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Could It Be Perimenopause

Could It Be Perimenopause? Early Changes That Are Easy to Overlook

You’re still having periods. You’re not necessarily having dramatic hot flushes. And yet, somehow, you don’t quite feel like yourself.

Perhaps you’re waking at 3am for no obvious reason. Your patience seems shorter than it used to be. You’re more anxious, headaches have changed, your periods are behaving differently, or you walk into a room and genuinely can’t remember what you went there for.

The difficult part is that none of these things may seem significant enough on its own. So it’s easy to blame stress, being busy, poor sleep or simply getting older.

Sometimes that will be the explanation. But when several changes start appearing around the same time, particularly from your 40s onwards, it’s worth considering another possibility: could you be entering perimenopause?

What Exactly Is Perimenopause?

Perimenopause is the transition leading up to menopause. During this time, the ovaries gradually change the way they function and hormone levels, particularly oestrogen, can fluctuate considerably.

Hormones don’t simply decrease in a smooth, predictable line. They can rise and fall, which helps explain why symptoms aren’t always consistent. You may have a few difficult weeks and then suddenly feel much more like yourself again.

Menopause itself is reached after 12 months without a menstrual period, provided there isn’t another medical reason for periods having stopped. In the UK, the average age of menopause is around 51, but perimenopause can begin several years earlier.

Perimenopause Doesn’t Always Begin With Hot Flushes

Hot flushes and night sweats are probably the symptoms most people associate with this stage of life, but they’re far from the whole picture.

Perimenopause can also bring changes in sleep, mood, concentration, headaches, energy levels, joints and muscles, libido, and vaginal or urinary health — many of which fall under our menopause symptoms care.

For many women, the first clues are quieter than expected and that can make them harder to recognise.

Your Periods May Change Without Disappearing

Your cycle might become slightly shorter or longer. Periods may become heavier or lighter, or the timing may simply become less predictable.

But they don’t necessarily become obviously irregular straight away.

I often hear women say:

“I thought it couldn’t be perimenopause because I’m still having periods.”

It can.

You can be perimenopausal while you’re still menstruating, and symptoms may begin well before your periods eventually stop.

Sleep Can Suddenly Become Less Reliable

You may start waking several times a night or find yourself wide awake in the early hours.

Night sweats can disturb sleep, but you don’t have to be waking drenched in sweat for your sleep to change during perimenopause.

And when sleep becomes fragmented, it can affect almost everything else. You may feel more tired, less patient, less focused and less able to deal with the kind of day-to-day pressures you would once have taken in your stride. If this sounds familiar, our article on acupuncture for insomnia: a path to restful nights may be helpful.

That can be frustrating, especially if you don’t yet understand why it’s happening.

You Might Feel More Anxious, Irritable or Emotionally Unsettled

For some women, this is one of the hardest changes to make sense of.

You may have spent years feeling capable and emotionally steady, then suddenly find yourself more overwhelmed, more irritable, less confident or more anxious than usual. That can feel very unlike you.

There can, of course, be many reasons for anxiety or low mood, so they shouldn’t automatically be blamed on hormones. But emotional and mood changes are recognised as part of the perimenopausal picture for some women. We explore this connection further in can acupuncture really rewire anxiety?

If what you’re experiencing is significant, persistent or affecting daily life, it’s important to speak to your GP.

Brain Fog, Headaches and Fatigue Can Be Part of the Picture Too

Forgetting names, losing your train of thought or struggling to concentrate can feel surprisingly unsettling.

If you’re used to juggling work, family and a busy life, it can be especially frustrating when your mind no longer feels as sharp or dependable as it once did.

Some women also notice changes in headaches or migraines, more muscle or joint discomfort, or increased tiredness.

None of these symptoms on its own proves that you’re perimenopausal. What matters is the wider picture, your age, menstrual cycle, symptoms, medical history and how things have changed over time.

Do You Need a Blood Test to Know If You’re Perimenopausal?

This is an area that causes a lot of confusion.

For women aged 45 and over who have typical perimenopausal symptoms, current UK guidance generally recommends identifying perimenopause from symptoms and menstrual changes rather than relying on routine hormone blood tests.

One reason is that follicle-stimulating hormone (FSH) and oestrogen can fluctuate considerably during perimenopause.

A blood test gives you a snapshot of what was happening on that particular day, so a normal result doesn’t necessarily rule perimenopause out.

There are situations where tests or further investigations may be appropriate. Symptoms beginning between 40 and 45 may need further assessment, while women under 40 with symptoms suggesting premature ovarian insufficiency should be properly investigated.

Your doctor may also want to rule out other causes, such as thyroid dysfunction or anaemia, depending on your symptoms and medical history.

When It’s Worth Checking Something Else Isn’t Going On

Greater awareness of perimenopause is valuable, but we don’t want to attribute every new symptom in our 40s to hormones.

If something feels severe, unusual, persistent or worrying, it’s worth getting it checked. Very heavy or unusual bleeding should be assessed. Significant changes in mood or mental health also deserve proper support.

