If you’re a woman in your late 40s, you know that nobody gives you a handbook on how to gracefully wade through the hormonal rollercoaster that is perimenopause. For many, it sneaks in quietly—one skipped period here, one unexpected night sweat there—until suddenly you’re Googling things like ““why are my periods suddenly irregular?” or “why am I getting hot flashes at night?”
If you’re starting to feel like your body has a new script you didn’t get the memo for, you’re not alone. Perimenopause is the natural transition before menopause, when estrogen and progesterone begin to fluctuate and (let’s be honest) start wreaking havoc. It can last a few years or stretch over a decade. The tricky part is that the signs aren’t always obvious. Which is why having a perimenopause symptoms checklist handy can make the whole journey feel a little less confusing.
So let’s break it down together. Here are the key signs of perimenopause, according to the NHS, to watch out for.
Sign #1: Irregular Periods and Cycle Changes
The first sign many women notice is that periods stop following the script. Maybe your cycle was always clockwork, 28 days on the dot, and suddenly you’re skipping months. Beyond skipped periods, the flow itself can shift. Your once-reliable five-day bleed might turn into a two-day sprint or a ten-day marathon. Some women also experience flooding, which is sudden heavy bleeding that feels overwhelming.
What’s happening underneath? Estrogen and progesterone are the hormones that regulate ovulation and the building and shedding of the uterine lining. As the ovaries gradually reduce their production, the hormonal signals become erratic. Some months, the lining builds up more than usual and bleeding is heavier and other times ovulation doesn’t occur at all, leading to a skipped or very light period.
This unpredictability can be frustrating (especially when your period shows up the one day you wore white jeans). Having products you trust in your bag helps you feel a little less ambushed. Nua’s zero irritation sanitary pads are a game-changer here, their multi-size pack is perfect when you’re not sure whether you’ll get a light day or a sudden heavy flow. Bonus: they’re rash-free, which matters more than ever when your skin feels extra sensitive.
Sign #2: Perimenopause & Mental Health
One minute you’re laughing at a meme, the next you’re crying at a detergent ad. Or worse, feeling a cloud of anxiety or sadness you can’t explain. Hormonal fluctuations during perimenopause can feel like being on a rollercoaster you never actually bought tickets for.
Estrogen plays a big role in regulating mood because it interacts with serotonin, the “happy hormone.” When estrogen levels dip, it can leave you feeling irritable, anxious, or just off. For some, mood swings and perimenopause also come with episodes of depression or heightened anxiety. These aren’t just “in your head”, they’re tied to real chemical changes.
So what can you do? Building stress-relief habits like deep breathing, regular walks, or meditation can help smooth out mood swings. Talking openly with a friend or therapist takes some of the weight off, and simple daily structure like consistent sleep, meals, and movement, gives your brain and body more stability to ride the hormonal waves.
Sign #3: Hot Flashes and Night Sweats
Ah, the infamous hot flashes. You’ll be sitting in a perfectly air-conditioned room, and suddenly it feels like you’re standing in the middle of a desert. Your face flushes, sweat trickles down your back, and you’re peeling off layers like it’s a strip show nobody asked for.
This is one of the most talked-about physical changes during perimenopause, and for good reason. It’s uncomfortable, unpredictable, and sometimes even embarrassing. The science behind it? As estrogen levels drop, the hypothalamus (the brain’s thermostat) becomes more sensitive to even tiny changes in body temperature. Sometimes that means it mistakenly thinks you’re overheating and triggers a cooling response. So, your blood vessels dilate, the heart rate rises, and sweat glands go into overdrive. That’s the hot flash. At night, the same mechanism can disrupt your sleep, leading to the drenched sheets we call night sweats.
To manage them, try dressing in layers, keeping your bedroom cool, and avoiding alcohol, caffeine, and spicy foods before bed. Some women also find relief with relaxation techniques like slow breathing or yoga.
Sign #4: Sleep Disturbances
It’s 2 a.m. You’re wide awake, scrolling through your phone, and wondering why your brain refuses to shut off. Insomnia is one of the sneakier perimenopause symptoms, often connected to night sweats but also to changes in brain chemistry. When estrogen drops, it alters levels of neurotransmitters like serotonin and melatonin, which normally help regulate your sleep-wake cycle. At the same time, the body’s core temperature control shifts, making you more likely to wake up overheated and restless.
Lack of sleep can amplify everything else—your mood, your energy levels, even your appetite. Creating a calming bedtime ritual can help: herbal tea, stretchy pajamas, and no doom-scrolling. If night sweats are the culprit, layering breathable fabrics and using a cooling mist can be a game-changer.
Sign #5: Vaginal Dryness and Discomfort
This is one of those physical changes during perimenopause nobody really talks about but should. As estrogen dips, vaginal tissues can become thinner, drier, and more sensitive. Suddenly, sex can feel different, and not always in a good way.
If intimacy starts to feel uncomfortable, know that you’re not broken or alone. Moisturizing products, natural lubricants, and open conversations with your partner can help. Also, paying attention to the type of period products you use makes a difference. Nua’s ultra-soft sanitary pads are ideal because the top layer is designed to be kind to sensitive skin, which is exactly what’s needed when your body is adjusting.
