You’re Not Imagining It — Your Hormones Are Changing: Perimenopause Explained by Dr Sarah Jenkins

If you are a woman in your late 30’s through to 50s and thinking “something is different, but I can’t explain it”, you are not imagining it.

Many women start to notice subtle but persistent changes in their body and mind. Sleep becomes lighter or disrupted. Anxiety increases. Energy levels drop. Mood feels less stable. Periods may change—or sometimes everything feels different even before cycles become irregular.

These changes are often due to perimenopause, the transitional phase before menopause, driven by fluctuating hormone levels including oestrogen and progesterone.

This article explains what is happening, why it is often missed, and what can actually help.

What is perimenopause?

Perimenopause is the stage leading up to menopause, when hormone levels begin to fluctuate rather than decline steadily.

This phase can last several years and typically starts in the 40s, although some women notice symptoms earlier. Women of colour and neurodiverse women present earlier.

During this time, oestrogen, progesterone AND testoterone levels rise and fall unpredictably. This hormonal instability is what causes many of the symptoms women experience.

Why perimenopause symptoms feel confusing

One of the most frustrating aspects of perimenopause is that symptoms often come and go.

You may feel fine one week and completely different the next.

This happens because hormone levels fluctuate day to day—not in a straight downward line.

Because of this variability, standard blood tests are often not helpful in diagnosing perimenopause. Many women are told their results are “normal,” even when symptoms are significant.

Common symptoms of perimenopause

Perimenopause affects every woman differently, but common symptoms include:

• Perimenopause fatigue and low energy

• Anxiety or increased stress sensitivity

• Low mood or emotional changes

• Brain fog and difficulty concentrating

• Waking at 3–4am or poor sleep quality

• Irregular or changing menstrual cycles

• Heavier or lighter periods than usual

• PMS becoming more severe

• Weight gain, especially around the abdomen

• Reduced stress tolerance

You do not need all these symptoms for hormones to be involved.

Why perimenopause is often missed

Perimenopause is frequently under-recognised because its symptoms overlap with:

• Stress and burnout

• Anxiety and depression

• Thyroid conditions

• Sleep disorders

• Busy life stages (work, parenting, caregiving)

As a result, many women are told:

• “It’s just stress”

• “Your blood tests are normal”

• “You’re too young for menopause”

This delay in recognition can leave women struggling unnecessarily for years.

Is it perimenopause or anxiety?

A common concern is whether symptoms are hormonal or psychological.

In reality, both can be connected.

Hormonal fluctuations can directly affect:

• serotonin regulation (mood)

• sleep cycles

• stress response systems

This is why anxiety, panic symptoms, and low mood often appear for the first time—or worsen significantly—in perimenopause.

What actually helps perimenopause symptoms?

There is no single treatment for perimenopause. Management should be individualised.

Options may include:

1. Lifestyle foundations

• Sleep support strategies

• Nutrition and blood sugar balance

• Strength training and movement

• Stress regulation techniques

2. Medical assessment

• Rule out thyroid issues, iron deficiency, or other contributors

• Symptom-based assessment rather than relying solely on blood tests

3. Hormone replacement therapy (HRT/BHRT)

For many women, HRT can significantly improve:

• sleep

• mood

• energy

• cognitive symptoms

4. Individualised treatment plans

Care should be tailored based on symptoms, risk factors, and personal goals.

When to seek medical advice

You should consider speaking to a doctor if:

• Symptoms are affecting your quality of life

• You feel “not like yourself” and cannot explain why

• Sleep, mood, or energy changes persist

• You suspect hormonal changes but have not had clear answers

You do not need to wait until symptoms are severe.

The most important thing to understand

You are not imagining it.

Your symptoms are real, and they often reflect underlying hormonal changes that can be understood and treated.

Perimenopause is not something you simply have to endure. With the right support, many women experience significant improvement in symptoms and quality of life.