Early Signs of Perimenopause: What no one tells you (until you’re in it)
Sudden body changes, even though your diet’s the same? Major hair fall? Fluctuating hormones? Sudden new and persistent chin hair? Wide awake at 3am and dead tired by 2pm? Losing words mid-sentence? These could all be early signs of perimenopause. If this sounds familiar, don’t worry. You’re not losing it. Your hormones might simply be entering a new phase.
You’ve heard of menopause. But have you heard of perimenopause?
Most women know menopause marks the end of their reproductive years. Far fewer know about the transition that comes before it.
Perimenopause, which means “around menopause”, is the hormonal phase leading up to menopause, when oestrogen and progesterone begin fluctuating. Menopause itself is only officially diagnosed after 12 consecutive months without a period.
While menopause typically starts in your late 50s or early 60s, contrary to popular belief, perimenopause can surprisingly start from as young as 30 – and can last anywhere from a few years to up to a decade.
According to the academic medical center Cleveland Clinic, the unexpected onset can feel like a ‘body betrayal’, leaving women feeling unprepared, misdiagnosed, or even thinking they are seriously ill or dying, despite still having regular periods.”
Unlike menopause, perimenopause rarely arrives with a neat announcement. Instead, it quietly changes everything.
What are the symptoms of perimenopause?
Hot flushes, night sweats and irregular periods are the symptoms most people know about.
But the reality is much broader. Women may also experience:
- Brain fog
- Anxiety
- Mood swings
- Poor sleep
- Joint pain
- Increased belly fat
- Hair thinning
- Low libido
- Fatigue
- Vaginal dryness
- Heart palpitations
- Dry eyes and skin
- Recurrent urinary infections
Associate Professor Rukshini Puvanendran, Co-Director of the KK Menopause Centre and Head & Senior Consultant from Family Medicine Service at KK Women’s and Children’s Hospital, says lesser-known symptoms include heart palpitations, dry eyes, dry skin, gingivitis, mouth dryness and recurrent urinary infections.
That’s a long list, which is exactly why so many women struggle to connect the dots.
Why so many women think it’s “just stress”
Claire* knew her body felt off, but she didn’t know what it was exactly – just that something was different. Having just turned 42, she felt young and vibrant, full of energy. And then suddenly, she felt like a trainwreck. She felt old, slow, and heavier around the waist, and her once-healthy libido and mood took a major dip. When her mother suggested perimenopause, she laughed it off.
Lynn* had just sent her eldest one to university, looking much younger than the 50-year-old she was. Proudly displaying silver streaks in her hair, she was in great shape for her age, active and happy. So when the occasional brain fog and joint pains started to get more intense and more frequent, she suspected menopause. But her gynae told her she was just ageing and that ‘these things were normal’. Eat healthier, exercise more and sleep better was the advice given, making her feel that it was all just in her head.
The message both women received was the same: push through.
Uma Thana Balasingam, Founder of Careerquake & Lean In Network Singapore, says this story is incredibly common. “By the time a woman in her early 40s walks into a clinic with new joint pain, anxiety, sleep problems, or weight that won’t shift, the conversation usually defaults to stress or lifestyle, because that’s what doctors are trained to look for first.”
She adds, “The healthcare system simply hasn’t caught up. GPs receive very little menopause training, and even less of it is focused on the years leading up to menopause, so early signs get missed for a long time.”
Your body isn’t broken, it’s just changing
Uma knows this firsthand. “For four years, I went to my annual check-up, rattled off my symptoms, and left with a pat on the back and the same line: you’re fine. Except I wasn’t fine.” Her cholesterol climbed. Her weight shifted. She developed a frozen shoulder seemingly out of nowhere.
“Not one of my doctors, trainers or nutritionists said perimenopause. So you start thinking it’s you. You assume you’re not eating well enough, not training hard enough or not sleeping enough, spending years quietly blaming yourself for something that was never about discipline.”
For many women, the biggest relief isn’t finding a treatment. It’s finally having a name for what’s happening.
How is perimenopause diagnosed?
One of the most frustrating parts of perimenopause is that there isn’t a single blood test that confirms it. Instead, doctors diagnose it based on symptoms, age, menstrual history and overall health. For women taking hormonal birth control, it can be even harder to recognise.
