Perimenopause: what's really happening (and why you're not going mad)

If you've found your way here, something brought you.

Maybe a quiet, persistent feeling that this isn't just stress, a bad week, or getting older. Maybe you're waking at 3am with your heart racing, forgetting words mid-sentence, or feeling rage that comes from nowhere. Maybe you've been wondering, quite seriously, whether you might be losing your mind.

What you are experiencing has a name. And there is far more known about it now than there was even five years ago.

What is perimenopause?

Perimenopause is the transitional phase leading up to menopause itself. During this time, your ovaries gradually produce less oestrogen, progesterone and testosterone, but not in a smooth or predictable decline. Hormones fluctuate, sometimes wildly, before they settle.

A few definitions, because the terms get tangled:

In the UK, the average age of menopause is 51[1]. This means for most women or people assigned female at birth perimenopause usually starts in the early-to-mid forties, but it can begin in the thirties for women who may go on to have early menopause (menopause between 40 and 45)[1], and it can start anytime from puberty onwards for people affected by Premature Ovarian Insufficiency (POI)[2]. There is no "too young" for perimenopause. It's said to last an average of four to five years, though for some it seems very quick, and for others it may last for a decade or more[1].

Think of perimenopause as the reverse of puberty - a major hormonal transition that reshapes who you are, often lasting longer than puberty itself, and rarely talked about with anything like the same care.

Why it can feel so disorientating

The public conversation about menopause has largely been dominated by hot flushes. But researchers have now mapped more than 40 recognised symptoms, clustered across three broad areas: physical, cognitive, and emotional. Most women experience some from each, often without realising they are connected.

Large UK surveys give a clearer picture of what tends to come up most[3]:

It is often the quieter symptoms, the ones that do not get talked about, that catch women out. The sudden tearfulness in the supermarket. The rage out of proportion to its trigger. The loss of confidence in meetings you used to chair. The body that feels unfamiliar. The intolerance of noise, light, or scratchy clothing you never had before.

It is also helpful to know that experiences vary widely.

Wherever you sit on that spectrum, your experience is individual and real, and you deserve to be taken seriously.

The fuller symptom picture

Suicidal ideation can increase during the menopause transition and should always be taken seriously. If you are experiencing thoughts of suicide or self-harm, please contact your GP, NHS 111, or the Samaritans (116 123) for immediate support.

This is by no means an exhaustive list. You may experience only a few symptoms. You may experience many. Symptoms can vary cycle to cycle, month to month, year to year. None of it means you are imagining things.

Perimenopause and mental health

For some women, the first sign that perimenopause has begun is psychological rather than physical. Oestrogen plays a role in regulating hormones like serotonin, dopamine and GABA, so when it fluctuates, mood, anxiety and resilience often shift before periods do.

Women with a history of premenstrual disorders, postnatal depression or anxiety can be particularly sensitive to these hormonal changes. A 2024 systematic review and meta-analysis of more than 16,000 women found that perimenopausal women are around 40% more likely to experience depression than premenopausal women[5], and many describe an anxiety that feels qualitatively different from anything they have known before.

This isn't weakness, and it isn't a character flaw. It's biochemistry meeting accumulated life pressure, caring responsibilities, work, relationships, finances, at the precise point your hormonal regulation system is rewiring itself.

If you are neurodivergent (or wondering)

Perimenopause often unmasks neurodivergence that was previously compensated for. Many women seek an ADHD or autism assessment for the first time in their forties, after perimenopausal hormone change exposes how their carefully learnt coping strategies no longer work.

Hormones don't cause neurodivergence, but they can unmask it. If old self-soothing strategies are suddenly making things worse, if sensory sensitivities are sharper, if executive functioning has fallen off a cliff or cognitive difficulties seem more insurmountable than usual, this may be part of your picture. The two are best supported together, not separately.

What we know helps

There is no single right path through perimenopause. But the evidence is clear on several things:

When to ask for support

You don't have to wait until things are unbearable. If symptoms are interfering with your sleep, work, relationships, or your sense of yourself, that is reason enough.

A few starting points:

• Speak to your GP, ideally one with menopause training, or ask to be referred to one.
• Track your symptoms for a few weeks (the Balance app is excellent, or download my Perimenopause Reflection & Symptom Tracker) so you have something concrete to bring to appointments.
• If you are under 45, ask about hormone testing.
• Consider therapy with a counsellor who specialises in menopause and hormonal change.

Trusted UK resources

Frequently asked questions

What is the average age of perimenopause in the UK?

Most women begin perimenopause in their early-to-mid forties, although it can start anytime before this. The average age of menopause itself in the UK is 51.

How long does perimenopause last?

On average, four to five years. For some women it lasts only a few months; for others, up to ten years or more.

Can perimenopause cause anxiety?

Yes. Fluctuating oestrogen affects hormones involved in serotonin, dopamine and GABA regulation, and anxiety is one of the most commonly reported symptoms. For some women it is the first sign that perimenopause has begun.

Can you be in perimenopause and still have regular periods?

Yes. Cycles often change gradually, and symptoms such as sleep difficulties, mood changes, brain fog and joint pain can appear well before periods become noticeably irregular.

Do I need a blood test to be diagnosed with perimenopause?

If you are over 45 and have typical symptoms, you usually don't. Diagnosis is based on age and symptom picture. Under 45, your GP may order hormone tests.

Is perimenopause the same as menopause?

No. Perimenopause is the transitional phase leading up to menopause. Menopause itself is defined as the one day exactly twelve months after your last period.

Take what's useful. Leave what isn't. Go gently with yourself in this time of transition.