5 Signs You're in Perimenopause & What to Do About Each One
You're sleeping terribly. Your mood feels like it belongs to someone else. Your skin is changing in ways that your usual products aren't fixing. And your cycle, which you could once set a clock by is doing something unpredictable.
You've Googled everything. You've wondered if you're just stressed, or anxious, or not eating right.
But here's what nobody may have told you yet: you might be in perimenopause. And you might have been for years.
According to Dr Rebecca Mitchell, director of the Health at Work Research Centre at Macquarie University, many women start experiencing symptoms in their late 30s with absolutely no idea they're going into perimenopause. nsw
That's not a personal failing. The earliest signs are often far more subtle than the hot flush stereotype. Anxiety, irritability, sleep disruption, joint pain and heavy bleeding are common early indicators that are frequently missed or misattributed. nsw
This post is here to change that. Here are five signs that deserve your attention and what to actually do about each one.
What Is Perimenopause?
Before we get into the signs, a quick clarification because this is one of the most commonly misunderstood transitions in women's health.
Perimenopause is not menopause. It's the transition toward menopause and it can last anywhere from two to ten years. The average age for women to reach menopause in Australia is 52, but perimenopause typically begins eight to ten years before that, meaning symptoms can start in your early to mid 40s, and sometimes earlier.
According to the Australian Government Department of Health, around one in two women report mild to moderate perimenopause symptoms, around one in four have symptoms severe enough to affect daily activities, and around one in four have no symptoms at all.
If you're in that first or second group, this is for you.
Sign 1: Your Sleep Has Changed
This is often the first thing women notice and the last thing they connect to their hormones.
Sleep disturbances during perimenopause include difficulty initiating or maintaining sleep, a higher frequency of night awakenings and poor-quality, non-restorative sleep. You might be waking at 3am for no apparent reason, lying there with a racing mind, and then dragging yourself through the next day.
Research shows that perimenopausal women experience significantly greater sleep disruption than premenopausal women, including longer and more numerous arousals resulting in measurably less sleep overall.
The flow-on effects matter too. Studies suggest that mood changes experienced during perimenopause may be mediated by sleep disruption meaning poor sleep isn't just a symptom, it's amplifying everything else.
What to do:
Don't accept poor sleep as inevitable or brush it off as stress. If your sleep has noticeably changed, especially if it's accompanied by other symptoms on this list it's worth a proper assessment. A comprehensive hormone review can determine whether hormonal changes are at the root of it, and what options exist to address it properly.
Schedule your Womens Health Consultation with The Elwood Clinic
Sign 2: Your Mood Feels Unfamiliar
Anxiety appearing for the first time. Irritability that feels disproportionate. Emotions that shift quickly and without warning. A general sense that you don't quite feel like yourself.
Anxiety can appear for the first time during perimenopause, or worsen if you've had anxiety in the past and emotional symptoms are often amplified by poor sleep, life stress and feeling unsure of what's happening.
Research has found that women experiencing perimenopausal anxiety are sometimes put on antidepressants by their GP, not because they're depressed, but because perimenopause wasn't even considered as a cause.
This is one of the most important things to understand: mood changes in perimenopause are not a mental health problem. They are a hormonal one and they deserve a hormonal assessment.
What to do:
If your mood has shifted noticeably and particularly if it's accompanied by sleep disruption, cycle changes or any of the other signs here raise it specifically in the context of perimenopause. A practitioner who understands the hormonal drivers can provide a far more targeted response than a generic mental health referral.
Sign 3: Your Skin Is Behaving Differently
This is the sign that catches many women off guard because they don't expect their skin to change so significantly, or so early.
During and after menopause, skin becomes thinner and less resilient and this process often begins during perimenopause as oestrogen starts to fluctuate and decline. The oestrogen-collagen connection is significant: oestrogen plays a key role in collagen production, skin hydration and elasticity.
In a survey of perimenopausal and menopausal women, 64% reported experiencing dry skin, 56% experienced itching, 30% had developed spots or acne and 22% reported a crawling skin sensation.
That 30% figure is worth pausing on. Adult acne particularly in women who never had it as teenagers is one of the more distressing and least talked-about perimenopausal symptoms. Some women notice drier skin, changes in hair texture or hair thinning during the transition and these changes can overlap with ageing, thyroid changes, iron deficiency or stress.
What to do:
Skincare alone often can't address hormonally driven skin changes. A two-pronged approach in-clinic treatments that work on the surface alongside naturopathic support that works from the inside out is far more effective. At The Elwood Clinic, this is exactly how we approach perimenopausal skin: treating what we can see while also investigating and addressing what's driving it internally.
Sign 4: Your Weight Is Shifting Despite Nothing Changing
You haven't changed what you eat. You're still exercising. But something around your midsection is different and it's not responding the way it used to.
During perimenopause, women experience an expansion of visceral adipose tissue. The fat that accumulates around the abdomen even in the context of minimal overall weight gain. This isn't a willpower problem or a lifestyle failure. It is a direct physiological response to hormonal change.
