Understanding perimenopause: Early signs, hormones and health impacts

Time to get ready for Chris’ big 4-0 party. Sophia sets up at the dining table and gets to work on a photo board. Old school, she knows, but everyone likes a good old-fashioned photo. She picks up a photo from their holiday to Bali around five years ago. Sophia can barely recognise herself. She was so much thinner and brighter. It’s night and day from how she looks and feels right now. Will she ever feel like herself again?

It seems this ‘peri’ era has well and truly commenced, and she will probably never feel like that bright, bubbly woman enjoying the poolside cocktail in Ubud. This week has been a nightmare, starting with her period being so heavy she could barely function and the cramps reminding her of the ones she used to have at school. It left her feeling tired and more grumpy than usual. Then there’s the 3am wake-ups every single night. What’s that all about? It has to be caused by hormonal imbalances, right? It’s all her girlfriends talk about these days. But what does it really mean? Isn’t menopause when you lose all your female hormones or something?

Most of the information online goes right over Sophia’s head. And you can forget about knowing where to start when it comes to feeling better. Sophia knows she is a fad-diet, fast-fix kinda girl which probably hasn’t helped her cause. She has tried so many so-called ‘solutions’ for her symptoms, and to be frank, nothing has made a noticeable difference. 

Sophia’s journey is one I hear almost daily in my work with women. In a world of information overload, you can often be left feeling confused and in overwhelm. A common question women ask me is, ‘Where do I even start?’

Because I truly believe it’s important to arm yourself with a baseline of knowledge when it comes to health, here’s an overview of what perimenopause is, the different stages of perimenopause, and the role your hormones play throughout. 

So, what is perimenopause?

Put simply, perimenopause is a series of events that is a normal life phase for a woman. It usually spans four to eight years, but each individual has a unique experience and the duration and severity of symptoms is extremely variable. Perimenopause can arrive as early as your mid-30s or as late as your early-50s. It is a very personal journey.

Before we dive in, it’s interesting to note that not all women experience symptoms of perimenopause and the degree of symptoms varies for those who do. It is estimated that 20 per cent have no symptoms, 60 per cent experience mild to moderate symptoms and 20 per cent have severe symptoms that impact daily life.

To understand what is happening in your body, it can help to briefly reflect back to earlier life, where you have likely experienced a natural menstrual cycle. Your typical 28-day cycle is moderated by hormones, starting with day one marked as the first day you get your period. Between days one and 14, the pituitary gland in your brain releases Follicle Stimulating Hormone (FSH) signalling the ovaries to prepare an egg for ovulation. This triggers an increase in the hormone oestrogen, which peaks just before ovulation, about day 14.

At day 14 (or mid-cycle) the pituitary releases a surge of Luteinizing Hormone (LH) which triggers the release of an egg. Ovulation is a term that describes the release of an egg from your ovary so it can travel to the uterus. After ovulation, between days 14 and 28, if pregnancy has not occurred, the levels of hormone progesterone rise and then fall again. At the same time, oestrogen levels trend downwards. About day 28, levels of oestrogen and progesterone drop, and menstruation starts again.

In the perimenopause phase, and yes, it is just a phase (which can be helpful to remember; it won’t last forever), your ovaries are winding down and beginning to run out of viable eggs. We are born with a finite number of eggs that steadily decreases over time. This means that each month when your pituitary gland releases FSH and LH, the ovaries do not always respond, as they are struggling to produce and release eggs.

This leads to key hormonal changes. You will make less progesterone and start to release different levels of oestrogen than you used to. The balance of oestrogen becomes erratic, with wild fluctuations occurring on a daily basis. These changes result in a raft of symptoms, the main one being erratic or irregular periods. Other symptoms can include vaginal dryness, changes in mood, irritability, anxiety, weight gain, hot flushes, night sweats and problems sleeping.

Perimenopause stages

To break it down even further, there are a few stages of the perimenopause transition, but remember, these vary and are not the same for each person. 

