Symptom · Perimenopause
Hot flushes
A sudden rush of heat, mostly in your face, neck and chest, sometimes with sweating and shivers. It’s the most common symptom of perimenopause, and one of the most treatable.
Why it happens
Oestrogen helps regulate your brain’s thermostat (the hypothalamus). When levels dip, it becomes oversensitive to small changes in temperature and sets off a cooling response: your blood vessels widen and you start to sweat, even when it isn’t hot.
What can set one off
- Caffeine and alcohol, especially later in the day.
- Spicy food and very hot drinks.
- Stress and strong emotions.
- Overheated rooms or too many layers.
Right now
- Breathe slowly: in for 4 seconds, out for 6.
- Wear layers you can take off easily.
- Keep a water spray or a small fan handy.
Every day
- Keep a note of what sets yours off.
- Choose bedding and clothes in natural fibres.
- Stay active: it helps with sleep and mood.
Hot flushes coming thick and fast, or hard to live with?
A doctor can explain what’s happening and help you find the treatment that works best for you.
General information only. It doesn’t replace advice from a doctor who knows your history.
Recognise several of these? That’s no coincidence.
Menopause isn’t just hot flushes. Symptoms can start years before your last period and affect your sleep, mood, energy, memory, weight and intimate health.
Tap a symptom to find out more.
Sleep problems
Out like a light one night, wide awake at 3am the next. Progesterone used to help you switch off, and there’s less of it now. Add night sweats from shifting oestrogen, and deep sleep is often the first thing to go.
Brain fog
Words on the tip of your tongue, reading the same line twice, losing your thread mid-sentence. Oestrogen helps fuel your brain, so when it swings, your focus does too. And less progesterone means poorer sleep, which makes the fog thicker.
Anxiety
An email, a meeting, running ten minutes late, and suddenly your stress is through the roof. Progesterone has a natural calming effect, and oestrogen helps keep serotonin steady. When both are in flux, everything feels heavier than it used to.
Joint pain
Knees that creak when you stand up, stiff hands first thing in the morning. Oestrogen helps keep inflammation in check, so when levels dip, joints can feel stiff and sore. Lower testosterone also makes it harder to keep the muscle that supports them.
Irregular periods
One cycle short, the next one long, then a month with nothing at all. You ovulate less often, so you make less progesterone, while oestrogen swings up and down. Periods can get heavier too. It’s often the very first sign of perimenopause.
Palpitations
Your heart suddenly races or pounds while you’re doing nothing at all. Shifting oestrogen affects the nerves that control your heart rhythm. Unsettling in the moment, rarely serious, but always worth mentioning to your doctor.
Mood swings
Laughing one minute, in tears the next, or ready to tell everyone where to go. Oestrogen and progesterone are rising and falling faster than before, and both affect the brain chemicals that keep your mood steady.
Weight gain
Your waistline is changing, even though you’re eating exactly the same. Lower oestrogen moves fat storage towards your tummy. And as testosterone gradually declines, you lose some muscle, so your metabolism slows too.
Low libido
Desire takes longer to show up, or sometimes doesn’t show up at all. Testosterone, which fuels desire, gradually declines, and lower oestrogen can make arousal slower and sex less comfortable. It’s common, it’s not ‘all in your head’, and it can be treated.
Vaginal dryness
Dryness, and sometimes a little discomfort day to day. Oestrogen keeps vaginal tissue naturally moist, so lower levels mean less moisture. It’s very common, and still far too rarely talked about.
Night sweats
Waking up soaked in the middle of the night, changing the sheets, then lying awake. It’s a hot flush triggered by shifting oestrogen, just at night. And with less calming progesterone, getting back to sleep is harder.
Painful sex
Discomfort, or real pain, during or after sex. Lower oestrogen makes vaginal tissue thinner and more delicate, so something that never used to hurt suddenly can. You don’t have to put up with it.
Dry skin
Skin that feels tight, marks more easily and has lost some of its bounce. Oestrogen helps your skin make collagen, and you can lose up to 30% of it in the first five years after menopause.
Fatigue
A tiredness that won’t shift, even after a good night’s sleep. Less progesterone means lighter, more broken sleep, and swings in oestrogen bring night sweats and low mood. You feel it from the moment you wake up.
Hair loss
More hair in your brush, a parting that looks wider than before. Oestrogen and progesterone both help keep hair growing. With less of them, androgens (hormones like testosterone) have more effect, and hair grows back finer.