Perimenopause Symptoms: The Full List, Early Signs and What Helps (UK)

What is perimenopause?

Perimenopause is when your hormone levels start to fall and your periods begin to change, before they stop completely. Menopause is when you haven’t had a period for 12 months. The NHS says menopause usually happens between 45 and 55, but it can happen earlier. Perimenopause often starts a few years before that: in the Massachusetts Women’s Health Study of more than 2,500 women, the median age it began was 47.5, and it lasted nearly 4 years on average. Smokers tended to start earlier.

Our guide to the stages of menopause and how long each one lasts covers the timeline in detail, including early and premature menopause.

Perimenopause symptoms: the full list

Symptoms can change over time. For example, hot flushes may ease while low mood or anxiety appears.

Early signs of perimenopause

The first signs are often subtle: periods that come closer together or further apart, worse PMS, broken sleep, waking hot in the night, feeling more anxious or irritable than usual, or forgetting words. Many women don’t connect these with perimenopause at first. Keeping a symptom diary for a few months helps you spot the pattern and talk to your GP. See also stress and cortisol in women.

iIf you are in your late 30s or early 40s and your periods are changing, it is still worth seeing a GP. Menopause before 45 is called early menopause and before 40 is premature ovarian insufficiency, and both are diagnosed differently (see testing below).

Less talked-about perimenopause symptoms

Hot flushes and irregular periods get most of the attention, but many women first search for something else. Here is what is known about the symptoms people ask about most, and where the evidence is thin.

Dizziness and vertigo

The NHS notes that hot flushes can make you feel dizzy, as well as causing palpitations or anxiety. There is also some research linking hormone changes with balance problems. In a US study of 1,377 people with benign paroxysmal positional vertigo (BPPV, a spinning feeling when you move your head), perimenopausal women were especially likely to develop it. That is one study, though, and the link is not proven.

Dizziness has plenty of other causes, including dehydration, stress and anxiety, iron deficiency anaemia (heavy periods are a common cause), inner-ear problems, standing up too quickly and side effects of medicines. See a GP if it keeps coming back, or comes with hearing changes, ringing in your ears, eyesight changes, numbness or fainting. Our guide to anxiety and dizziness covers the stress side.

Is itchy skin a sign of menopause?

Yes, it can be. The NHS lists skin changes, including dry and itchy skin, among the symptoms of menopause and perimenopause, and says itchy skin is common after the menopause and usually gets better over time. Falling oestrogen is the likely reason. Oestrogen helps skin hold on to moisture and collagen, and research reviews link lower levels with drier, thinner skin that itches more easily.

Some women also describe a crawling or tingling feeling under the skin, sometimes called formication.

What helps. The NHS self-care advice for itchy skin is to:

• use an unperfumed moisturiser or emollient regularly
• have cool or lukewarm baths or showers, and keep them short
• pat or tap your skin instead of scratching
• wear loose cotton or silk, and avoid wool, synthetic fabrics and perfumed soaps

iHRT may also help, as a research review found oestrogen can improve some of these skin changes. Ask your GP whether it suits you.

When to see a GP. The NHS says to see a GP if itching is all over your body, is severe, or doesn’t get better with self-care or keeps coming back. Less commonly, itching is a sign of thyroid, liver or kidney problems. If your skin or the whites of your eyes look yellow (jaundice), ask for an urgent GP appointment or contact NHS 111.

Itchy ears and scalp

Itchy ears and an itchy scalp are widely reported in perimenopause forums, but there is very little research on them specifically. Dry skin in the ear canal or on the scalp is a plausible explanation, but the NHS lists dandruff, eczema, psoriasis and fungal infections among the common causes of itchy skin, so ask a pharmacist if it doesn’t settle, and see a GP if it keeps coming back. Our guide to dry skin has practical tips.

Joint and muscle pain

Muscle aches and joint pains are on both the NHS and NICE lists of menopause symptoms, and the NHS notes joint pain can carry on after menopause. Read more in our joint pain guide.

Palpitations

A faster, slower or more noticeable heartbeat is a recognised perimenopause symptom, and often comes with a hot flush. The NHS still advises seeing a GP about palpitations so that other causes can be ruled out. An overactive thyroid can also cause palpitations, heat sensitivity, anxiety and poor sleep: see overactive thyroid symptoms.

Brain fog and ADHD-like symptoms

Memory and concentration problems are on the NHS symptom list, and forgetting words is one of the most common things women describe. Some women notice distractibility and disorganisation that feels like ADHD for the first time in their 40s, while women already diagnosed often say their ADHD feels harder to manage.

Research here is still small. A Dutch study of 209 women with ADHD found they reported more severe menopausal symptoms, and a 2026 Irish interview study of 19 women described how much harder perimenopause made their ADHD and mental health to manage. Perimenopause does not cause ADHD, but if your focus has changed a lot, or your ADHD medicine seems to work less well, talk to your GP. Our guide to menopause brain fog goes into causes and what helps.

Does perimenopause make you tired?

Often, yes. The NHS lists hormonal changes such as the menopause among the common causes of tiredness, and sleep problems are a recognised perimenopause symptom, made worse by night sweats. The main reasons:

• Broken sleep from night sweats. See perimenopause and sleep and night sweats.
• Heavier periods. These are a very common cause of iron deficiency anaemia, whose main symptom is tiredness. In the US SWAN study of 2,329 women, 3 or more heavy bleeds in 6 months went with feeling tired more often. See iron deficiency symptoms.
• Low mood, anxiety and stress, which are perimenopause symptoms too.

iTiredness isn’t always hormonal: an underactive thyroid, sleep apnoea and depression can cause it too. See a GP if you’ve felt tired for a few weeks without knowing why, or your periods are much heavier than before. See also why am I always tired?