And if possible perimenopausal symptoms are starting before the age of 40, it’s important to investigate why.

Perimenopause may explain a lot, but it shouldn’t stop us looking for another cause when something doesn’t quite fit.

If Perimenopause Is Making Everyday Life Harder

There isn’t one menopause plan that suits every woman.

For some, understanding what’s happening and making a few practical changes can make a real difference. For others, symptoms begin to affect sleep, work, relationships or general wellbeing enough that they want more support — you can read more about supporting your overall general health and wellbeing during this transition.

Regular physical activity, including resistance and weight-bearing exercise, can be particularly valuable at this stage of life. Looking after sleep, nutrition, bone health and cardiovascular health also matters.

Hormone replacement therapy (HRT) is considered the most effective treatment for many perimenopausal and menopausal symptoms and can be started during perimenopause, you don’t have to wait until your periods stop.

Whether HRT is appropriate depends on your symptoms, medical history, individual risks and personal preferences.

What If You Don’t Want HRT — or You’ve Been Advised Not to Take It?

HRT isn’t the right choice for every woman.

Some women can’t take certain types because of their medical history. Others simply prefer to explore non-hormonal options.

Not taking HRT doesn’t mean there’s nothing you can do. Depending on your symptoms, options may include cognitive behavioural therapy (CBT), lifestyle approaches and particular non-hormonal medicines.

There are also newer treatments. In 2026, NICE recommended fezolinetant as an option for moderate-to-severe hot flushes and night sweats when HRT isn’t suitable.

If you have a complex medical history, it can be helpful to speak to a clinician with specialist menopause expertise about what may be appropriate for you.

And a quick word about “natural” menopause remedies: natural doesn’t automatically mean safe or effective. Some supplements and herbal products can interact with medicines, so it’s worth checking before taking them.

Where Might Acupuncture Fit?

For some women, acupuncture is another supportive option they choose to include as part of their perimenopause care.

Women come to see me for different reasons. One may be struggling mainly with sleep and night sweats; another with headaches, anxiety or simply feeling that her body isn’t responding to stress in the way it used to.

My approach is to look at what’s happening for the individual woman rather than treating “perimenopause” as one single set of symptoms. You can read more about this in how acupuncture eases menopause symptoms.

Research into acupuncture during the menopausal transition has focused particularly on symptoms such as hot flushes and night sweats. Some clinical trials and reviews have reported improvements in symptom frequency, severity and menopause-related quality of life, although results have varied and comparisons with sham acupuncture have been less consistent.

So while acupuncture can’t be guaranteed to improve a particular symptom for every woman, there is research suggesting potential benefit.

For women who don’t want HRT, can’t take it, or who are using HRT but still feel they need additional support, acupuncture may be something they wish to explore alongside appropriate medical care.

I also think the wider conversation matters. Perimenopause rarely happens in isolation from the rest of life. Sleep, stress, work, exercise, diet and existing health problems can all influence how someone is feeling.

Taking time to understand that wider picture helps me tailor treatment to the person in front of me rather than reducing everything to a list of symptoms — this is very much the ethos behind how we work at The Acupuncturists.

What’s a Useful First Step?

If you’ve been reading this and thinking, that sounds familiar, it can help to keep a simple note of your periods and symptoms for a few months.

Recording things such as cycle dates, sleep, hot flushes or night sweats, headaches and mood can make patterns easier to spot and gives you something useful to discuss with your GP or menopause healthcare professional.

You don’t need to wait until symptoms become unbearable before asking for help. There are hormonal and non-hormonal treatments, lifestyle changes and supportive approaches that can all have a place. What suits one woman won’t necessarily be right for another.

If you’d like to understand more about where acupuncture may sit alongside your wider perimenopause or menopause care, you can also read our menopause symptoms page.

A Few Common Questions

Can I be in perimenopause if my periods are still regular?

Yes. Perimenopause begins before periods stop, and some women develop symptoms while their cycles are still quite regular.

What if my symptoms don’t seem “typical”?

Perimenopause can affect women very differently, and not everyone experiences prominent hot flushes or night sweats. Anything significant, unusual or worrying should still be medically assessed.

Do I have to take HRT if my symptoms are troublesome?

No. HRT is an effective option for many women, but it isn’t the only approach. Non-hormonal treatments and supportive options can also be discussed with your GP or menopause clinician.

Can acupuncture be used alongside HRT?

Yes. Acupuncture is sometimes used alongside conventional menopause care, including HRT. It’s helpful to let your acupuncturist know about any medication or medical treatment you’re using.

Sources and further reading

Disclaimer

This article is intended for general information and education only and isn’t a substitute for personalised medical advice, diagnosis or treatment. Perimenopausal symptoms vary considerably between women, and similar symptoms can sometimes have other causes. If you’re concerned about symptoms or changes in your health, please speak to your GP or an appropriately qualified healthcare professional. Acupuncture should be used alongside, rather than as a replacement for, appropriate medical care.