What Are the First Signs of Perimenopause? 10 Changes You Might Not Expect

Perhaps you've noticed that your periods have become a little unpredictable, you're not sleeping quite as well as you used to, or you're feeling unusually anxious about things that wouldn't normally bother you.

Maybe you've started waking up exhausted, forgetting what you walked into a room for or finding yourself increasingly irritated by everybody around you.

And somewhere along the way, you've begun wondering whether this could be perimenopause.

We often associate menopause with hot flushes and periods stopping, but the reality is that the first signs can be much more subtle.

For some women, the changes begin in their early forties, sometimes before they've even considered that perimenopause might be approaching.

So what should you be looking out for?

What is perimenopause?

Perimenopause is the transitional stage leading up to menopause, when hormone levels begin to fluctuate and your menstrual cycle starts to change.

Menopause itself is reached when you've gone 12 consecutive months without a period, provided you're not using hormonal contraception that affects your bleeding.

Although menopause usually happens between 45 and 55, the transition can begin several years earlier.

And because every woman experiences it differently, there isn't one definitive list of symptoms or a particular order in which they appear.

Here are ten changes worth being aware of.

1. Your periods start behaving differently

Changes to your menstrual cycle are often one of the earliest signs of perimenopause.

You might notice your periods arriving closer together, becoming further apart, lasting longer or getting heavier or lighter.

Perhaps you've always had a predictable 28-day cycle, but suddenly you're experiencing periods every 24 days, or you're never quite sure when the next one will arrive.

These changes can happen as ovulation becomes less predictable.

However, unusually heavy bleeding, bleeding between periods or bleeding after sex should always be discussed with your GP rather than automatically attributed to perimenopause.

2. You're suddenly feeling more anxious

This is one that can really catch women by surprise.

Perhaps you've never considered yourself an anxious person, but lately you're worrying about things that wouldn't normally concern you.

You might feel uneasy for no obvious reason, notice your confidence slipping or find that situations you've managed comfortably for years suddenly feel overwhelming.

Hormonal fluctuations during perimenopause can contribute to mood changes and anxiety, although sleep disruption, stress and other health factors may also play a role.

If anxiety is something you're experiencing, I've written more about why anxiety can increase during perimenopause.

3. You keep waking up during the night

Perhaps you're falling asleep perfectly well but finding yourself wide awake at 3am, wondering why on earth you can't get back to sleep.

Or maybe you've started waking several times throughout the night, even though you haven't changed anything about your bedtime routine.

Sleep disturbances are common during perimenopause and can be associated with hormonal changes, night sweats and changes in mood.

But persistent insomnia can also have other causes, including sleep apnoea, medication or underlying health conditions.

I've explored this in more detail in my article about waking up at 3am during perimenopause.

4. Your concentration isn't what it used to be

Have you found yourself walking into a room and forgetting why you went there?

Or perhaps you're struggling to find a word halfway through a conversation, finding it harder to concentrate at work or feeling as though your brain is permanently full.

Brain fog is a commonly reported experience during perimenopause.

Hormonal changes may contribute, but sleep deprivation, stress and other factors can make concentration and memory difficulties worse.

It's frustrating, particularly if you've always been organised and capable of juggling several things at once.

Significant, progressive or unusual cognitive changes should be assessed by a healthcare professional rather than assumed to be hormonal.

5. You're more irritable than usual

Perhaps the smallest things have started irritating you.

The noise of the television, somebody asking another question when you're trying to concentrate, or being expected to organise something you've organised a hundred times before.

You might find yourself becoming more short-tempered or emotional, sometimes without understanding why.

Mood changes are recognised symptoms of perimenopause, but I also think it's worth considering the wider demands of midlife.

Many women are managing careers, children, relationships, ageing parents and an enormous amount of responsibility.

Hormonal changes can be happening alongside all of this.

And sometimes it might be worth asking whether you're actually becoming less patient, or whether you've simply been carrying too much for too long.

6. You're feeling tired even after resting

There's ordinary tiredness, and then there's the kind of exhaustion that makes everything feel like an enormous effort.

Perhaps you're sleeping for eight hours but still waking up feeling as though you haven't rested.

You might notice your energy levels fluctuating or find that you're struggling to manage the things you used to do comfortably.

Fatigue can accompany perimenopause, particularly when sleep has become disrupted.

However, persistent exhaustion shouldn't automatically be blamed on hormones. Iron deficiency, thyroid conditions and other health problems can cause similar symptoms.

7. Your joints and muscles feel different

You might notice aching joints, increased stiffness or muscle discomfort that seems to have appeared without an obvious explanation.

Perhaps your knees feel stiff when you first get up, your shoulders ache more frequently or you find it takes longer to recover after exercise.

Joint and muscle discomfort can occur during perimenopause, although these symptoms have many possible causes.

If you're experiencing persistent pain, swelling or significant changes in mobility, it's important to have them assessed.

8. You're experiencing heart palpitations

Some women notice their heartbeat becoming more noticeable during perimenopause.

You might experience occasional fluttering, a racing sensation or become more aware of your heartbeat.

Palpitations can occur during menopause-related hot flushes, but they can also be associated with anxiety, caffeine, thyroid problems and heart rhythm conditions.

Because there are several possible explanations, new or recurring palpitations should be discussed with your GP.

If palpitations occur with chest pain, severe breathlessness or fainting, seek urgent medical help.

9. Your skin, hair or body feels different

Perhaps your skin has become noticeably drier, your hair seems thinner or you've started experiencing itching without understanding why.

You might also notice changes in how your body stores weight, particularly around your middle.

Changes in skin, hair