If an evening drink suits you, our Magnesium Glycinate Sleep Complex has 148mg of magnesium a serving, and magnesium contributes to a reduction of tiredness and fatigue. It isn’t a perimenopause treatment.

Is perimenopause worse than menopause?

For many women, yes: symptoms are often at their most intense in late perimenopause, when periods become far apart and unpredictable. After menopause, many symptoms gradually ease, though not for everyone.

The research backs this up:

• Hot flushes: in the US SWAN study of more than 3,000 women, hot flushes and night sweats were reported most often in late perimenopause, and nearly as often in early postmenopause.
• Mood: another SWAN analysis found women were two to four times more likely to have an episode of major depression during perimenopause or early postmenopause than before it began.
• Sleep: trouble falling and staying asleep became more likely as women moved through the transition.
• Overall: the Massachusetts study found symptom reporting rose in perimenopause and fell again after menopause.

Some changes do continue or build after menopause, though. Bone density keeps falling and joint pain can carry on, so menopause is not simply the easier stage. How long symptoms last varies a lot from woman to woman: our guide to how long menopause lasts covers this.

How to test for perimenopause

For most women there is no test needed. NICE guidance says that if you are 45 or over, otherwise healthy, and have recently started getting hot flushes or sweats along with changes to your periods, a GP should identify perimenopause from your symptoms, without blood tests.

What about home perimenopause tests? Home kits sold in pharmacies measure only FSH in your urine. The chair of the British Menopause Society, speaking for the Royal College of Obstetricians and Gynaecologists, has said these tests are not a good method of detecting menopause or perimenopause, that they are of no value if you use hormonal contraception, and that a negative result doesn’t mean you aren’t perimenopausal. A symptom diary is more useful to take to your GP.

Ruling out other causes. Some conditions overlap with perimenopause. An underactive thyroid can cause tiredness, low mood, poor concentration, weight gain, dry skin and irregular or heavy periods, and an overactive thyroid can cause palpitations, heat sensitivity and anxiety. If your symptoms don’t quite fit, your GP may suggest a thyroid blood test.

What helps

The NHS suggests:

• Regular sleep routines and plenty of rest. See how to sleep better.
• A healthy, balanced diet with calcium-rich foods such as milk, yoghurt and kale.
• Regular exercise, including weight-bearing and strength exercise. See creatine for women.
• Relaxation such as yoga, tai chi or meditation. See box breathing.
• Talking to others going through the same thing.
• Not smoking and keeping alcohol within the recommended limits.

Treatment: HRT and other options

Hormone replacement therapy (HRT) is the main treatment for menopause symptoms and can help with hot flushes, sleep, mood and joint aches. If you’re over 45, a GP can usually diagnose perimenopause from your symptoms without a blood test. Other options include CBT, which can help with low mood, anxiety and hot flushes, and some non-hormonal medicines. Your GP can talk you through the risks and benefits. NICE also advises GPs to talk about contraception with women who have perimenopause symptoms, so ask about this too.

Best vitamins and supplements for perimenopause

The honest answer: no vitamin or supplement is a proven treatment for perimenopause symptoms, and supplements don’t replace HRT or medical advice. A few are worth knowing about.

Vitamin D contributes to the maintenance of normal bones. For a fuller, evidence-ranked list, see the best supplements for menopause, magnesium for menopause and supplements for women over 40. If you have seen functional mushrooms marketed for menopause, our guide to mushrooms for menopause looks at what the trials actually show. The NHS advises talking to a doctor before taking herbal supplements. If you take HRT or other medication, check with your GP or pharmacist before starting any supplement.

Our Magnesium Glycinate Sleep Complex is an evening magnesium drink, and our Evolabs Mint CBD Oil includes vegan, algae-based vitamin D3. Neither is a treatment for perimenopause or menopause symptoms. The FSA’s 10mg a day figure is precautionary advice rather than a legal limit, set while longer-term safety research continues. At Evopure we think it is a very cautious figure, and many adults use more. If you go above it, increase slowly, and check with your GP or pharmacist first if you take any medication, including HRT.

When to see a GP

The NHS advises seeing a GP if you think you have perimenopause symptoms and want to know your options, you have palpitations, your periods become heavier than before, or you have any bleeding after 12 months without a period. Early advice can help, so don’t wait until symptoms are severe.

Related guides

• Curious about CBD? See CBD for menopause: what the research says.
• See why am I so irritable?
• Crying for no reason: why it happens.
• Stress and hair loss.
• CBD for women’s arousal: what the evidence says.
• PMOS, the new name for PCOS.
• PMDD vs PMS.
• New or worse sleep problems before each period can be part of perimenopause; see insomnia before your period.
• Younger and not sure why your period is late? Read can stress delay your period.
• Ashwagandha for menopause and perimenopause: the trials and the safety cautions.
• Dry, gritty eyes can also become more common around the menopause: see dry eyes causes.
• Nails often become more brittle with age and after the menopause. See our guide to brittle nails.
• Menstrual migraine and other types of migraine.
• Heart palpitations, including before your period.
• What triggers vertigo, including hormonal changes and vestibular migraine.
• If you’re a partner trying to understand what’s going on, our guide to perimenopause for partners explains what you might notice and how to help.
• Many of these symptoms overlap with what social media calls high cortisol; our guide on how to lower cortisol naturally explains the difference and when to see your GP.
• Many women try collagen in midlife; here is what collagen supplements can and can’t do, and their side effects.
• Curious about plant options? Read maca root benefits for women, including the perimenopause pilot study and its limits.
• If you’re more tired around changing periods, see why am I so tired on my period.
• Wondering whether a menopause tea helps? See does Twinings menopause tea work for the ingredients and the research.
• Some women also notice more vivid dreams, often linked to night sweats and broken sleep.