Perimenopause: The symptoms no one warns you about

Most women have heard about hot flushes and night sweats.

What many don’t realise is that perimenopause can affect almost every part of the body.

Over the years, I have seen women attend appointments convinced they have developed a neurological condition, a heart problem, an autoimmune disease, or that they are simply “losing the plot.”

Often they are surprised to discover that fluctuating hormones may be playing a significant role.

Perimenopause is the transition leading up to menopause. It can begin several years before periods stop completely and is sometimes described as a second puberty in reverse.

Unlike menopause itself, hormone levels during perimenopause do not decline smoothly. Oestrogen and progesterone can fluctuate dramatically, sometimes rising before falling again. This is one reason symptoms can seem unpredictable, appearing out of nowhere, disappearing for weeks or months, and then returning unexpectedly.

Most women are familiar with the common symptoms:

• Irregular periods
• Hot flushes
• Night sweats
• Sleep disturbance
• Mood changes

But there are many other symptoms that receive far less attention.

Neurological and Sensory Symptoms

Some of the most surprising symptoms involve the nervous system.

Women may experience:

• Ringing in the ears (tinnitus)
• Electric shock sensations or “body zaps”
• Tingling in the hands, feet or legs
• Internal vibrations or buzzing sensations
• Vertigo or dizziness
• Burning feet
• A sensation of insects crawling on the skin (formication), often worse at night
• Burning mouth syndrome causing tingling or discomfort of the mouth and gums
• Persistent itchy ears

These symptoms can be alarming, particularly when they occur suddenly. And sometimes before any of the more well known symptoms.

Mental and Emotional Changes

Many women tell me they no longer feel like themselves.

Symptoms may include:

• Brain fog
• Poor concentration
• Forgetfulness
• Increased anxiety
• Panic attacks
• Low mood
• Loss of confidence
• Sudden irritability
• Unexpected episodes of anger or rage

These changes can affect work, relationships and self-esteem and are often among the most distressing symptoms women experience.

Physical Changes You Might Not Associate With Hormones

Hormones influence far more than reproductive health.

Symptoms may include:

• Heart palpitations
• Dry or sore eyes
• Dry mouth
• Changes in body odour
• Bloating and digestive discomfort
• New or worsening constipation
• Joint pain and stiffness
• Frozen shoulder
• Brittle nails
• Hair thinning or increased hair shedding
• Changes in skin texture
• New allergies or histamine sensitivities
• Increased sensitivity to clothing, jewellery or touch

For some women, these symptoms appear years before menopause is recognised.

Why Can Perimenopause Cause So Many Different Symptoms?

One of the reasons perimenopause can be so confusing is that hormones do far more than regulate periods and reproduction.

Oestrogen receptors are found throughout the body, including the brain, bones, skin, bladder, blood vessels and digestive system. As hormone levels begin to fluctuate, it is not surprising that symptoms can appear in many different places.

At the same time, progesterone levels gradually fall, which can affect sleep, mood and anxiety levels. Testosterone also declines, which may contribute to reduced energy, loss of muscle mass and changes in libido.

What makes perimenopause particularly challenging is that hormone levels do not simply decline in a straight line. Oestrogen often rises and falls dramatically, sometimes from day to day.

It is this hormonal instability that creates the rollercoaster of symptoms many women describe.

Some experts have compared perimenopause to adolescence in reverse, or a second puberty. Just as puberty brings a period of rapid hormonal change and adjustment, perimenopause can affect both the body and mind in ways many women never expect.

Why Are These Symptoms Often Missed?

Many of these symptoms mimic other medical conditions.

Fatigue may be attributed to a busy life.

Anxiety may be blamed on stress.

Palpitations may raise concerns about the heart.

Joint pain may be dismissed as ageing.

Women themselves often normalise symptoms, assuming they are simply part of getting older or juggling work, family and other responsibilities.

As a result, many women spend months or even years wondering why they no longer feel like themselves.

When Should You Seek Medical Advice?

Although many symptoms can be related to perimenopause, it is important not to assume that hormones are always the explanation.

Fatigue, palpitations, dizziness, weight changes and low mood can also be caused by conditions such as thyroid disease, anaemia, vitamin deficiencies, diabetes and other medical conditions.

If you are concerned about any new or persistent symptoms, it is always sensible to seek advice from a healthcare professional.

Keeping a symptom diary can be extremely helpful, particularly when symptoms seem to come and go without an obvious pattern.

The Good News

Perimenopause is not an illness, but it can have a significant impact on quality of life.

The good news is that there are many ways to help.

Lifestyle changes, improving sleep, regular exercise, stress management, nutritional support and, where appropriate, hormone replacement therapy can all play an important role.

I have written separately about the Six Pillars of Perimenopause Care, which explores practical ways to support your health during this transition.

Most importantly, if you no longer feel like yourself, you are not imagining it.

Many women experience symptoms they never expected.

You do not have to struggle through it alone.

Understanding what is happening is often the first step towards feeling better.

Thank you for reading. If this article has helped you recognise some of the changes you may be experiencing, I hope it reassures you that you are not alone. Perimenopause can be challenging, but understanding what is happening is often the first step towards feeling better.

You can find more practical health articles in the Practical Health section of the blog, including my article on the Six Pillars of Perimenopause Care.