Sign #6: Change in Libido
Your desire for intimacy may rise, dip, or feel inconsistent. Estrogen, testosterone, and progesterone all influence sexual desire in different ways. Estrogen helps maintain vaginal tissue health and blood flow, which affect comfort and arousal. Testosterone fuels sexual motivation and responsiveness. Progesterone often has a dampening effect, calming the nervous system and lowering desire. As these hormones rise and fall unpredictably in perimenopause, the balance between stimulation and inhibition shifts, so changes in libido are normal. For some, lower libido is tied to vaginal dryness or fatigue while for others, hormonal surges can actually heighten it.
Either way, be gentle with yourself and communicate openly with your partner. There’s nothing wrong with exploring new ways of connecting.
Sign #7: Brain Fog, Memory Lapses, and Headaches
Ever walked into a room and completely forgotten why? Or found yourself searching for the word “spoon” like it’s hidden in a crossword puzzle? Add to that the sudden headaches that seem to strike out of nowhere.
When estrogen and progesterone levels fluctuate, they also affect how neurotransmitters like serotonin and dopamine work in the brain. This disrupts communication between neurons in regions that control focus and memory, leading to brain fog. At the same time, changes in blood vessel regulation can dilate or constrict vessels unpredictably, which is why headaches often appear. Together, these shifts make it harder to concentrate or recall simple things.
It’s frustrating, especially if you pride yourself on being on top of everything. Writing down even the smallest tasks and carrying a notebook everywhere can help. Lowering the mental load also eases some of the mood swings and perimenopause stress.
Sign #8: Breast Tenderness
Sore, swollen, or tender breasts can show up unexpectedly. This is because rising and falling estrogen increases fluid retention in breast tissue, while fluctuating progesterone can cause the milk glands to swell, both of which stretch the tissue and trigger pain receptors. It can feel like PMS on steroids. This is one of those perimenopause symptoms that’s both uncomfortable and confusing if you’re not expecting it.
Wearing a supportive bra (yes, even at home sometimes) and using warm compresses can ease the discomfort. And don’t ignore it, if breast pain is severe or comes with lumps, it’s a cue for when to see a doctor for perimenopause, just to be safe.
Sign #9: Frequent Urination and UTIs
Lower estrogen levels affect the urinary tract too, making tissues thinner and more vulnerable. Suddenly, you might feel the urge to pee more often, or find yourself dealing with recurring urinary tract infections.
Staying hydrated, practicing good intimate hygiene (we recommend this intimate wash), and using breathable period products, like Nua’s panty liners, helps minimize irritation and catch any incontinence. If UTIs keep coming back, that’s means it’s time see a doctor to rule out anything else.
Sign #10: Fatigue, Joint and Muscle Pain
That bone-deep tiredness that doesn’t go away with a full night’s sleep? Or the random joint aches that make you wonder if you suddenly aged ten years overnight? These are surprisingly common in perimenopause.
Lower estrogen levels can increase the release of inflammatory molecules, making joints ache. At the same time, estrogen normally supports muscle repair and helps regulate deep sleep, so when it dips, recovery slows and rest feels less restorative. Gentle exercise like yoga or walking, and prioritizing rest, can help.
Sign #11: Weight Gain
Another frustrating part of perimenopause? Gaining weight, especially around the midsection, even if your habits haven’t changed much. Declining estrogen shifts how your body stores fat, while a slowing metabolism doesn’t help.
This isn’t about obsessing over numbers on the scale, it’s about understanding why your body is changing. Eating balanced meals, staying active, and being kind to yourself are far more important than crash diets. Remember: this is a season of transition, not failure.
Sign #12: Skin Changes, Including Dryness and Itchiness
Estrogen supports collagen production, so as levels dip, skin can become drier, thinner, and more sensitive. Itchy patches, breakouts, or a sudden lack of glow can all be signs of physical changes during perimenopause.
Switching to gentle skincare products and keeping your body moisturized helps.
When should you see a doctor for perimenopause?
This one’s important. Changes in your cycle, mood, or body are expected, but sometimes it’s not just perimenopause. If your bleeding is extremely heavy, super irregular, or happening after 12 months without a period, it’s time to check in with your doctor.
The doctor might recommend perimenopause hormone tests to check your levels of estrogen, progesterone, FSH (follicle-stimulating hormone), and thyroid hormones. These tests aren’t always perfect, hormone levels fluctuate day to day, but they can provide helpful context and rule out other conditions.
Remember: Asking for help is not overreacting. It’s self-respect.
Redefining What Perimenopause Means
Perimenopause can feel like a series of curveballs—irregular periods one month, mood swings the next. But here’s the truth no one tells us: it’s not just an ending. It’s a new chapter.
Your body is recalibrating, shifting into a different rhythm. That doesn’t mean your femininity, your vitality, or your worth are fading. It means you’re entering a stage where your wisdom, self-knowledge, and resilience are sharper than ever.
Yes, some days you’ll need a strong cup of tea, a long shower, and maybe two Nua sanitary pads tucked in your tote bag just in case. But you’ll also discover new ways to connect with yourself, prioritize your wellbeing, and redefine what it means to feel powerful in your own skin.
Perimenopause is not the end of your story—it’s simply a new chapter, and you get to write it your way.
Have questions about perimenopause? Read more here or leave your questions in the comments!
