoms most often linked with this transition, many women’s earliest signs are subtler changes they don’t immediately associate with hormones.
Sleep can become less predictable, mood may feel different, anxiety can appear or intensify, and concentration or memory may not feel quite as sharp. Headaches or migraines can change, joints and muscles may ache, skin can feel different, and libido can shift. Some women notice their body responds differently to alcohol, exercise or stress long before they consider themselves menopausal.
This is partly why perimenopause can be confusing. Many of these experiences are nonspecific and can occur for completely unrelated reasons. But when several begin appearing together during the typical age range, perimenopause becomes a reasonable part of the conversation.
Why am I suddenly waking up at 3 am?
Sleep disruption is one of the most frustrating changes women report during perimenopause. Sometimes the reason is obvious, especially when hot flushes or night sweats wake you. For other women, sleep simply becomes lighter, more fragmented or much harder to return to once they wake.
Changing reproductive hormones interact with systems involved in temperature regulation, mood and sleep, while stress, alcohol, caffeine, children, work and changes to our natural sleep patterns can add another layer. This means you can experience disrupted sleep during perimenopause without ever waking drenched in sweat.
Sleep is also a good example of how difficult it can be to separate perimenopause symptoms from one another. Poor sleep can affect energy, mood, appetite, pain sensitivity, exercise recovery, concentration and our ability to manage stress. What initially looks like six unrelated problems may therefore have several overlapping contributors.
Does perimenopause cause brain fog and forgetfulness?
Brain fog is another symptom women frequently describe during the menopausal transition. You might walk into a room and forget why you’re there, lose a familiar word mid-conversation, or find yourself rereading the same paragraph because nothing seems to stick.
Memory and concentration changes are common during perimenopause, although hormones are unlikely to be the only influence. Sleep disruption, stress, anxiety and the sheer cognitive load many women are carrying during this stage of life can all contribute.
Occasionally forgetting someone’s name or losing your train of thought doesn’t mean your brain is suddenly deteriorating. Significant, persistent or rapidly worsening cognitive changes, however, should still be investigated rather than automatically attributed to hormones.
Why do my joints suddenly feel stiff or sore?
Joint and muscle aches are another part of perimenopause that often catches women by surprise. It might be stiffness when you first get out of bed, knees that suddenly dislike stairs, hips that ache after sitting too long, or workouts that linger in your body much longer than they once did.
Oestrogen interacts with tissues throughout the musculoskeletal system and is involved in processes affecting bone, muscle, cartilage and inflammatory signalling. As hormonal patterns change, some women notice changes in stiffness, aches or recovery.
That doesn’t mean every sore knee at 44 is hormonal, and new or persistent joint pain deserves proper assessment. But if your body suddenly feels different despite not significantly changing what you’re doing, perimenopause may be one part of the picture.
We’ll look much more closely at the relationship between perimenopause, joint health and inflammation in the next article in this series.
Why am I so tired during perimenopause?
Fatigue can be one of the hardest symptoms to make sense of because so many factors can contribute. If your sleep has deteriorated, that alone can significantly affect your energy. Mood changes, increased stress, heavier periods, slower exercise recovery, and the general demands of midlife can add to it.
This is also one symptom we should be particularly careful not to label as hormonal automatically. Iron deficiency, thyroid disorders, sleep apnoea, nutritional deficiencies, medication effects and other medical conditions can all contribute to persistent fatigue.
Perimenopause is common, but so are other health conditions, and the two can coexist. If fatigue is persistent, severe, or noticeably different from your normal energy levels, it is worth discussing rather than assuming you simply need to tolerate it until menopause.
Can perimenopause affect your gut?
Many women report digestive changes through midlife, including increased bloating and changes to bowel habits. Hormones can affect gastrointestinal motility and the nervous system, while changes in diet, sleep, stress, and physical activity can also influence how the gut behaves.
There is also growing scientific interest in the relationship between the gut microbiome and oestrogen metabolism, sometimes referred to in research as the estrobolome. This is an emerging area rather than a simple explanation for every digestive change during perimenopause, but it reinforces how interconnected these systems can be.
The same caution applies here as it does elsewhere. Persistent digestive symptoms shouldn’t automatically be dismissed as hormonal, particularly if they are severe, worsening or accompanied by other concerning symptoms.
Why does stress suddenly feel harder to handle?
One of the more interesting things women describe during perimenopause is not necessarily having more stress, but feeling less able to absorb the stress that was already there.
Your workload may not have changed dramatically. Family life may be much the same. You may have managed similar pressures perfectly well for years, yet suddenly your tolerance for them seems different.
Hormonal fluctuations can interact with mood, sleep and the systems involved in our stress response. If sleep is also disrupted and you're dealing with physical symptoms at the same time, your capacity to deal with everyday pressure can understandably feel reduced.
This doesn't mean you've suddenly become bad at coping. It means the biological environment you're coping in isn't necessarily the same as it was ten years ago.
What are the “34 symptoms of perimenopause”?
If you’ve spent any time searching perimenopause online, there’s a good chance you’ve encountered a list of the “34 symptoms of menopause” or “34 symptoms of perimenopause”.
There isn’t an official medical rule stating that perimenopause has exactly 34 symptoms. The number has become popular online because it provides a convenient way of grouping together a wide range of physical and psychological experiences associated with the menopausal transition.
Some are well-recognised menopause symptoms, while others are much less specific and can occur for numerous reasons. Rather than trying to tick off enough symptoms to qualify for perimenopause, it is more useful to look for changes and patterns. What has changed? When did it begin? Does it fluctuate with your menstrual cycle? Is it affecting your quality of life? Could something else need investigating?
A checklist can start a conversation. It shouldn't be what diagnoses you.
