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Perimenopause: What's really happening in your body — and why nobody talks about it

By Sabina Moretti · Certified Menopause Wellness Coach · wise-women-balance.ch

In brief

Perimenopause often begins years before periods stop — and it is the most symptom-rich phase of the menopause transition. This article explains what happens hormonally, which symptoms are typical, and why so many women go years without a diagnosis.

"I thought I was losing my mind"

I hear this often. Months of broken sleep. Heart pounding. Heart palpitations for no reason. Mood swings that feel like someone else is in control. And a doctor who says: 'Your tests are normal.' The tests can be normal. And you can still be in perimenopause.

What exactly is perimenopause?

Perimenopause means 'around the menopause'. It is the transition phase that precedes menopause — and it can last 4 to 10 years. Hormone levels — particularly oestrogen and progesterone — fluctuate irregularly and often dramatically.

Typically begins: mid-40s, sometimes earlier. Can start as young as 35.

The most common symptoms — and their hormonal cause

1. Hot flushes and night sweats

Oestrogen regulates the thermostat in the brain (hypothalamus). When levels fluctuate, that thermostat loses stability — the result is sudden heat surges.

2. Sleep disruption

Progesterone has a sedating effect. As it declines, many women struggle to fall asleep or wake in the night — often accompanied by night sweats or a racing heart.

3. Irregular periods

One of the first signs: periods become shorter, longer, heavier, lighter, or simply unpredictable. This is not illness — it is hormonal transition.

4. Mood swings, irritability, anxiety

Oestrogen influences serotonin and GABA. As oestrogen levels drop, irritability, tearfulness, and even panic attacks can occur.

5. Brain fog

Difficulty concentrating, word-finding problems, the feeling of thinking through fog — this is not imagined. Oestrogen is neuroprotective.

Why am I not getting a diagnosis?

Because blood tests in perimenopause often show 'normal'. FSH and oestradiol fluctuate daily. The diagnosis of perimenopause is clinical: based on symptoms, age, and cycle changes.