Symptom · Perimenopause
Fatigue
Tiredness that won’t lift even after a good night’s sleep, exhaustion that just settles in: fatigue is one of the most common symptoms of perimenopause, and one of the most overlooked.
Why it happens
Poor sleep is often the main culprit: with less progesterone, sleep gets lighter, and night sweats break it up. Swings in oestrogen can also drag down your mood and energy, and changing hormone levels may affect how your cells make energy.
What can make it worse
- Poor sleep and night sweats.
- Ongoing stress and mental load.
- Irregular meals.
- Not moving enough, which can keep tiredness going.
Right now
- Take a proper break rather than pushing through.
- Step outside into daylight for a few minutes: it gives you a lift.
- Drink some water: being dehydrated makes tiredness worse.
Every day
- Make regular sleep your top priority.
- Keep moving, even gently: it builds your energy over time.
- Notice when your energy dips, and plan your day around it.
Tiredness that isn’t getting better?
A doctor can check nothing else is behind it, and help you get your energy back.
General information only. It doesn’t replace advice from a doctor who knows your history.
Recognise several of these? That’s no coincidence.
Menopause isn’t just hot flushes. Symptoms can start years before your last period and affect your sleep, mood, energy, memory, weight and intimate health.
Tap a symptom to find out more.
Hot flushes
A wave of heat rising from your chest to your face, lasting one to five minutes. When oestrogen dips, your brain’s thermostat becomes oversensitive, so even a tiny change in temperature can set one off.
Sleep problems
Out like a light one night, wide awake at 3am the next. Progesterone used to help you switch off, and there’s less of it now. Add night sweats from shifting oestrogen, and deep sleep is often the first thing to go.
Brain fog
Words on the tip of your tongue, reading the same line twice, losing your thread mid-sentence. Oestrogen helps fuel your brain, so when it swings, your focus does too. And less progesterone means poorer sleep, which makes the fog thicker.
Anxiety
An email, a meeting, running ten minutes late, and suddenly your stress is through the roof. Progesterone has a natural calming effect, and oestrogen helps keep serotonin steady. When both are in flux, everything feels heavier than it used to.
Joint pain
Knees that creak when you stand up, stiff hands first thing in the morning. Oestrogen helps keep inflammation in check, so when levels dip, joints can feel stiff and sore. Lower testosterone also makes it harder to keep the muscle that supports them.
Irregular periods
One cycle short, the next one long, then a month with nothing at all. You ovulate less often, so you make less progesterone, while oestrogen swings up and down. Periods can get heavier too. It’s often the very first sign of perimenopause.
Palpitations
Your heart suddenly races or pounds while you’re doing nothing at all. Shifting oestrogen affects the nerves that control your heart rhythm. Unsettling in the moment, rarely serious, but always worth mentioning to your doctor.
Mood swings
Laughing one minute, in tears the next, or ready to tell everyone where to go. Oestrogen and progesterone are rising and falling faster than before, and both affect the brain chemicals that keep your mood steady.
Weight gain
Your waistline is changing, even though you’re eating exactly the same. Lower oestrogen moves fat storage towards your tummy. And as testosterone gradually declines, you lose some muscle, so your metabolism slows too.
Low libido
Desire takes longer to show up, or sometimes doesn’t show up at all. Testosterone, which fuels desire, gradually declines, and lower oestrogen can make arousal slower and sex less comfortable. It’s common, it’s not ‘all in your head’, and it can be treated.
Vaginal dryness
Dryness, and sometimes a little discomfort day to day. Oestrogen keeps vaginal tissue naturally moist, so lower levels mean less moisture. It’s very common, and still far too rarely talked about.
Night sweats
Waking up soaked in the middle of the night, changing the sheets, then lying awake. It’s a hot flush triggered by shifting oestrogen, just at night. And with less calming progesterone, getting back to sleep is harder.
Painful sex
Discomfort, or real pain, during or after sex. Lower oestrogen makes vaginal tissue thinner and more delicate, so something that never used to hurt suddenly can. You don’t have to put up with it.
Dry skin
Skin that feels tight, marks more easily and has lost some of its bounce. Oestrogen helps your skin make collagen, and you can lose up to 30% of it in the first five years after menopause.
Hair loss
More hair in your brush, a parting that looks wider than before. Oestrogen and progesterone both help keep hair growing. With less of them, androgens (hormones like testosterone) have more effect, and hair grows back finer.