Symptoms of perimenopause and how to manage them

Women in bed with a headache, showing signs of perimenopause


Published October 2026
Expert contributor: Dr Terri Foran, sexual health physician and board member, Australasian Menopause Society


Irregular periods, restless nights, brain fog… the symptoms of perimenopause can be subtle. Here’s what to look out for.


Ever feel like your body's running on its own timetable? One month your period shows up early, the next it's a couple of weeks late. You feel tired and foggy during the day, only to find yourself wide awake at 3am.

The symptoms of perimenopause can turn up years before your periods actually stop, and they can be confusing to navigate alone. Around 82% of Australian women who've had menopause symptoms say it's affected their quality of life, yet only 57% have spoken to a doctor about it.

If you think you may be in perimenopause, or aren’t sure what to expect when it arrives, here’s what you need to know.

Perimenopause: What is it?

Menopause is when you haven’t had a period (or any spotting) for 12 months, which usually happens between the ages of 45 and 55. Perimenopause is the stage leading up to this, sometimes called the ‘menopause transition’.

During this time, your hormone levels change, which can cause physical symptoms. “Some months, you’ll have a normal period and feel okay. Other months, you might produce extra oestrogen, which can lead to symptoms like breast tenderness, nausea and headaches,” Dr Terri Foran, sexual health physician and board member of the Australasian Menopause Society, told Health Agenda.

“And then there might be months where you produce less oestrogen and start noticing things like hot flushes. All these hormonal fluctuations can also affect mood.”

What are the symptoms of perimenopause?

Perimenopause affects everyone differently, but irregular periods are usually the first symptom. Your period might come more or less often, last for shorter or longer than normal, be lighter or heavier than usual, or not come at all.

Other common symptoms of perimenopause include:

  • hot flushes and night sweats
  • trouble sleeping
  • mood swings, anxiety or low mood
  • vaginal dryness
  • brain fog or trouble concentrating
  • weight gain (particularly around the belly)
  • low libido.

Surprising symptoms that catch some women off-guard include joint and muscle aches, urinary problems, dry or itchy skin, and even gum or teeth problems.

When does perimenopause start and how long does it last?

There's no single age when perimenopause begins. It usually starts in your 40s and lasts around four to six years. The average age Australian women reach menopause is 51,  although it can happen earlier or later.

Around one in 10 women will go through premature or early menopause, which is when your final period happens before the age of 40 (premature) or 45 (early). We don’t always know why premature or early menopause happens, but it’s different to perimenopause and can be caused by things like surgery, cancer treatments, some autoimmune diseases and genetic disorders, and a family history of early menopause.

Can you get pregnant during perimenopause?

Short answer: yes. Even if your periods are irregular, you’ll still occasionally ovulate during perimenopause, so pregnancy is possible. It’s important to practise safe sex during this time if you don’t want to become pregnant.

How to manage your symptoms

Understanding the symptoms of perimenopause is the first step. The next is finding what helps. A few lifestyle changes can make a real difference to how you feel day to day:

  • Move your body. Regular exercise, including some strength training, can help to lower your risk of chronic disease and reduce symptoms like anxiety or low mood.
  • Eat well. A balanced diet is essential for overall wellbeing and can help you maintain a healthy weight. It may also help to reduce some menopause-related symptoms. For nutrition support, eligible RT Health members can access the evidence-based CSIRO Total Wellbeing Diet*, which combines a higher protein, low-GI eating plan with proven weight management tools to help improve habits.
  • Prioritise sleep. Set a regular bedtime. Avoid screens, caffeine and alcohol before bed, and create a consistent wind-down routine like having a bath or listening to music to help your body relax and prepare for rest.
  • Avoid triggers. Spicy food, hot drinks, alcohol, caffeine and smoking can trigger hot flushes and night sweats – it’s best to limit them or cut them out entirely.
  • Lean on your support system. Talking to friends, family or a mental health professional about what you're going through can ease the mental load.

If any of the symptoms of perimenopause are getting in the way of your day-to-day life, whether it’s the muscle aches, weight gain, sleepless nights or low mood, it's worth having a chat with your GP.

“We can’t diagnose perimenopause with a blood test because hormones are constantly changing, so what a blood sample shows today could be completely different a week from now,” says Dr Foran. That said, your doctor can assess your symptoms, rule out other causes and talk you through perimenopause treatment options.

They might recommend menopausal hormone therapy (MHT) – formerly hormone replacement therapy (HRT) – or non-hormonal prescription medicines that target hot flushes or night sweats. Cognitive behavioural therapy (CBT) can also help with mood changes, while non-prescription medicines are available for symptoms like muscle aches and sleep problems.

If you have eligible extras cover with RT Health, you may be able to claim towards services like physiotherapy or psychology, which can help you manage symptoms like joint pain or low mood.

Need a little extra support?

Perimenopause can be a challenging time, both physically and emotionally. If you or someone you know needs extra support, eligible RT Health members^ can claim for online cognitive behavioural courses delivered by THIS WAY UP. These are evidence-based programs developed by psychiatrists and clinical psychologists and can help you manage depression, generalised anxiety, social anxiety, health anxiety, panic and more.

Depending on your level of cover, you may also be able to access benefits for mental health services under the psychology annual limit of your cover. Check your RT Health Cover Guide to see what's available to you.




Important information

* The CSIRO Total Wellbeing Diet is available to RT Health members with hospital cover who:

• are aged 18 or over

• have a Body Mass Index of 28 or above

• have multiple lifestyle risk factors like smoking, physical inactivity and poor nutrition.

^ THIS WAY UP is available to RT Health members with Deluxe Extras, Top Extras and Smart Extras cover, up to their annual limit of $120 per person, paid under Psychology benefits. The benefit payable will depend on the program you choose.

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