From brain fog to brittle nails, the change creeps in quietly. A new shake-up means fewer women will be left guessing.
Perimenopause arrives before periods stop for good, yet it rarely sends a clear memo. Symptoms flicker on and off. Many women chalk them up to stress, age or burnout. Now, routine health checks are set to ask the right questions, putting this life phase centre stage.
What perimenopause really means
Perimenopause is the body’s transition towards menopause. Oestrogen and progesterone swing up and down, sometimes within hours. The phase begins when symptoms start and ends 12 months after the final period. It can last a few months or stretch close to a decade. Most women first notice changes in their early forties, though some feel shifts earlier.
Hormones influence every system. Mood, sleep, joints, skin, eyes and the brain all respond. That is why the picture looks different from one person to the next. The hormonal turbulence, not a single trigger, drives the pattern.
Research suggests three in four women report perimenopausal symptoms. Many feel them for an average of seven years.
Symptoms you might miss
Hot flushes and night sweats get headlines. They are not the only clues. The early signs often look like day-to-day life strain. That is where many get caught out.
- Irregular or heavier periods, or cycles that shorten
- Brain fog, word-finding pauses, dips in focus
- Mood swings, anxiety spikes, irritability
- Sleep disruption, especially waking at 3am wide awake
- Joint stiffness, new body aches, morning soreness
- Headaches or a change in migraine pattern
- Vaginal dryness or itching, pain with sex, urinary frequency
- Reduced libido and vaginal discomfort
- Dry eyes, tinnitus, altered taste or smell, brittle nails
For many, the most disabling changes relate to the brain. Memory slips, low motivation and anxiety affect work, home life and parenting. These aren’t character flaws. They map closely to fluctuating oestrogen signalling in brain regions that govern attention, mood and sleep.
The health check shift that could change lives
England’s routine health checks for adults aged 40 to 74 run every five years. Menopause questions are being built in for the first time. The move could guide almost 5 million women towards timely support. The aim is simple. Spot symptoms early. Start evidence-based care. Reduce long-term risks tied to falling hormones.
New screening questions mean fewer women will be told to “push through” symptoms that respond well to treatment.
Policymakers have framed the change as overdue. Women have often been left to join the dots themselves, or asked to wait it out. A structured prompt during a check-up can change the trajectory for midlife health.
Parenting through perimenopause
Many women juggle this transition while managing school runs, homework and teens. Patience thins. Noise feels harsher. Sleep loss bruises the next day. Children may read forgetfulness or snappiness as rejection. Misunderstandings grow when nobody names what is happening.
Age-appropriate conversations help. A simple script works. “Mum’s hormones are changing. I may get tired or overwhelmed quickly. It’s not your fault.” Families who talk about it report fewer flare-ups and steadier bonds. A shared language lowers shame and blame on all sides.
Health risks that sit beneath the symptoms
Lower oestrogen affects bone density, blood vessels and glucose control. That shifts risk for osteoporosis, heart disease, type 2 diabetes and cognitive decline over time. Symptom care is one goal. Protection for future health is another.
| Issue | What changes | What to discuss |
|---|---|---|
| Bone health | Faster bone loss after 45 | Weight-bearing exercise, calcium, vitamin D, fracture risk checks |
| Heart health | Rising blood pressure and cholesterol | Blood pressure, lipids, exercise plan, smoking cessation |
| Metabolic health | Insulin resistance can increase | Waist measurement, glucose or HbA1c, nutrition support |
| Brain health | Sleep and mood regulation shift | Insomnia strategies, mood screening, treatment options |
Treatment and support that actually help
Most women over 45 can be diagnosed based on symptoms. Hormone blood tests often fluctuate too much to give a clear answer. Under 45, tests may guide decisions and rule out other causes.
Hormone therapy
Modern hormone replacement therapy (HRT) usually pairs body-identical oestrogen with progesterone if you have a uterus. Oestrogen can be delivered as gel, patch or spray. Vaginal oestrogen targets local symptoms directly. Some women benefit from testosterone for low libido and energy. Personal and family history shape choices, so a GP review is vital.
Non-hormonal options
Cognitive behavioural therapy supports sleep and anxiety. Certain antidepressants or non-hormonal medicines can cut hot flushes. Pelvic floor physiotherapy eases bladder symptoms and supports sexual comfort. Lubricants and moisturisers help dryness. Migraine care may need adjusting as hormones shift.
Lifestyle that moves the dial
- Track symptoms for 8–12 weeks to spot patterns and triggers.
- Set a strict sleep window, cut late caffeine, and dim screens.
- Lift weights twice a week and walk daily for bones and mood.
- Reduce alcohol to protect sleep and hot flush control.
- Add protein at each meal to steady energy and support muscle.
- Schedule rest. Lower the bar at home. Share the load.
If symptoms disrupt daily life, book a GP appointment. You do not need to wait for periods to stop.
Five frequent questions
How do I tell stress from perimenopause?
Stress and perimenopause often overlap. Clues point to hormones when cycles change, hot flushes appear, morning joint stiffness grows, sleep fragments and mood swings spike. If you are over 40 and ticking several boxes, assume hormones are involved and seek advice.
Can it begin in your thirties?
Yes. A small proportion enter early menopause, and symptoms can appear beforehand. If you are under 45 with repeated symptoms, see your GP. Blood tests and other checks may be suggested.
Do I need blood tests?
Often not after 45. Hormone levels swing, so a single reading may mislead. Clinicians usually diagnose from symptoms and history. Under 45, tests can help rule out thyroid issues, pregnancy or other causes.
Which symptoms fly under the radar?
Tinnitus, dizziness, dry eyes, a change in taste or smell, gum bleeding and deep bone aches can all link to hormonal shifts. Many women only connect them once treatment improves both the obvious and the odd symptoms together.
How do I talk to my children about it?
Keep it direct and calm. Explain that body changes can make you tired or snappy but love and safety have not changed. Invite questions. Agree a signal for when you need a pause. Families report fewer clashes when everyone understands the context.
What to do this week
Start a simple symptom diary. Note sleep, cycle changes, mood, flushes, pain and stressors. Bring it to your GP. Ask about HRT suitability, local vaginal treatments, migraine adjustments and bone health checks. Request blood pressure, lipid and glucose measurements at your next check-up.
If sex is painful, raise it. Local oestrogen and pelvic floor therapy can transform comfort. If anxiety surges, ask about talking therapies and short-term medicines that suit your health profile. If work is tough, discuss small adjustments such as flexible start times or access to cooler spaces.
A wider lens on midlife health
Perimenopause is not a failure of willpower. It is a biological transition with predictable patterns and workable solutions. Small, steady steps protect bones, the heart and the brain for decades. Plan strength training with a friend. Build a wind-down routine. Keep a midlife health folder with test results and notes. These habits stack benefits, even on messy days.
Consider a “what if” plan for rough weeks. Prepare easy meals in the freezer. Set family roles for school admin. Create a quiet signal at home. These moves reduce friction, preserve energy and make room for recovery. The goal is not perfection. The goal is steadier ground while hormones settle.
This is the first time I’ve seen dry eyes, tinnitus and brittle nails tied to perimenapause—explains A LOT. Thank you for the clear, not-too-jargony guide. I’d definitly been chalking it up to “stress”. Starting a symptom diary and booking a GP review; curious about risks vs benefits of HRT and testosterone add-ons for low libido.