Very early perimenopause

Periods may still come like clockwork, or you may notice they are slightly irregular. Common symptoms at this stage include: 

• Heavy periods
• Increased period pain
• Sleep disturbances
• Mood changes
• Migraines.

Early perimenopause

Periods or cycles start to become a lot more irregular. Common symptoms at this stage include: 

• Hot flushes
• Night sweats
• Heavy periods
• Mood changes
• Irritability 
• Weight gain.

Late perimenopause

Cycles become longer, and periods come further and further apart. Common symptoms at this stage include: 

• Worsening hot flushes
• Night sweats 
• Aches and pains 
• Vaginal dryness 
• Brain fog 
• Fatigue 
• Low libido 
• Weight gain.

What do your hormones do for you?

Here are some of the main roles that the three key hormones – oestrogen, progesterone and testosterone – play in your health:

Oestrogen

Prior to menopause, the body produces a type of oestrogen called oestradiol. As oestrogen receptors are found throughout the body, including the reproductive tract, breasts, bone, brain, liver, colon, skin, salivary glands and more, the effects are wide reaching.

Oestrogen plays a role in regulating your menstrual cycles, supporting a healthy metabolism, reducing inflammation, building muscle and bone, and helping to maintain things like your skin’s moisture, mood, brain and heart health. 

Progesterone

Your body relies on progesterone for many different processes and functions, such as helping regulate menstrual cycles, supporting a healthy metabolism, having a calming effect on the brain, reducing inflammation, supporting immune health, preventing bone loss, modulating libido and protecting the heart. 

Testosterone

Levels of testosterone decline as you age and trend downwards as perimenopause progresses. Often, women experience more pronounced symptoms of low testosterone towards the later stages of perimenopause. These include low libido, thinning hair, muscle weakness, mood swings, fatigue, weight gain, and poor memory and concentration.

Testosterone plays a role in regulating libido, bone and muscle health, heart health, mood, energy and sleep. 

Perimenopause symptoms unpacked

Many different symptoms can appear as you move through the stages of perimenopause. When women come to me for help, their top concerns are weight gain, heavy periods, reduced energy levels, brain fog, sleep disturbances, mood changes, aches and pains, and higher levels of stress and anxiety.

However, women experience a range of symptoms, caused by high or low levels of hormones, which change rapidly as their bodies adjust. Perimenopause looks different for every woman and doesn’t fit nicely into one box. 

Low oestrogen

• Less frequent and/or lighter periods 
• Night sweats 
• Trouble sleeping 
• Vaginal dryness 
• Brain fog 
• Poor concentration 
• Low mood 
• Mood swings 
• Anxiety 
• Dry skin 
• Midline weight gain 
• Joint pain 
• Fatigue 
• Low libido.

High oestrogen

• Low mood
• Irritability 
• Breast tenderness 
• Bloating 
• Weight gain 
• Fatigue. 

Low progesterone

• Premenstrual syndrome
• Irregular or missed periods 
• Breast pain and tenderness 
• Spotting between cycles 
• Heavy periods 
• Fluid retention 
• Trouble sleeping 
• Anxiety 
• Low libido 
• Mood swings and irritability 
• Hot flushes.

High progesterone

• Low mood 
• Irritability 
• Dizziness.

Low testosterone

• Low libido 
• Muscle weakness 
• Mood swings and irritability 
• Hair thinning 
• Fatigue 
• Weight gain 
• Poor memory and concentration.

A phase, not a full stop

While perimenopause can feel unsettling, unpredictable and at times overwhelming, it is not a sign that your body is failing you. It is a natural transition, marked by hormonal shifts that affect far more than just your cycle. The more you understand what is happening beneath the surface, the more empowered you can feel to seek appropriate support, make informed lifestyle choices and tune in to what your body needs.

This phase may look different for every woman, but with the right knowledge and guidance, it is one that can be navigated with clarity, confidence and self-compassion.