Perimenopause symptoms can creep up quietly – or hit all at once. Either way, if you felt like you finally knew your body and now nothing works the same way anymore, you’re not imagining it. The exhaustion, the irritability, the brain fog, the cycles that seem to have a mind of their own. This is perimenopause, and it deserves a proper explanation.
You’re not falling apart. Your body is shifting. And there’s a lot you can do about it.
Perimenopause vs Menopause – What’s the Difference?
Most women think of menopause as the whole chapter – the hot flashes, the weight gain, the mood swings. But menopause itself is technically just one day: the day your menstrual bleeds have been absent for 12 consecutive months. After that, you’re post-menopausal.
Perimenopause is everything leading up to that point – the transition period where your hormones begin to shift and your body starts responding. It typically begins in your early 40s and lasts an average of 7.5 years, though it can be as short as a couple of years or as long as 12.
Not all of perimenopause is symptomatic. But it is a phase when things are moving, and the more supported your body is, the smoother that tends to be.
The duration and intensity of your experience is shaped by lifestyle, stress, sleep, nutrition, digestion, gut and liver health, adrenal and thyroid function, and your body’s ability to detoxify. These are exactly what we look at inside Decode, my starting point program.
Common Perimenopause Symptoms
The most common perimenopause symptoms include:
- Fatigue that doesn’t resolve with rest
- Hot flushes and night sweats
- Sleep disturbances – difficulty falling asleep, waking between 1–4am
- Brain fog, poor memory, scattered thinking
- Mood swings, anxiety, depression, tearfulness
- Worsening PMS or cycle changes (heavier, lighter, irregular)
- Joint pain and muscle loss
- Heart palpitations
- Low libido and vaginal dryness
- Hair loss, dry or itchy skin
- Weight gain, particularly around the belly
- Digestive issues
- Increased headaches or migraines
Perimenopause also has two distinct phases, which do feel different. In the early menopausal transition, oestrogen tends to run high and erratic, so you’re more likely to experience heavy periods, breast tenderness, emotional lability, and anxiety. Cycles become variable – sometimes wildly so.
In the late menopausal transition, oestrogen is declining, and symptoms shift toward hot flashes, vaginal dryness, depression, brain fog, and longer cycle gaps. Knowing which phase you’re in changes how you support yourself.
Why Your Symptoms Might Not Be “Just” Perimenopause
Brain fog, mood swings, insomnia, hot flashes, heavy periods – these can all be perimenopause symptoms but driven by inflammation, insulin resistance, chronically elevated cortisol, or poor cardiovascular health, completely independently of your hormone levels.
Which means two women with identical symptoms can have entirely different root causes.
This is exactly why a generic perimenopause protocol rarely gets the full job done. Your symptoms are a signal, but the source needs investigating. Layering supplements or lifestyle changes onto an unidentified underlying driver is, at best, slow. At worst, it makes things worse.
This is what we untangle inside Decode – looking at your individual body chemistry rather than guessing from a symptom list.
What’s Actually Happening to Your Hormones
Think of oestrogen in perimenopause like a ketchup bottle you’re banging on the bottom – nothing comes out, then a tiny bit, then a huge splodge, then nothing again. That’s the reality of what your oestrogen is doing.
As your ovarian reserve declines, your ovaries and follicles continue producing oestradiol, but progesterone drops as ovulation becomes less predictable. Your brain (the hypothalamus and pituitary) notices and turns up its signals, increasing FSH to compensate – which is why it can feel like a hormonal rollercoaster with no apparent trigger.
High oestrogen symptoms tend to look like: swelling, breast tenderness, migraines, heightened emotions. Low oestrogen symptoms tend to look like: dryness, joint pain, memory issues, low libido.
DHEA, testosterone, cortisol, insulin, leptin, and ghrelin are all impacted too – affecting your sleep, appetite, mood, metabolic function, and energy.
After menopause, when the ovaries stop producing oestrogen and progesterone, your adrenal glands, peripheral tissues (including fat cells), and even the brain take over small-scale hormone production. This is why adrenal health in perimenopause is not optional – it’s foundational. It’s also why the state of your adrenals before you hit this transition matters enormously.
My focus isn’t on managing your hormones directly – it’s on restoring the foundations that allow your body to regulate them better on its own.
This Is Not Something You Just Push Through
A 2023 study in the journal Occupational Medicine surveyed 407 women and found that the most common symptoms affecting employees more than 50% of the time at work were fatigue, difficulty sleeping, poor concentration, and poor memory. Work performance was impacted for 65% of respondents.
You are not alone in this. And you don’t have to white-knuckle your way through it.
Your body is speaking up for a reason. The question is whether you have the right information to actually hear it – and the right support to do something about it.
Where to Start
If you’re waking between 1 and 4am, running on coffee, crashing by afternoon, and wondering where your motivation went – your body is asking for support. That’s not weakness. That’s data.
Download my free Guide to Perimenopause – it covers the hormone picture in depth, what tests to ask your doctor for, how to support yourself through the transition, and much more.
Or if you’re ready to go deeper: Decode is my starting point program where we look at what your body actually needs to feel stable, energised, and like yourself again – using HTMA (Hair Tissue Mineral Analysis) to understand your individual mineral status, stress response, and body chemistry. Your data, not a generic protocol.
Because your experience of this transition is uniquely yours. And you deserve answers that reflect that.
[→ Download the Free Guide]
[→ Learn About Decode]
— Carla x