Perimenopause Symptoms: Signs, Weight Changes & Help

Perimenopause symptoms usually start with changes to your periods. They might come more or less often, or bleeding might get heavier or lighter. Many women also get hot flushes, night sweats, poor sleep, low mood or anxiety, brain fog, and weight gain around the middle. The NHS says these symptoms usually last 7 to 9 years, sometimes longer, and they can change over that time.

Perimenopause is a natural stage of life, but that doesn't mean you have to just put up with it. Below, we go through the common symptoms (including the less obvious ones), how perimenopause is diagnosed in the UK, why weight often changes at this stage, and the everyday steps that can help. We also cover when it's worth speaking to your GP.

What is perimenopause?

Perimenopause is the run-up to menopause. The NHS explains that perimenopause happens when your periods become irregular, and menopause is when they stop altogether. You've reached menopause once you haven't had a period for 12 months (and you're not using hormonal contraception).

These changes are caused by falling and fluctuating hormone levels, particularly oestrogen. The NHS says menopause usually affects women between the ages of 45 and 55, but it can happen earlier. Early menopause, or premature ovarian insufficiency, can happen before 45, for example after surgery to remove the ovaries, and sometimes for no known reason.

Because hormone levels go up and down rather than dropping steadily, perimenopause symptoms often come and go. You might have a run of bad weeks followed by a calmer spell. That unpredictability is one reason many people don't realise at first that their symptoms are connected.

Common perimenopause symptoms

The NHS lists a wide range of symptoms. You're unlikely to get all of them, and how strongly you feel them varies from person to person.

Changes to your periods

This is usually one of the first signs. Your periods may come more often or less often, and bleeding may get heavier or lighter. Some months you might skip a period altogether.

Hot flushes and night sweats

A hot flush is a sudden feeling of heat, usually in the face, neck and chest. The NHS says hot flushes can make you sweat a lot, cause palpitations or anxiety, or make you feel dizzy. When they happen at night, they're called night sweats, and they can wake you up and leave your bedding damp.

Sleep problems

Struggling to get to sleep or stay asleep is very common, whether it's caused by night sweats or happens on its own. Poor sleep can leave you feeling irritable, stressed and anxious, and it can affect your appetite and food choices the next day. Our guide on whether 7 hours of sleep is enough explains how sleep and weight are connected.

Mood changes, poor memory and brain fog

You might notice mood swings, low mood, anxiety or a shorter fuse than usual. Many women also describe brain fog: forgetting words, losing your train of thought or finding it harder to concentrate. The NHS includes problems with memory and concentration in its list of symptoms. These changes can feel worrying, but they're a recognised part of perimenopause.

Weight gain

The NHS says weight gain during perimenopause and menopause is common, and that it often happens around the stomach and upper body. Many women find their usual habits don't seem to work in the same way. We look at why this happens, and what helps, further down.

Vaginal symptoms and urinary problems

Lower oestrogen can cause vaginal dryness, a burning feeling, irritation or itching. You may also get more urinary tract infections (UTIs), or symptoms that feel like a UTI, and some people notice leaking when they cough, sneeze or exercise.

Other symptoms you might not expect

The NHS also lists:

• A faster, slower or more noticeable heartbeat (palpitations)
• Muscle aches and joint pains
• Headaches and migraines that are worse than usual
• Hair thinning or hair loss
• Dry and itchy skin
• Reduced sex drive
• Sensitive teeth, painful gums or other mouth problems
• Weakening bones (loss of bone density)

Some of these, such as joint pain and vaginal dryness, can continue after menopause.

How long do perimenopause symptoms last?

According to the NHS, symptoms usually last for 7 to 9 years, sometimes longer, and they can change during this time. For example, you might have hot flushes and night sweats for a while, and then find these ease but are replaced by other symptoms such as low mood or anxiety.

There's no way to predict exactly how long perimenopause will last for you. What you can do is keep track of your symptoms, so you and your GP can see patterns and decide what support you need.

How is perimenopause diagnosed?

There's no single test for perimenopause. The NHS says a doctor may diagnose it based on your age and symptoms.

For people aged 45 or over, NICE guidance says perimenopause should be diagnosed based on symptoms alone, without confirmatory laboratory tests. That's because hormone levels, such as follicle-stimulating hormone (FSH), fluctuate during perimenopause, so a single blood test doesn't give a reliable answer, and knowing the result wouldn't change how you're treated. NICE says perimenopause can be diagnosed in this age group if you have hot flushes or night sweats that have recently started, along with any changes in your menstrual cycle.

Blood tests may still be useful to rule out other causes. NICE notes that tests such as a blood count or thyroid function tests may still be needed if a non-menopausal cause is suspected. An underactive thyroid, for example, can cause symptoms such as tiredness, weight gain and low mood, which can overlap with perimenopause.

If you're under 45 and have symptoms, speak to your GP, as the approach to diagnosis can be different.

Keeping a symptom diary

Before your appointment, it can help to note down:

• The dates of your periods and how heavy they are
• When hot flushes or night sweats happen, and anything that seems to trigger them
• How you're sleeping
• Changes in your mood, memory or concentration
• Any other symptoms, such as joint pain or palpitations

A few weeks of notes gives your GP a much clearer picture than trying to remember everything on the day.

