10 Perimenopause symptoms and signs women should not ignore

Perimenopause can affect much more than menstrual cycles. From unexplained anxiety and brain fog to joint pain, disturbed sleep and changes in libido, the hormonal transition can bring symptoms that women often mistake for stress or ageing. Dr Shivika Gupta, Fertility Specialist at Birla Fertility & IVF, Gurugram, explains the signs to watch for, how to distinguish them from other health conditions and when to seek medical advice.

Perimenopause is the transition leading up to menopause, during which ovarian hormone levels fluctuate and gradually change. It can last several months or years before menopause, which is defined as 12 consecutive months without a menstrual period.

While many women begin experiencing perimenopause in their 40s, symptoms can start earlier, sometimes in the late 30s. The transition does not always begin with missed periods, making it easy to overlook the initial signs.

According to Dr Shivika Gupta, recognising the pattern of symptoms is important, particularly when changes in sleep, mood or physical health appear without an obvious explanation.

Hot flushes and night sweats are commonly associated with perimenopause, but they are not the only symptoms women may experience. Some of the less obvious signs include:

. Sleep disturbances: Difficulty falling asleep, waking frequently or waking too early.

. Brain fog: Trouble concentrating, memory lapses and difficulty finding the right words.

. Anxiety



and mood changes: New-onset anxiety, irritability or unexplained mood swings.

. Joint pain and stiffness: Aches that affect everyday movement, including in the hands, knees and hips.

. Skin and hair changes: Changes in skin texture and hair quality that may coincide with other hormonal symptoms.

Women may attribute these changes to work pressure, stress or ageing. However, when several symptoms occur together, particularly alongside menstrual changes, perimenopause may be one possible explanation.

These symptoms are not exclusive to hormonal changes, and persistent or worsening complaints should be medically evaluated.

Feeling tired despite spending enough time in bed, struggling to concentrate at work or repeatedly losing one's train of thought can be frustrating.

During perimenopause, fluctuations in oestrogen and progesterone may contribute to changes in sleep. Some women experience difficulty falling asleep, lighter sleep or early morning waking, even without hot flushes.

Poor sleep can further affect attention, memory and concentration. Hormonal changes may also influence brain functions involved in mood and cognition, contributing to what is commonly described as brain fog.

These difficulties do not automatically indicate dementia or another neurological condition. However, symptoms that are persistent, severe or progressively worsening should not be dismissed as perimenopause without assessment.