Perimenopause is the 4–10 year hormonal transition before menopause. Most women don't realise they've entered it — the symptoms creep in, get blamed on stress or motherhood, and a one-off hormone test comes back 'normal'. Here's the full symptom checklist our health specialists uses on consults, and the test pattern that catches perimenopause even when single-hormone results look fine.
Cycle changes
Often the first signal. Progesterone falls before estrogen does, so cycles become shorter, heavier, or unpredictable.
- •Periods closer together (every 21–25 days)
- •Heavier or more painful flow
- •Spotting before periods
- •Skipped or unusually long cycles
Sleep and mood
This cluster is the one most women dismiss as 'just stress'.
- •Waking 2–4am, unable to get back to sleep
- •New or worse anxiety, racing thoughts
- •Low mood without an obvious cause
- •Irritability, shorter fuse
- •Brain fog, word-finding trouble
Vasomotor and physical
These appear later for many women — sometimes years after the cycle and mood changes.
- •Night sweats, hot flushes
- •Joint aches
- •Stubborn weight around the middle
- •Hair thinning, dry skin
- •Low libido, vaginal dryness
What to test
A single estradiol is almost useless in perimenopause — it can be high one week and low the next. The panel that actually helps:
- •Estradiol, progesterone, FSH, LH (sex hormone pattern)
- •TSH, free T4, free T3, TPO antibodies (thyroid is the great mimic)
- •Fasting insulin, HbA1c (metabolic context — drives weight and mood changes)
- •Vitamin D, ferritin, B12 (fix the simple deficiencies first)
- •Cortisol AM, DHEA-S (stress and adrenal reserve)
What you do with the results
The results are the start, not the answer. On the consult, your specialist talks through the pattern — not just individual numbers — and lays out a 90-day plan covering nutrition, training, sleep, supplements and whether to discuss HRT with a prescriber.
Frequently asked
Symptoms can begin in the late 30s — and 'early perimenopause' before 40 is more common than most doctors flag.
Day 21 of a 28-day cycle is ideal for progesterone, but the other markers can be drawn any day. We help you time the draw correctly.