You’re Not Imagining It: Recognising the Signs of Perimenopause
Written by Michelle Ringin, Western Medicinal Herbalist & Weight Management Practitioner (NHAA 155639) l Date Published: 9 October 2026 l Last reviewed: 9 October 2026 l Reading time: 10 minutes
Perimenopause is the transition leading up to your final period, when your ovarian hormones begin to fluctuate. It most often begins in your 40s and can last several years. Common signs include changes to your cycle, hot flushes, broken sleep, mood changes, brain fog and aching joints. In Australia, the average age of menopause is 51.
If you’ve found yourself lying awake at 3am, snapping at people you love, forgetting words mid-sentence or wondering why your jeans suddenly fit differently, you might have quietly asked yourself, “What is going on with me?”
You’re not imagining it, and you’re certainly not alone. October is Menopause Awareness Month, and it’s the perfect time to talk openly about the transition so many women move through with very little information or support.
What Is the Difference Between Perimenopause, Menopause and Postmenopause?
These words are often used interchangeably, but they describe different stages:
• Perimenopause is the transition. Your hormones begin to fluctuate, your cycle may change, and symptoms often begin. This stage can last several years.
• Menopause is your final menstrual period. It can only be confirmed in hindsight, once you’ve gone 12 months without a period.
• Postmenopause is the stage of life after menopause. Some symptoms settle, while others, such as vaginal dryness, may continue.
If your periods stop before the age of 45 (early menopause) or before 40 (premature menopause), please speak with your GP. This matters for your long-term bone and heart health, and there is good support available.
Why Do Hormonal Changes Cause Such a Wide Range of Symptoms?
Oestrogen receptors are found throughout your body- in your brain, skin, bones, joints, blood vessels, bladder and vaginal tissues. Progesterone, meanwhile, has a naturally calming effect on your nervous system and plays a role in restful sleep.
During perimenopause, these hormones don’t decline in a gentle, straight line. Progesterone often begins to fall first, while oestrogen can swing high and low in unpredictable patterns. It’s less a gentle slope and more a rollercoaster, which is why your symptoms might come and go, shift from month to month, or feel different from one cycle to the next.
What Are the Common Signs of Perimenopause?
Every woman’s experience is different. You might notice a few of these, or many:
• Changes to your cycle: periods that come closer together or further apart, become heavier or lighter, or are less predictable.
• Temperature changes: hot flushes and night sweats, sometimes with a racing heart or a sense of unease beforehand.
• Sleep: difficulty falling asleep, or waking in the small hours and struggling to get back to sleep.
• Mood and mind: anxiety, irritability, low mood, tearfulness, feeling overwhelmed, brain fog and losing words.
• Your body: aching joints and muscles, headaches or changes to migraine patterns, breast tenderness, and changes in where your body stores weight.
• Energy and libido: fatigue that rest doesn’t fully fix, and changes in desire.
• Intimate and urinary health: vaginal dryness, discomfort, and needing to pass urine more often.
When Should You See Your GP?
Herbal medicine can sit beautifully alongside medical care, but some symptoms always deserve a medical check first. Please see your GP if you notice:
• Very heavy bleeding, bleeding between periods, or bleeding after sex.
• Any bleeding after menopause (12 months or more without a period).
• New heart palpitations, chest discomfort or breathlessness.
• Low mood that persists, or thoughts of self-harm. If you are in crisis, please call Lifeline on 13 11 14 or 000 in an emergency.
• Periods stopping before the age of 45.
• Symptoms that are significantly affecting your work, relationships or quality of life.
Can a Blood Test Tell You If You’re in Perimenopause?
Not usually. Because hormone levels fluctuate so much from day to day during perimenopause, a single blood test often doesn’t give a clear picture. For women over 45, perimenopause is generally recognised through your symptoms and cycle changes rather than hormone testing.
Your GP may still suggest some tests, particularly if you’re younger or if things like iron levels or thyroid function could be contributing to similar symptoms. That’s why a symptom diary is so valuable- it helps you and your practitioners see the pattern.
How Can You Support Yourself Through Perimenopause?
Track what you notice
For six to eight weeks, jot down your cycle, sleep, mood, energy, hot flushes and aches. Patterns often appear that you’d never notice day to day, and it makes appointments far more productive.
Nourish your changing body
Aim to include protein at each meal to support muscle and steady blood sugar, plenty of fibre and colourful plants, and calcium-rich foods for your bones. Foods containing phyto-oestrogens, such as ground flaxseed, legumes, tofu and tempeh, have traditionally formed part of the diet in cultures where women report fewer menopausal symptoms.
Protect your sleep
A steady evening rhythm, a cool bedroom and gentler evenings can make a meaningful difference. I explore this in depth in the next article in this series on menopause and sleep.
