Something feels different...
Your sleep's not right. Your mood is more fragile than it used to be. Energy dips for no clear reason. Your periods have started doing strange things.
But menopause? That's years away, surely.
So what is this?
I hear this almost every week. A woman in her early 40s sits across from me, trying to put words to something she can't quite name. "I just don't feel like myself," she says. "But I don't know if this is anything. Or if I'm just... getting older?"
And every time, I want to say: I hear you. And I know exactly what this is.
What you're describing has a name. It has an explanation. And you deserve more than the ten minutes most appointments allow. That's what this is for.
I'll be honest with you, I'm not just writing this as a doctor. Two years ago, I noticed it in myself. I'd always been the person with endless energy, constantly on the go, juggling work, two kids, the gym, everything. Then gradually, things started to feel harder. I needed more time to recover. More time to plan. Tasks that used to feel effortless started requiring extra effort. I became snappy over things I'd never have noticed before, socks on the floor, shoes in the hallway, the kids bickering in the back seat. And the acne came back. At 41. Just like my teenage years.
I knew something had changed. I just hadn't yet joined the dots.
That's perimenopause. And if any of that sounds familiar, you're in the right place.
What Perimenopause Actually Is
Perimenopause is the transition before menopause. The bridge between your fertile years and the point when periods stop completely.
It's not a single moment. Not an illness. Not something you've done wrong.
It's a gradual process where your hormone levels, particularly oestrogen and progesterone, start fluctuating. Sometimes wildly. And it typically lasts 4 to 10 years before periods stop completely, though it varies significantly from woman to woman.
Here's the thing that surprises most people: oestrogen doesn't just slowly decline. It goes up, down, up, down. Sometimes dramatically. Sometimes within the same week.
These hormonal swings influence far more than your reproductive system. They affect sleep quality, mood regulation, temperature control, brain function, bone density, and heart health.
This is why perimenopause can feel like it's affecting your whole body. Because it is.
When Does This Actually Start?
Here's what surprises most women: perimenopause can begin in your late 30s or early 40s.
The average age is around 45. But "average" means plenty of women start earlier and earlier, and that doesn't mean something's wrong.
I recently saw a patient who was 38. Sleep disruption. New anxiety. Irregular periods. "Am I too young for this?" she asked.
No. You're not.
A few things can influence timing: family history (when did your mum go through menopause?), smoking, certain medical treatments, and some health conditions. But for most women, it simply reflects the natural variation in how our bodies move through this stage.
Why It Looks Different for Everyone
There's no standard perimenopause experience. I see this in the clinic every week, and I've experienced it myself, where it doesn't follow a script.
Some women notice sleep changes first. Others find anxiety arrives out of nowhere. Some have the classic hot flushes. Others feel it most in their mood, their focus, their sense of themselves.
Common symptoms include irregular periods, hot flushes and night sweats, sleep problems, mood changes, brain fog, fatigue that's deeper than usual tiredness, changes in libido, vaginal dryness, joint aches, and heart palpitations.
But you don't need all of these to be in perimenopause. You might have just one or two that feel significant. And that's enough.
The Problem with Diagnosis
This is frustrating for many women: perimenopause doesn't always show up clearly on tests.
Hormone blood tests capture one moment in time. But in perimenopause, hormones fluctuate sometimes wildly throughout your cycle and even day to day. A test might catch oestrogen on a "high" day and completely miss what you experience when it drops.
So perimenopause is usually diagnosed based on your age, your symptoms, and your cycle. That's it. A clinical picture, not a single result.
If you've been told your tests are "normal", but you still feel awful, that doesn't mean nothing's happening. It means perimenopause is diagnosed by listening, not just by numbers on a page. More on this in the next post.
Where Lifestyle Comes In
Hormonal changes drive perimenopause. But how you experience symptoms is shaped by other things, too, such as sleep quality, stress, activity levels, nutrition, alcohol, and the support around you.
I want to be really clear about something here, because I see it misunderstood constantly.
This doesn't mean symptoms are "in your head." They're not.
Sometimes you can lifestyle your way out of perimenopause. Sometimes you can't.
But it does mean that supporting these areas can genuinely change how symptoms affect your daily life. I've seen it in patients. I've experienced it myself. Small, realistic changes, not overhauls, not punishing regimes, can make a real difference to how you feel while your body moves through this transition.
That's the lifestyle medicine angle I bring to this, not instead of medical support, but alongside it.
What Happens Next
Understanding that you're in perimenopause often brings relief. Not because it fixes everything, but because it makes sense of something that's felt confusing and frightening.
When symptoms have a name and context, they're less scary. When you understand what's happening, you can start making decisions about what kind of support would actually help.
Perimenopause is change, not decline. And you don't have to figure it out alone.
If you're reading this at 10 p.m, phone in hand, wondering whether any of this sounds like you it probably does.
Most women I see have spent months, sometimes years, quietly doubting themselves. Going to appointments and leaving with normal test results and no real answers. Feeling like they're failing at something they can't even name.
You're not failing. And you're not imagining it! It's real! As real as it can get!
You don't need to have this all figured out before you ask for help.
That's what I'm here for: to help you make sense of what's happening and work out what to do about it, together.