Perimenopause: The Often-Missed Phase That Can Change Everything

Perimenopause is the stage before menopause, and for many women, it is where the biggest changes actually happen. It is the time when hormone levels begin to fluctuate, especially oestrogen and progesterone, even though periods may still be regular or only slightly irregular. This phase can last several years and often begins in a woman’s late 30s or early 40s, sometimes earlier.

For many women, perimenopause comes as a surprise. They feel different, but do not immediately connect their symptoms to hormonal change. Because periods have not stopped, it is easy to assume something else is going on, stress, burnout, anxiety or simply ageing. This is why perimenopause is often misunderstood, overlooked or misdiagnosed.

How Common Is Perimenopause?

Perimenopause affects millions of women. In the UK, around one in three women aged 35 to 44 are thought to be experiencing early perimenopausal symptoms, whether they recognise it or not. Studies suggest that up to 75 to 90 per cent of women will experience symptoms during this phase, with many describing them as disruptive to daily life.

Despite how common it is, many women say they were never told what perimenopause was or what it might feel like.

Symptoms That Can Feel Confusing or Overwhelming

Perimenopause symptoms can be wide-ranging and unpredictable. Hormone levels rise and fall rather than declining steadily, which is why symptoms can feel intense one month and manageable the next.

Common symptoms include changes to periods, such as them becoming heavier, lighter, closer together or further apart. Sleep problems are very common, as are night sweats and hot flushes. Many women experience fatigue that does not improve with rest.

Emotionally and mentally, perimenopause can be particularly challenging. Anxiety, low mood, irritability and sudden emotional reactions are frequently reported. Brain fog is another common experience, where concentration feels harder and memory less reliable. Some women describe feeling unlike themselves for the first time in their lives.

Physical symptoms can include headaches, joint pain, heart palpitations, weight changes, bloating and changes in libido. Because these symptoms affect multiple systems in the body, women often see different professionals before realising hormones are the root cause.

What It Can Feel Like in Real Life

Many women say perimenopause crept up on them. One day they were coping, the next they felt overwhelmed by emotions they could not explain. Some recall lying awake night after night, feeling anxious for no clear reason. Others noticed their confidence at work slipping, struggling to remember words or losing focus during meetings. Women who experience perimenopause earlier than expected often feel dismissed. Being told they are too young can delay diagnosis and leave them feeling unheard. It is common for women to spend years believing something is wrong with them, rather than understanding their body is transitioning.

Perimenopause and Work

Perimenopause often coincides with busy life stages. Many women are advancing in their careers, managing families or caring for others when symptoms peak.

Brain fog, fatigue, sleep deprivation and anxiety can affect confidence and performance. Some women begin to doubt their abilities, even though nothing about their skills has changed. Many stay silent at work, worried they will be judged or misunderstood.

Where employers are open and supportive, small adjustments can make a significant difference. Flexible working, understanding managers, temperature control and permission to rest or reset during the day can help women remain productive and engaged.

Getting Support and Seeking Help

The most important thing to know is that help is available. If symptoms are affecting daily life, speaking to a GP is a valid and important step. Keeping a record of symptoms can help make conversations clearer and more productive.

Treatment options may include hormone replacement therapy, depending on individual circumstances, as well as non-hormonal approaches. Lifestyle changes can also be supportive. Gentle exercise, prioritising sleep, reducing alcohol, managing stress and seeking emotional support all play a role.

Talking openly with friends or joining support groups can be incredibly reassuring. Simply knowing that others feel the same can reduce fear and isolation.

How to Support Someone Going Through Perimenopause

If someone you care about is in perimenopause, kindness and patience matter. Listening without minimising their experience can help them feel seen. Offering practical support, flexibility and reassurance can ease pressure, especially during difficult days. Encouraging professional support, without pushing or judgement, can also be helpful. Perimenopause is not something to endure quietly.

A Time of Change, Not Failure

Although perimenopause can feel unsettling, many women later describe it as a period of growth. It often prompts a reassessment of health, boundaries and priorities. Some women find they become more self-aware, more confident in saying no, and more intentional about how they live and work. Perimenopause is not a sign that something is wrong. It is a natural transition that deserves understanding, care and compassion. If you are experiencing it, you are not alone. And if you are supporting someone who is, your empathy can make all the difference.