Keep moving
Walking, strength training and gentle practices such as yoga support your bones, muscles, mood and metabolism. Strength work, in particular, becomes more important as oestrogen changes.
Lighten the load where you can
Perimenopause often arrives at the busiest time of life- careers, teenagers, ageing parents. Your nervous system is already working hard. Rest is Medicine, and saying no is sometimes the most supportive thing you can do.
Explore all of your options
Menopausal hormone therapy (MHT) is an effective option for many women and is well worth discussing with your GP. Herbal medicine, nutrition and lifestyle support are also valuable, either on their own or alongside MHT. You deserve to hear about all of your choices.
How Can a Medical Herbalist Help With Perimenopause?
When you come to see me, we start by listening. I want to understand your whole story- your cycle, your sleep, your stress, your digestion, your history and what you’d most like to change.
From there, I create a personalised liquid herbal formula made just for you, alongside practical nutrition and lifestyle support. Herbs such as Sage, Black Cohosh, Withania and Shatavari have long been traditionally used to support women through this transition, and I explore these in detail in the final article of this series.
I also check for any interactions with medications you take and am always happy to work alongside your GP.
A Note on Safety
Herbs are medicines. Please speak with a qualified practitioner before starting any herbal product, particularly if you take prescription medications, use MHT or hormonal contraception, have a history of hormone-sensitive cancer, or have liver, kidney or heart conditions.
Frequently Asked Questions
Can perimenopause start in your 30s?
Perimenopause most commonly begins in your 40s, but some women notice changes in their late 30s. If your periods stop before 40, or you have significant symptoms at a younger age, please speak with your GP.
How long does perimenopause last?
It varies widely. For many women, perimenopause lasts several years before the final period, and some symptoms can continue for a time afterwards.
Can a blood test confirm perimenopause?
Usually not on its own. Hormone levels fluctuate from day to day in perimenopause, so for women over 45 it is generally recognised through symptoms and cycle changes. Your GP may order tests to rule out other causes.
Can herbal medicine help with perimenopause?
Herbs such as Sage, Black Cohosh, Withania and Shatavari are traditionally used to support women through perimenopause and menopause. A Medical Herbalist can create a personalised formula and check it is safe alongside any medications you take.
Can I take herbs if I am on MHT?
Sometimes, but not always. Some herbs can interact with hormone therapy and other medications, so it is important to work with a qualified Medical Herbalist and let your GP know what you are taking.
Final Thoughts
Perimenopause can feel confusing, frustrating and, at times, lonely. But understanding what’s happening in your body is a powerful first step. Once you can name it, you can begin to support it.
Track what you notice, nourish yourself well, protect your rest, and reach out for support- from your GP, from a Medical Herbalist, and from the women around you who are walking the same path.
So many women sit across from me and say, “I thought I was going mad.” You’re not. Your body is moving through one of the biggest transitions of your life, and it deserves to be listened to with patience and care. Perimenopause isn’t something to push through alone. It’s an invitation to slow down, get curious, and give yourself the support you’ve probably been giving everyone else.
Michelle Ringin, Medical Herbalist
Ready to Feel Heard?
If anything in this article sounded like you, I’d love to help you make sense of it and create a plan that fits your body and your life.
You can book a free 15-minute discovery call or an initial consultation at Inner Peace Holistic Herbal Therapy & Weight Management Clinic in Lithgow via the online booking calendar, call 0490 335 602, or email info@innerpeacehealth.com.au.
Looking for deeper, ongoing support? Thrive Through the Change is my ten-module perimenopause and menopause program, available as Thrive Complete (with one-on-one clinical care and a personalised herbal formula) or Thrive Together (a warm group program). Reach out to join the waitlist.
Important Information
This article is general information only and is not a substitute for individual medical advice. Herbal medicines can interact with prescription medications and are not suitable for everyone. Always speak with your GP or a qualified health practitioner before starting any new treatment, and seek prompt medical care for any new, severe or worrying symptoms.
About the Author
Michelle Ringin is a Medical Herbalist (NHAA Member #155639), Nutritionist and Weight Management Practitioner with over 14 years of clinical experience. She runs Inner Peace Holistic Herbal Therapy & Weight Management Clinic in Lithgow, NSW, where she supports people and their dogs with personalised herbal medicine, nutrition and lifestyle care. Healing, Naturally. Together.
Published: 26 September 2026 · Medically reviewed by: Michelle Ringin, Medical Herbalist
References and Further Reading
Australasian Menopause Society. Information sheets for women. menopause.org.au
Jean Hailes for Women’s Health. Menopause and perimenopause. jeanhailes.org.au
International Menopause Society. World Menopause Day 2026. imsociety.org
Inner Peace Holistic Herbal Therapy
Healing, