Nobody Told Me It Would Feel Like This. But Then Again, Nobody Told Me Much At All.
How can we know or possibly imagine how we’re going to feel in perimenopause? The first step is to understand what perimenopause is - then identify your symptoms….
There is a conversation happening in kitchens, offices, gym changing rooms, and hen party tables all over the world. It goes something like this: one woman mentions she has not been sleeping well, that she feels inexplicably anxious, that her brain has not been working properly for months. Another woman looks at her and says "that sounds like perimenopause." And the first woman laughs, because she had no idea because nobody told her (spoiler alert, that was me at 39!)
If you are reading this wondering whether what you are experiencing might be the beginning of your hormonal transition, the first thing I want you to know is that you are not imagining it. The second thing I want you to know is that you are almost certainly not alone in having missed it — or in having had it missed by the people who were supposed to help you.
Perimenopause is one of the most significant hormonal shifts a woman's body will ever go through, and it remains one of the least talked about, least understood, and most frequently misdiagnosed transitions in women's healthcare. That is not acceptable. So let us change it.
What actually is perimenopause?
Perimenopause is the transitional phase that precedes menopause — the years during which your ovaries gradually begin to produce less oestrogen and progesterone. It is not a single event so has no specific start date, it is a process, and it can begin as early as your mid to late thirties, long before most women would think to consider it.
Menopause itself is defined as the point at which you have gone twelve consecutive months without a period. That is one day, technically — the day you reach that twelve-month mark. Everything before it is perimenopause. Everything after it is postmenopause.
The perimenopause transition typically lasts between four and ten years. For some women it is shorter whilst for others it extends well beyond that. There is no standard timeline, no predictable sequence, and no reliable way to know at the outset how long it will last or how it will feel. What there is, however, is a very long list of symptoms that are worth knowing about — because the earlier you recognise what is happening, the earlier you can do something about it.
The symptoms — and why they are so easy to miss
There are over 45 recognised symptoms of perimenopause and menopause. Most women know about hot flushes and missed periods. Very few know about the rest.
Here is what perimenopause can actually look like:
Sleep Difficulty falling asleep, waking in the night — particularly between 2am and 4am — vivid or disturbing dreams, waking unrefreshed regardless of how many hours you have slept, and night sweats that drench you and then leave you wide awake and shivering.
Mood and mental health Anxiety that appears without a clear trigger, low mood, a short fuse that does not feel like you, sudden episodes of rage that pass as quickly as they arrive, a flat or disconnected feeling, loss of motivation, and a creeping sense that you are not quite yourself anymore.
Cognitive function Brain fog — that specific, frustrating inability to find words, follow a thread, or hold a thought — reduced concentration, memory lapses, and a general sense of mental sluggishness that no amount of sleep or caffeine seems to shift.
Physical symptoms Hot flushes, heart palpitations, joint and muscle pain that moves around and has no obvious cause, headaches or migraines that are new or worsening, changes in your skin and hair, increased urinary frequency or urgency, and a noticeable reduction in your physical resilience — feeling more sore after training, recovering more slowly, and finding that your body no longer responds to exercise the way it used to.
Cycle changes Periods that become irregular — heavier, lighter, more frequent, or further apart. Increased PMS. Spotting between periods. Cycles that were previously predictable becoming erratic. This is often one of the first physical signs, though by no means always the first symptom women notice.
Libido and intimate health Reduced interest in sex, vaginal dryness or discomfort, increased sensitivity or pain during sex, and changes in how your body responds that can feel confusing and isolating if nobody has explained that they are hormonal and entirely normal.
Metabolism and weight Unexplained weight gain, particularly around the abdomen, difficulty losing weight despite no change in diet or exercise, increased bloating, and changes in how your body uses and stores energy.
Not every woman will experience all of these and many women will experience only a handful but the sheer range of symptoms is precisely why perimenopause gets missed — because no single symptom points definitively to hormones, and because taken individually, each one has a more obvious explanation close to hand.
The way life gets in the way
Here is the truth about why so many women in their late thirties and forties do not recognise perimenopause when it arrives: their lives are full to the absolute brim and the symptoms of perimenopause are specifically designed to look like the consequences of that fullness.
You are tired because you are busy. You are anxious because there is a lot to be anxious about. You are not sleeping well because your mind does not switch off. You are gaining weight around your middle because you are stressed and not prioritising yourself. You are forgetting things because you have seventeen things on your mental list at any given moment. Your joints ache because you train hard. Your mood is unpredictable because, frankly, a lot is asked of you.
Every single symptom has an alibi. And so the months pass, and the years pass, and women continue to push through — blaming themselves, adjusting their expectations, and quietly absorbing a level of difficulty that they should never have been asked to simply manage alone.
There is also a generational layer to this: many of us grew up watching our mothers and grandmothers (although to be fair we didn’t actually know we were watching them go through menopause, we just thought they were a bit more tired or crank than normal) go through menopause in silence, or with a dismissive comment from a doctor, or with the clear message that this was simply what getting older felt like and there was nothing much to be done about it. That message is deeply embedded, even in women who intellectually know better so it makes us reluctant to complain, slow to seek answers, and quick to tell ourselves we are probably just tired.
And then there is the healthcare piece. Despite significant progress in recent years, perimenopause is still routinely misdiagnosed and anxiety symptoms are treated with antidepressants without any hormonal investigation. Heart palpitations trigger cardiac referrals that come back clear. Joint pain is attributed to early arthritis. Insomnia is managed with sleep hygiene advice rather than any conversation about what might be driving it. Women are told they are too young, their bloods are normal, everything looks fine. I have been told this so many times by my clients and it makes me furious. What right does a Doctor have to make a woman feel ridiculous and that she is a time waster when she has reached out for help - which in some cases has taken her months to pluck up the courage to do so?
Everything looks fine on the outside but it does not feel fine on the inside.
So how do you know?
The honest answer is that there is no single test that confirms perimenopause. Hormone levels fluctuate so significantly during this transition that a blood test on any given day can appear entirely normal while your oestrogen is actually in the process of declining. The most reliable diagnostic tool is your own experience — your symptoms, your cycle, your age, and your history.
This is exactly why having a conversation with someone who understands the full picture matters so much. Not a brief appointment where you mention one symptom and leave with a referral. A proper, unhurried conversation that takes everything into account — your sleep, your mood, your training, your nutrition, your stress, your cycle, your life.
That is what I do. Not because I have a test that gives you a definitive answer, but because I know how to listen, how to join the dots, and how to help you understand what your body is telling you — and what to do about it.
The most important thing I can tell you
You do not have to feel this way and just get on with it. You do not have to wait until your symptoms are severe enough to feel justified in asking for help. You do not have to spend another twelve months wondering whether it is your hormones or your life that needs addressing.
Perimenopause is not the end of anything.: understood and supported, it is the beginning of the most self-aware, intentional, and powerful chapter of your life.
But it starts with knowing what is happening.
Menopause is not the end. It is the beginning.
Not sure if what you are experiencing is perimenopause?
The clearest next step is a conversation. I offer a free discovery call for women who want to make sense of what their body is going through and understand what kind of support would actually help.
It is not a sales call. It is not a quick chat with a script. It is a proper, unhurried conversation about where you are, what you are experiencing, and what your options are.
If anything in this blog felt familiar, I would love to hear from you.
[ BOOK YOUR FREE DISCOVERY CALL → ]
And if you are ready to take a more structured approach to understanding and resetting your menopause, my MenoReset 30-Day Lifestyle Course covers everything — hormones, sleep, nutrition, training, and stress — in four weeks, at your own pace, for £49.