“It can be challenging for a woman on the birth control pill to determine whether she is going through perimenopause, as the medication simulates regular periods and hides symptoms such as hot flushes,” explains Associate Professor Rukshini.
If something feels different, don’t dismiss it or convince yourself you’re simply stressed. Start the conversation with your GP or gynaecologist.
Perimenopause isn’t a one-size-fits-all thing. It’s different for each of us
Like puberty, perimenopause is a transition, not a particular point in a woman’s life. One day you’re in control of your life, and literally overnight, you wake up with unexplained symptoms.
“Oestrogen not only regulates the menstrual cycle but influences many of our organs,” says Associate Professor Rukshini.
As hormone levels fluctuate, symptoms vary enormously. One woman may struggle with anxiety and insomnia. Another may experience joint pain and brain fog. Someone else may have regular periods while battling unexplained fatigue and weight gain.
“Presently, there is no way to predict when a woman will enter perimenopause or how long the transition will take.”
Stop feeling guilty and blaming yourself. See your gynae and confirm your suspicions
Perhaps the hardest part of perimenopause isn’t the hot flushes or sleepless nights. It’s believing you’ve somehow failed. That you’re not disciplined enough. That you’re eating the wrong foods, exercising the wrong way or simply not coping as well as everyone else.
As Uma puts it: “What’s hard is that perimenopause tends to land in the years women are finally senior enough to lead, so the body changes and the working life shifts at the same time… The relief, when it finally comes, is just having the word for it.”
And that word is perimenopause. Knowing what’s happening doesn’t make every symptom disappear, but it replaces confusion with understanding and self-blame with self-compassion.
It’s just perimenopause. Don’t put your life on pause for it.
More than anything, perimenopause is a reminder that your body isn’t working against you. It’s adapting, recalibrating and moving through a transition that half the population will experience, yet far too few women are prepared for.
The more we talk about it, the easier it becomes to recognise the signs, ask the right questions and seek the support we need. Because perimenopause shouldn’t be something women have to discover through late-night Google searches and years of self-doubt. It should be a conversation we’re having long before it arrives.
What are the early signs of perimenopause?
The early signs of perimenopause can vary from woman to woman, but common symptoms include irregular periods, hot flushes, night sweats, poor sleep, brain fog, mood swings, anxiety, joint pain, weight gain around the abdomen, hair thinning and fatigue. Some women also experience lesser-known symptoms such as heart palpitations, dry eyes, vaginal dryness and recurrent urinary tract infections.
At what age does perimenopause usually start?
Perimenopause can begin as early as your mid-30s, although it most commonly starts in your 40s. The transition typically lasts four to eight years, but for some women it can continue for up to a decade before menopause begins.
Can you have perimenopause even if you're still getting regular periods?
Yes. Many women continue having regular periods during the early stages of perimenopause. Hormone levels begin fluctuating long before periods become irregular, which means symptoms such as poor sleep, anxiety, brain fog and hot flushes can appear while your menstrual cycle still seems normal.
How is perimenopause diagnosed?
There isn't a single blood test that can confirm perimenopause. Doctors usually diagnose it based on your age, symptoms, menstrual history and overall health. If you're experiencing new or persistent symptoms, it's worth speaking to your GP or gynaecologist, even if your routine blood tests come back normal.
Why is perimenopause often mistaken for stress?
Many symptoms of perimenopause, including fatigue, anxiety, poor sleep, weight gain and brain fog, overlap with stress and burnout. Because hormone fluctuations aren't always considered first, many women spend years believing they're simply overworked or ageing, rather than recognising they may be entering perimenopause.
How long does perimenopause last?
Perimenopause lasts an average of four years, but the experience varies widely. Some women transition in just a few years, while others experience symptoms for eight to ten years before reaching menopause, which is defined as 12 consecutive months without a period.
What should I do if I think I have perimenopause?
If you think you're experiencing the early signs of perimenopause, don't ignore your symptoms or assume they're "just part of getting older." Keep track of changes to your menstrual cycle, sleep, mood and energy levels, and make an appointment with your GP or gynaecologist.
Getting the right information early can help you better understand your options and manage symptoms before they begin affecting your quality of life.
Important Notice: This article is for general information and should not be considered medical advice. While we strive for accuracy, medical conditions vary, and the treatments mentioned may not suit everyone. Consult a qualified healthcare professional for personalised medical guidance.
