September is recognised by many women’s health advocates as Perimenopause Awareness Month. It gives us an important opportunity to talk openly about a stage of life that affects every woman differently, yet is still too often misunderstood or dismissed.

For many women, perimenopause does not begin with an obvious hot flush. It may start with disrupted sleep, increased anxiety, heavier or less predictable periods, changes to the skin, unexplained tiredness, brain fog or simply the feeling that something is no longer quite right.

You may find yourself asking:

Why don’t I feel like myself anymore?

If that sounds familiar, you are not imagining it—and you do not have to struggle through it alone.

What is perimenopause?

Perimenopause means “around menopause”. It is the transitional stage leading up to menopause, during which hormone levels fluctuate and periods begin to change.

Menopause itself is reached when you have not had a period for 12 consecutive months. Perimenopause can begin several years before that point and commonly affects women between the ages of 45 and 55, although it can start earlier.

Every experience is different. Some women notice only minor changes, while others experience symptoms that affect their work, relationships, confidence, sleep and overall quality of life.

Choose your next step: book a personalised consultation with me and lets look beyond isolated symptoms to consider your wellbeing, confidence, skin, lifestyle and the changes you want to make in your life.

Could your symptoms be connected to perimenopause?

Changes to the menstrual cycle are often among the first recognised signs. Your periods may become:

  • More or less frequent
  • Heavier or lighter
  • Longer or shorter
  • Less predictable than before

However, perimenopause can affect much more than your periods. Possible symptoms include:

  • Hot flushes and night sweats
  • Difficulty falling asleep or staying asleep
  • Tiredness and reduced energy
  • Mood swings, anxiety or low mood
  • Brain fog, forgetfulness and difficulty concentrating
  • Headaches or worsening migraines
  • Heart palpitations
  • Muscle aches and joint pain
  • Vaginal dryness or discomfort
  • Recurrent urinary symptoms or urinary tract infections
  • Reduced libido
  • Changes to body composition or weight
  • Dry, itchy or more sensitive skin
  • Hair thinning
  • Reduced confidence or feeling disconnected from yourself

You do not need to experience every symptom for perimenopause to be a possibility. Symptoms may also change over time—sometimes appearing, disappearing and returning in a different form.

It is equally important not to assume that every new symptom is caused by hormones. Thyroid conditions, anaemia, vitamin deficiencies, medication effects and other health concerns can sometimes cause similar changes. A proper conversation with a healthcare professional can help you understand what may be happening.

Why perimenopause can be difficult to recognise?

Perimenopause often arrives during an already demanding stage of life. You may be balancing work, family responsibilities, caring for parents, changing relationships or questions about your identity and future.

When sleep, concentration, mood and energy begin to change at the same time, it can be easy to blame stress—or to blame yourself.

You may think you need to become more organised, more disciplined or simply “push through”. But struggling is not a personal failure. Your body may be asking for a different kind of attention and support.

Recognising the pattern can be the first step towards making informed decisions and feeling more in control.

Start by noticing what has changed

Before speaking to your GP or another qualified healthcare professional, it may help to keep a simple symptom record.

For a few weeks, make a note of:

  • Changes to your periods
  • Hot flushes or night sweats
  • Sleep quality
  • Energy levels
  • Mood and anxiety
  • Concentration and memory
  • Headaches or migraines
  • Joint or muscle discomfort
  • Skin changes
  • Urinary or intimate symptoms
  • The effect these changes are having on your daily life

You do not need a complicated tracking system. A few honest notes can make it easier to see patterns and explain what you are experiencing.

When should you speak to your GP?

You do not have to wait until your symptoms become unbearable. Speak to your GP, nurse or pharmacist if your symptoms are worrying you or affecting your sleep, work, relationships, emotional wellbeing or daily life.

You should also seek medical advice if:

  • Your bleeding has become significantly heavier
  • You are bleeding between periods or after sex
  • You experience persistent or concerning palpitations
  • Your symptoms have started before the age of 45
  • You are experiencing severe anxiety, depression or other significant changes to your mental health
  • You have any vaginal bleeding after 12 months without a period

Postmenopausal bleeding should always be checked, even if it happens only once or involves a small amount of spotting.

What support is available?

There is no single solution that is right for every woman. Support should reflect your symptoms, health history, preferences and personal circumstances.

Options may include:

Hormone replacement therapy

Hormone replacement therapy, commonly known as HRT, can help manage many symptoms associated with perimenopause and menopause. Different types and methods of taking HRT are available.

A qualified healthcare professional should explain the potential benefits and risks in relation to your individual health and help you make an informed decision.

Non-hormonal support

If you cannot take HRT, do not want to take it or need additional support, other options may be available. Menopause-specific cognitive behavioural therapy can help some women manage hot flushes, sleep difficulties and depressive symptoms associated with menopause.

Other treatments may be recommended depending on the symptoms you are experiencing.

Everyday foundations

Lifestyle changes do not make perimenopause disappear, and women should never be made to feel responsible for symptoms they cannot simply “fix”. However, supportive daily habits can protect your health and help you feel stronger throughout the transition.

These may include:

  • Eating a varied, balanced diet
  • Including adequate protein and calcium-rich foods
  • Regular resistance and weight-bearing exercise
  • Creating a consistent sleep routine
  • Reducing smoking and excessive alcohol consumption
  • Finding realistic ways to manage stress
  • Making time for rest and recovery
  • Staying connected to supportive people
  • Asking for adjustments at work when needed

The aim is not perfection. It is to identify small, sustainable changes that support your body rather than placing it under more pressure.

Perimenopause can affect how you see yourself

The emotional experience of perimenopause deserves as much attention as the physical symptoms.

Changes to your body, skin, energy, confidence or libido can alter how you feel about yourself. You may feel less visible, less certain or disconnected from the person you used to be.

This stage can be challenging, but it can also become an opportunity to reassess what you need, how you want to live and what feeling strong means to you now.

You are not required to return to an earlier version of yourself. You can learn how to support the woman you are becoming.

You deserve informed and individual support

Perimenopause is not something you have to endure silently. Understanding your symptoms, preparing for a healthcare appointment and receiving the right emotional and practical support can make a meaningful difference.

At Beauty for Ashes, I support women through midlife, perimenopause and menopause with a compassionate, whole-person approach. We look beyond isolated symptoms to consider your wellbeing, confidence, skin, lifestyle and the changes you want to make in your life.

This support complements—rather than replaces—medical assessment and treatment.

If you are ready to understand what has been changing and explore your next steps, you can:

You do not need to have everything figured out before asking for help. Sometimes the most important first step is simply being able to say:

Something has changed, and I am ready to understand it.

Medical information notice: This article provides general information and is not a substitute for individual medical advice, diagnosis or treatment. Speak to your GP or another appropriately qualified healthcare professional about symptoms or concerns affecting your health.