How do you know if you're in perimenopause?

Perimenopause is becoming a household word these days. When it comes to mind, most people think of hot flushes, mood swings and irregular periods. While there are a variety of symptoms associated with perimenopause, it's not the cause of every midlife woman’s problems. 

So, how do you know if you’re in perimenopause, and who should you turn to for help? Good news: We’ve got a practical, no-nonsense approach to help you feel informed and supported through this life stage. 

What are the first signs of perimenopause?

Each woman has a unique experience with the menopause transition. Hot flushes are often coined as the hallmark symptom of menopause or perimenopause. While it’s certainly a common and troublesome symptom for some women, there tends to be others that cause more daily disturbance. Irregular periods and changes in flow and cycle length can be a sign your body is changing. 

Hear from Sarah on why hot flushes are just one part of the story. 

Other common symptoms include:

• Sleep disturbances 
• Anxiety and low or changing moods
• Low energy and energy slumps
• Sleep disturbances - a.k.a 3 am wake ups
• Mood changes, often described as more intense Premenstrual Syndrome (PMS)
• Brain fog and trouble concentrating 
• Headaches, with worsening migraines for some women
• Midline weight gain 
• Joint aches and pains
• Vaginal dryness

It’s really important to know that not all women will experience perimenopause related symptoms. Around 20% experience no symptoms, 60% mild to moderate symptoms, and 20% experience severe symptoms that impact daily life. 

How do you know if you’re in perimenopause?

This is the million dollar question, right? There is no one single blood test or other diagnostic marker that can 100% diagnose you as being in perimenopause. But, with the help of your doctor, there are ways you can identify key trends of symptoms and hormones, that together paint a picture of your body changing in this life phase.

Step 1 - Keep a symptoms checklist

The duration of perimenopause changes for each woman, the average length being 4 to 8 years. Over this time, symptoms will change, often being more mild in early perimenopause and more pronounced and different in later perimenopause. Again, this is very unique to each woman, no one has the same exact experience. 

That said, it’s a good idea to keep a track of symptoms over time. This not only gives your doctor a better view of what’s happening (to aid a diagnosis), but also allows you to track changes over time, which may need different treatments and lifestyle approaches. 

Step 2 - Speak to your doctor and see what blood tests you might need

Bring your symptom checklist to the doctor and have a discussion about what could be happening for you. It’s easy to assume everything is perimenopause-related, but that can sometimes do more harm than good. Your doctor can help you with blood tests and other investigations to rule out any other causes. 

For example, low levels of iron can sometimes have similar symptoms to perimenopause (i.e. low energy) and you want to be sure all of that is covered before managing perimenopausal hormone shifts. 

Step 3 - Be aware of symptoms and changes

With time, symptoms will usually change. As that happens, you should discuss with the doctor how to change your diet, lifestyle and medications to help support your body through this time. And if symptoms start to impact your daily life, don’t wait to speak up. Seek help, you don’t have to suffer in silence. 

How can I manage my symptoms?

The good news is there are science-based strategies that can help many women who experience troublesome symptoms. Always speak to a doctor who can help bring a plan together for you. Here are some tips to guide you on your way. 

Optimise your diet

One way to support perimenopausal change is to consider adopting a Mediterranean style diet. Do this by having a more plant-focused eating style, with lots of veggies, fruit, wholegrains, legumes, nuts and extra virgin olive oil as the main fat source. 

This dietary pattern also includes moderate amounts of fish, poultry and dairy, while limiting red meat, processed foods, refined grains, and added sugars. Research is still building in this space, but the anti-inflammatory aspects of the Mediterranean diet may play a role in supporting the body during perimenopause and beyond. 

Lifestyle changes

Self care, mindfulness and taking time to recharge and rest can go a long way in supporting your nervous system during this time of change. Prioritising a good sleep schedule and minimising stress are also essential, as well as spending time in nature, with friends, and staying well connected. 

Consider evidence-based supplements

Some supplements have been shown to help support hormonal symptoms, as well as playing a role in modulating energy levels, sleep, stress and more. Speak to your naturopath or pharmacist to learn more. 

Speak to your doctor about medicated treatments

Hormone Replacement Therapy (HRT) also known as Menopausal Hormone Therapy (MHT) is a common option for managing symptoms. It can be very effective, but your doctor can assess if they are suitable for you. There are also other medications to help with specific symptoms, your doctor can share more details. 

What else could it be?

Other conditions and causes can mimic perimenopause symptoms. Hypothyroidism and low iron and just two examples but there are many others. 

The key is to seek medical support and never assume the cause of your symptoms. Before you seek treatment options, you should be clear on what the cause is, or speak to your doctor for more help and guidance. 

When to speak to a doctor

In the case that symptoms are impacting your day to day, you should always speak to a doctor. In this life stage, low mood and anxiety can be common, and this can become serious for some women. Never delay seeking help, as there are options to help you feel better and more like yourself again. 

The bottom line

Perimenopause is a significant life stage, and for some women, symptoms can be troublesome and impact daily life. The body is going through significant hormonal and other changes, and it makes sense that different symptoms will arise. 

But there are science-based strategies you can do to feel better. The first step is to work out if you’re in perimenopause, starting with a symptoms checklist and an open conversation with your doctor. 

Reviewed by the Healthylife health experts October 2025.