Perimenopause symptoms: What to expect and how to feel your best

After decades in your body, you know when something's different. Maybe your periods have become irregular, or you're waking up drenched in sweat. Your mood might feel more unpredictable, or you're no longer sleeping as well as you used to. These changes are usually the first signs of perimenopause.

Perimenopause involves hormonal shifts that are no less dramatic than those experienced during puberty [1]. Yet, while we openly discuss puberty when it happens in our teens, perimenopause often remains a taboo topic in conversations about our health. So it makes sense that many women don’t realise that these big changes are actually completely normal.

Perimenopause is a natural transition, and its related symptoms are manageable with practical steps, medical guidance when needed, and a good dose of self-care.

This article explains what's normal, when you might need to see a clinician, and practical ways to feel more like yourself during this time of change.

What is perimenopause?

The term perimenopause refers to the time leading up to your final menstrual period, known as menopause. It's also called the menopause transition.

During this phase, your ovaries begin to make less oestrogen, and your hormone levels become less predictable. Your menstrual cycle may change, ovulation might be skipped, and symptoms linked to these hormonal fluctuations can appear.

Perimenopause officially ends 12 months after your last period, which is when you've officially reached menopause [2] – and by this point, you've definitely earned a gold medal (and a cool flannel).

What are the early symptoms of perimenopause?

The symptoms during early perimenopause can be subtle — they're often the first sign that something's afoot. These physical symptoms might include:

• Changes in your menstrual cycle: Irregular periods, cycles becoming shorter or longer, heavier or lighter bleeding [3]
• Spotting between periods or missed periods: This is one of the first symptoms many women notice [4]
• New or worsening symptoms similar to premenstrual syndrome: Such as bloating, breast tenderness, mood swings [4]

These early symptoms may appear even before the more widely recognised signs of perimenopause kick in, sometimes while you're still in your reproductive years.

Common symptoms of perimenopause

As symptoms during perimenopause progress, many women experience a broader range of changes:

• Hot flushes (sometimes called hot flashes) and night sweats. These vasomotor symptoms (caused by changes in your blood vessels that affect temperature regulation) are very common, and can appear suddenly and range from mildly annoying to incredibly disruptive [3]
• Trouble sleeping, such as difficulty falling asleep or waking repeatedly. This can often be linked to night sweats [5]
• Mood swings, anxiety, low mood or irritability. These emotional symptoms may accompany the hormonal shifts [3][5]
• Brain fog, trouble concentrating or forgetfulness. Many women describe feeling as though they're "thinking through cotton wool" [5]
• Vaginal dryness and changes in sexual comfort or libido. This can happen as your body's tissues respond to changing hormone levels [3]
• Weight gain, particularly around the abdomen, despite no major change in diet. This is one of the most commonly reported symptoms [4]
• Musculoskeletal aches, headaches, and general tiredness [3]

If you're experiencing any combination of these symptoms, you're in good company — they're incredibly common during perimenopause. While they vary in severity from person to person, they're a normal part of this transition.

Other symptoms of perimenopause you might experience

Beyond the more common experiences above, you might notice some other physical and emotional symptoms:

• Skin changes (drier skin, hair thinning)
• Breast tenderness
• Urinary urgency or increased need to pass urine due to genitourinary changes (changes affecting the urinary tract and vaginal tissues) [5]
• Heavy menstrual bleeding or new-onset bleeding irregularities — these may require investigation to rule out other health conditions [2][4]
• Changes in libido, increased anxiety, or new-onset depression

It's worth noting that while many women have mild or moderate menopausal symptoms, some experience severe symptoms that impact their lives day-to-day and may need more targeted support. That doesn't make you weak or different — it's simply a reflection of how complex and varied our biology is.

What causes perimenopause symptoms?

Changing hormone levels are at the root of many symptoms you'll experience — particularly fluctuations in oestrogen and progesterone. Your ovaries will gradually reduce their hormonal output, affecting body systems like thermoregulation (hence the hot flushes), sleep regulation, mood, bone health, and cardiovascular health [3][5].

Certain factors can also influence when perimenopause begins or how it feels. Family history of early menopause, lifestyle factors such as smoking, body weight, prior surgery, or certain medical treatments and conditions can all play a role [6].

How is perimenopause diagnosed?

There’s no single perimenopause test that tells you definitively whether you are perimenopausal. A diagnosis of perimenopause is usually made based on your symptoms (such as irregular periods, hot flushes, night sweats) and changes to your menstrual cycle [7].

Blood tests measuring hormone levels can be misleading, since hormone levels fluctuate widely during this transition. Your doctor will likely focus more on the pattern of symptoms and changes to your period [7].

If you're under 45 and have symptoms of perimenopause, your doctor may order tests to rule out other conditions, including thyroid problems or other hormonal issues. They may also review your contraceptive needs, as birth control options can make a big difference in managing both symptoms and preventing unplanned pregnancy during this transitional phase [2][7].