Up to 70% of women are affected by midlife weight gain, making it one of the most common perimenopausal experiences and one of the most frustrating, precisely because traditional approaches stop working.
Menopause also accelerates skeletal muscle loss, reducing basal metabolic rate and energy expenditure meaning the body's calorie needs change at the same time as its fat distribution patterns. Sleep disturbance and declining physical activity during this period further compound the picture.
What to do:
Understanding that this is hormonal, not a failure of effort is the first step. The second is getting a proper assessment that looks at the full picture: hormones, metabolism, sleep, stress and gut health.
Sign 5: Your Cycle Is Doing Something New
Changes in oestrogen and progesterone cause irregular periods, which are often one of the first signs of perimenopause. You might notice cycles that are more or less regular, or periods that are heavier or lighter than before.
This is because oestrogen doesn't decline in a smooth, predictable line it fluctuates. Hormone levels during perimenopause often fluctuate significantly, meaning women can feel completely well for much of the time and then have episodes of feeling dreadful when levels drop. This explains why some months feel completely normal and others feel entirely unmanageable.
It's also worth knowing that perimenopause does not mean you can't get pregnant. Fertility declines but doesn't disappear, contraception remains relevant until menopause is confirmed.
What to do:
If your cycle has changed noticeably particularly alongside any of the other signs here, it's worth discussing with a practitioner who takes a thorough, whole-body view. Cycle changes alone don't confirm perimenopause, but in the context of other symptoms they're a meaningful signal that deserves proper investigation.
You Don't Have to Figure This Out Alone
New research published in 2026 involving over 17,000 women across 158 countries found significant disconnects between the symptoms women recognise as perimenopausal and the symptoms they actually experience contributing to delays in care and unnecessary reductions in quality of life.
In other words: the information gap is real, and it's affecting women's health outcomes.
You don't need to put up with symptoms that are worrying you. There are treatment and support options that can help and you deserve care that takes your experience seriously.
At The Elwood Clinic, our Women's Health Consultations start with a dedicated 60-minute consultation. An unhurried conversation about what's been going on, how long it's been happening, and what a personalised plan looks like for you.
If something on this list resonated, that's reason enough to come in.
This article is intended for general information purposes only and does not constitute medical advice. Please consult a qualified health practitioner regarding your individual circumstances.
References
Mitchell, R. (2026). Perimenopause research and women's health in Australia. Macquarie University, Health at Work Research Centre. Published in The Lighthouse, Macquarie University. https://lighthouse.mq.edu.au/article/2026/march-2026/pip-edwards-perimenopause-research-unmasks-health-crisis
Australian Government Department of Health, Disability and Ageing. (2026). Perimenopause: Understanding symptoms. Australian Government. https://www.health.gov.au/perimenopause/understanding/symptoms
Australian Government Department of Health, Disability and Ageing. (2026). Perimenopause: Understanding perimenopause. Australian Government. https://www.health.gov.au/perimenopause/understanding/perimenopause
Kliman, L. (2025). Perimenopause signs, symptoms and diagnosis.https://drlenkliman.com.au/articles/perimenopause-signs-symptoms-what-to-expect/
SFI Health. (2026). Perimenopause in 2026: Why new global research calls for updated diagnostic criteria and improved symptom recognition. https://sfihealth.com/news/perimenopause-in-2026-why-new-global-research-calls-for-updated-diagnostic-criteria-and-improved-symptom-recognition
NSW Agency for Clinical Innovation. (2022). Menopause — managing sleep disturbance: Evidence brief. NSW Health Menopause Taskforce. https://aci.health.nsw.gov.au/__data/assets/pdf_file/0011/959231/Menopause-managing-sleep-disturbance-ACI-evidence-brief.pdf
Shechter, A., & Boivin, D. B. (1997). Sleep disruption and mood changes associated with menopause. PubMed, National Library of Medicine. https://pubmed.ncbi.nlm.nih.gov/9330235/
Chemist2U. (2026). Common menopause symptoms and management.https://chemist2u.com.au/menopause/menopause-symptoms/
Healthdirect Australia. (2026). Perimenopause. Australian Government. https://www.healthdirect.gov.au/perimenopause
Stockman, S., et al. (2026). Perimenopause as an obesogenic sensitive period: Contributions to elevated cardiovascular risk. PMC, National Library of Medicine. https://pmc.ncbi.nlm.nih.gov/articles/PMC12818170/
Midi Health. (2026). Hormonal instability and midlife weight gain. https://www.joinmidi.com/
Newson, L. (2023). Skin changes during perimenopause and menopause. Dr Louise Newson Health. https://www.drlouisenewson.co.uk/knowledge/skin-changes-during-perimenopause-and-menopause
Sun Doctors Australia. (2026). Can menopause increase skin cancer risk? https://sundoctors.com.au/blog/can-menopause-increase-skin-cancer-risk/