Can a blood test tell me if I’m in perimenopause?
This surprises many women because testing hormones seems like the obvious way to find out.
For women over 45 experiencing typical symptoms, Australian clinical guidance generally recommends diagnosing perimenopause based on symptoms and menstrual history rather than relying on routine hormone testing. One reason is that hormone levels fluctuate considerably during the transition, so a single blood test only shows what was happening at that moment.
Blood tests may be appropriate in some cases, especially when symptoms start at a younger age, periods stop unexpectedly, or another medical condition needs to be ruled out. Your doctor can determine whether testing makes sense based on your individual circumstances.
So how do you actually know if you’re in perimenopause?
Often, the combination of your age, menstrual history, and symptoms starts to build the picture. Tracking changes can be surprisingly useful because patterns that develop over several months can be hard to remember retrospectively.
You don’t necessarily need another app measuring every bodily function. Even simple notes about changes to your periods, sleep, hot flushes, headaches, mood, joint discomfort and energy can make conversations with your healthcare professional more useful.
Most importantly, if symptoms are affecting your quality of life, there are evidence-based treatment options available. Menopausal hormone therapy may be appropriate for some women, while non-hormonal treatments and lifestyle approaches can also play important roles depending on the symptoms and individual.
Perimenopause is a normal biological transition. That doesn't mean you're required to struggle through it without support.
Perimenopause isn't only about managing symptoms
This is perhaps the part of the conversation I think deserves more attention.
Perimenopause happens at a point in life when the decisions we make around muscle, bone, cardiovascular health, metabolic health, sleep, nutrition and physical activity become increasingly important for the decades ahead. The goal therefore doesn't need to be simply making it through perimenopause with the fewest possible symptoms. It can also be an opportunity to look more closely at what supports long-term health.
Maintaining muscle through resistance training matters. Eating enough protein matters. Bone health and cardiovascular fitness matter. A varied diet rich in whole foods and plant compounds matters, as do sleep, recovery and managing chronic stress.
Inflammatory and oxidative balance also form part of this broader healthy-ageing picture, which is particularly relevant as we begin thinking less about lifespan alone and more about healthspan, or the number of years we spend living in good health.
Where Healthspan fits
Healthspan wasn't formulated to treat perimenopause or replace hormones, and we think that distinction matters.
STMNA Bioactives developed Healthspan around a broader idea: healthy ageing involves multiple interconnected biological pathways, not one symptom requiring one ingredient. Its six plant extracts, curcumin, Boswellia, grape seed, resveratrol, ashwagandha and black pepper, have been selected for their research across areas including inflammatory balance, oxidative stress, stress resilience, joint health and bioavailability.
That broader approach becomes particularly relevant during midlife because perimenopause itself isn't one isolated biological event. Hormonal changes occur alongside changes in muscle, bone, sleep, recovery, metabolic health, and how our bodies respond to stress.
Supporting those foundations doesn't make fluctuating hormones disappear, nor should a supplement be positioned as an alternative to appropriate medical treatment. It is simply one part of a much larger approach to feeling and functioning well as we age.
The bottom line
Perimenopause can begin before your periods become irregular, and the first signs aren't always hot flushes. Changes to sleep, concentration, mood, joints, headaches, digestion, energy, and how your body responds to stress can all be part of the transition.
They can also have other causes, which is why recognising perimenopause should start a conversation rather than end one. You don't need to diagnose yourself from an online checklist, and you don't need to accept disruptive symptoms simply because they're happening during a normal stage of life.
Understanding what is changing gives you a much better foundation for deciding what to do next.
And if one of the biggest changes you've noticed is that your body suddenly feels stiffer, sorer or considerably slower to recover than it did a few years ago, that's exactly where we're going next.
Next in the series: Why Do Your Joints Suddenly Hurt in Perimenopause?
FAQ: Perimenopause Symptoms
What are the first signs of perimenopause?
The first signs vary between women. Changes to menstrual cycles are common, but some women initially notice sleep disruption, hot flushes, mood changes, brain fog, headaches, joint or muscle aches, anxiety or changes in how their body responds to stress.
Can perimenopause start in your 30s?
Yes. Perimenopause most commonly begins during the 40s, but some women can begin experiencing the transition during their late 30s. If symptoms start much earlier, discuss them with a healthcare professional, as other conditions may need to be considered.
Can I be in perimenopause even if my periods are regular?
Yes. Menstrual changes don't necessarily occur first. Some women experience symptoms such as sleep disruption, mood changes or hot flushes while their periods remain relatively regular.
Does perimenopause cause joint pain?
Joint and muscle aches are recognised symptoms during the menopausal transition. Changing oestrogen levels may influence musculoskeletal tissues and inflammatory signalling, although joint pain can have many other causes and persistent symptoms should be properly assessed.
Does perimenopause cause brain fog?
People commonly report changes in concentration and memory during perimenopause. Hormonal changes may contribute, while disrupted sleep, stress, anxiety and other factors can also affect cognitive function.
Why am I so tired during perimenopause?
Disrupted sleep, mood changes, stress, heavier menstrual bleeding and changes to recovery may influence fatigue during perimenopause. Persistent fatigue can also be caused by conditions such as iron deficiency or thyroid disorders, so it shouldn't automatically be assumed to be hormonal.
Can a blood test diagnose perimenopause?
For women over 45 experiencing typical symptoms, perimenopause is generally identified using symptoms and menstrual history rather than routine hormone testing because hormone levels can fluctuate considerably. Testing may be appropriate in certain circumstances, particularly for younger women or when another condition is suspected.
How long does perimenopause last?
The length of perimenopause varies considerably between women and can last several years. It ends when menopause is reached, which is defined as 12 consecutive months without a menstrual period.
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