A shift in perimenopause care

Reading through all these symptoms and changes can feel overwhelming — even bleak. Many women describe feeling dismissed or confused when they seek help, and historically, healthcare professionals have had significant gaps in their knowledge about perimenopause and menopause.

But things are changing. Australia is developing its first national clinical guidelines for perimenopause and menopause, which will help doctors diagnose, treat and care for women in a more consistent way [8]. The Australian Government has also introduced new Medicare items for menopause and perimenopause assessments, alongside better access to treatments and expanded specialist clinics [8].

This shift means your concerns are being taken more seriously. The conversation around perimenopause is opening up, research is expanding, and healthcare providers are getting better training — we love to see it.

How to manage and treat perimenopause symptoms

While perimenopause is a natural part of life and can't be pushed back or prevented, many women find practical ways to ease symptoms and feel their best.

Lifestyle and diet changes that can manage perimenopause

• Sleep support: Keep a consistent sleep schedule, reduce evening screen time, and create a cool, comfortable sleep environment to help combat night sweats and sleep problems [2]
• Nutrition: Focus on a balanced diet with plenty of whole grains, fibre and protein to support energy and mood. Reducing caffeine and alcohol may help with hot flushes and night sweats [2][4]
• Movement: Staying active with regular exercise (a mix of aerobic, resistance and flexibility work) helps mood, sleep, metabolic health, and may lessen the severity of some symptoms [2]
• Stress management: Mindfulness, breathing exercises, yoga or gentle movement can help with mood changes and emotional symptoms. Your nervous system will feel the difference [4]
• Vaginal dryness support: For vaginal dryness, non-medicated options such as water-based lubricants and moisturisers (suitable for vaginal use) plus pelvic floor work may help. It's absolutely fine to talk to a women's health physio about this — they've heard it all before.

Medical and non-medical treatment options

When symptoms are more significant (for example, moderate or severe hot flushes, or mood changes that interfere with daily life), your doctor may discuss treatment options such as hormone therapy (sometimes called hormone replacement therapy) or other prescription supports [2][3].

Some women already taking birth control pills may find that these help manage perimenopausal symptoms, while others may need different approaches. It's important that any discussion of treatment is individualised — what suits one person may not suit another, based on health history, increased risk factors (like family history of serious illnesses or heart disease) and the severity of symptoms.

Some women may prefer non-hormonal treatments if hormone therapy isn't appropriate, or opt to use these treatments alongside lifestyle changes.

When to see your doctor about perimenopause symptoms

You should consult your doctor if you have:

• Very heavy or prolonged bleeding or bleeding after sex. This may signal something other than perimenopause [2]
• Symptoms that interfere significantly with your daily life (for example, severe hot flushes, poor sleep, mood changes, brain fog)
• New pelvic pain, very irregular bleeding, or other changes that could signal other health conditions

Having conversations about your symptoms early can help you and your doctor shape a plan to manage your symptoms that's tailored to you and your lifestyle.

Can perimenopause be prevented or delayed?

In short, no, perimenopause is a natural part of a woman's life. While you can't reliably prevent the transition, maintaining a healthy lifestyle — including a good diet, regular exercise, and avoiding smoking — supports your general well-being and may influence how you experience this significant stage of life [3][6].

Caring for yourself through perimenopause

Perimenopause isn't just a physical transition — it's an emotional one, too. Some women feel liberated, welcoming a new chapter free from periods or contraception worries. Others might feel a sense of loss or grief for what feels like the end of one life phase.

As you navigate both the physical and emotional aspects of perimenopause, these strategies can help:

• Keep a symptom diary: Note periods, hot flushes, night sweats, mood, sleep, vaginal dryness, and weight changes, as these help you see patterns and give your clinician useful information.
• Be kind to yourself: This is a time of change and adjustment. Prioritise sleep, movement, social connection and rest. Your body is doing something big — cut yourself some slack.
• Reach out: Talk with friends, join a support group, see a health professional. You don't have to soldier on if you notice brain fog, have trouble concentrating or experience mood changes.

If you ever feel your symptoms are too much to manage, or if you're worried, book an appointment with your GP.

Finding support through perimenopause

Thousands of women go through perimenopausal symptoms and find relief when they combine practical self-care with the right medical support. These organisations have information and resources on perimenopause and menopause that can help:

• Jean Hailes for Women's Health
• Australasian Menopause Society (AMS)
• Menopause Alliance Australia
• Beyond Blue
• Healthdirect Australia
• Lifeline

Remember, your regular GP is always your first point of contact for personalised medical advice about your symptoms and treatment options.

At Juniper, we understand that perimenopause is a significant transition that affects your whole well-being. If you're experiencing perimenopausal symptoms and looking for support, our team is here to help you navigate this phase with personalised care and practical guidance.

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