Perimenopause
Understanding perimenopause, the years before the change
Perimenopause can begin a decade before periods stop. A clear-eyed look at the symptoms, the timeline, and what genuinely helps.
Dervis Gurol · 22 April 2026 · 6 min read
Most women hear the word menopause long before they hear the word perimenopause. Yet it is the perimenopausal years (often the early forties, sometimes the mid thirties) that bring the first wave of symptoms, and the most confusion.
What is actually happening
Perimenopause is the gradual wind-down of ovarian function. Oestrogen and progesterone do not fall in a neat line, they swing. One month is normal, the next is not. Cycles shorten, then lengthen, then skip. Sleep frays. Mood thins. The body feels less reliable.
Symptoms that are easy to miss
Hot flushes and night sweats get the headlines, but many women in perimenopause notice quieter changes first.
- Disrupted sleep, often waking at 3 or 4 a.m.
- New or worsening anxiety, low mood, or brain fog
- Joint aches, particularly in the hands and knees
- Heavier or unpredictable periods
- Reduced libido and vaginal dryness
When to seek a review
If symptoms are interfering with sleep, work, or relationships, it is reasonable to ask for a proper hormone review. You do not need to be in full menopause to qualify for treatment, and you do not need a blood test to start the conversation.
The most common thing patients say in their first appointment is, I wish I had come sooner. We try to make sure no one leaves wishing that.