Perimenopause and weight: why it changes

Weight gain is one of the symptoms women ask about most, and it's listed by the NHS as common during perimenopause and menopause, often around the stomach and upper body.

Several things tend to happen at once in midlife, and they can add up:

• Hormonal changes. Hormone levels shift during perimenopause, and the NHS notes that weight gain at this stage often happens around the stomach and upper body rather than elsewhere.
• Disrupted sleep. Night sweats and broken sleep can leave you tired, which can make it harder to stay active and easier to reach for quick energy.
• Mood and stress. Low mood, anxiety and brain fog can make planning meals and keeping up with exercise feel like more effort.
• Less activity. Tiredness, joint aches and a busy schedule can all mean you end up moving less than you used to, without really noticing.
• Life in general. Midlife often brings busy jobs, caring responsibilities and less time for yourself.

Weight matters for more than how your clothes fit. The NHS says a higher BMI increases the chance of developing long-term conditions such as type 2 diabetes and heart disease, and that measuring your waist can help you understand whether you're carrying too much weight around your tummy. Tracking your waist measurement alongside the scales can give you a fuller picture.

If you're on HRT or thinking about it and wondering how it affects your weight, our article on whether HRT causes weight gain looks at what the evidence says.

What can help with perimenopause symptoms?

The NHS says eating well, exercising and looking after your mental wellbeing can help with symptoms during perimenopause and menopause. Here's how that looks in practice.

Keep moving, and add strength work

The NHS recommends exercising regularly, with a focus on weight-bearing exercise to build strength, as this can help protect against weakening bones. The NHS physical activity guidelines advise adults to aim for at least 150 minutes of moderate intensity activity a week, and to do strengthening activities that work all the major muscle groups on at least 2 days a week.

Strength work also helps you hold on to muscle, which matters if you're trying to manage your weight. If you're new to it, our guide to maintaining muscle while losing weight is a good starting point. Many women also ask about supplements to support training. Our article on creatine for women explains what the research shows.

Eat a balanced diet

The NHS advises a healthy, balanced diet. In practice, that means building meals around vegetables, fruit, wholegrains, pulses and a source of protein, and keeping highly processed foods as occasional extras. Fibre-rich foods are filling and tend to be lower in calories. Our guide to how much fibre you need per day shows what 30g looks like on a plate. The NHS also suggests taking vitamin D supplements, which matters for bone health.

There's no special "perimenopause diet", and you don't need to cut out whole food groups. Small, steady changes you can stick with are more useful than strict rules.

Look after your sleep

The NHS recommends getting plenty of rest and keeping to regular sleep routines. If night sweats wake you, a cooler bedroom, layered bedding and breathable nightwear can help.

Watch for hot flush triggers

The NHS suggests avoiding or reducing potential triggers, such as spicy food, caffeine, hot drinks, smoking and alcohol. Keeping a note of when your flushes happen can help you spot your own triggers.

Cut back on alcohol and stop smoking

The NHS says smoking can make menopause symptoms worse, and advises trying not to drink more than the recommended limit, as alcohol may affect your symptoms. The NHS low-risk drinking advice is not to drink more than 14 units a week on a regular basis, spread over 3 or more days, with several drink-free days each week.

Support your mental wellbeing

Relaxing activities such as yoga, tai chi or meditation may help. The NHS says cognitive behavioural therapy (CBT), a type of talking therapy, can help with low mood and anxiety, sleep problems and hot flushes. Your GP can tell you how to access it.

Be cautious with supplements

Many products are marketed for menopause. The NHS advises talking to a doctor before taking herbal supplements or complementary medicines.

Medical treatment for perimenopause symptoms

If your symptoms are affecting your daily life, the NHS advises talking to a doctor, nurse or pharmacist about hormone replacement therapy (HRT) and the other options available. HRT replaces the hormones that fall during perimenopause and menopause, and the type you're offered depends on things such as whether you still have periods. The NHS also notes that HRT can reduce the risk of osteoporosis.

If HRT doesn't suit you, you can't take it or you'd rather not, the NHS says other treatments are available. For example, you may be offered CBT for hot flushes and night sweats, or an antidepressant if perimenopause is causing low mood or anxiety. For vaginal dryness, there are prescribed treatments, and vaginal moisturisers and lubricants are available from pharmacies without a prescription. The NHS adds that there's very little evidence on how well herbal remedies such as red clover and black cohosh work, or how safe they are.

Whether a treatment is right for you depends on your symptoms, your medical history and your preferences, so it's a conversation to have with your GP.

When to see a GP

The NHS advises contacting your GP if:

• You think you have symptoms of perimenopause or menopause and want to know what your options are
• You have symptoms such as a fast heartbeat (palpitations)
• You still have periods, but your bleeding pattern has changed and you're bleeding more than before
• You haven't had a period for 12 months or more and have any vaginal bleeding

You don't need to wait until symptoms are severe. The NHS says early advice can help reduce the effects of menopause and perimenopause on your health, relationships and work. It's also worth speaking to your GP if you're under 45 and have symptoms, or if your weight is changing and you're worried about your health.

This article is for informational purposes only and does not constitute medical advice. Always consult with a qualified healthcare professional before starting any treatment.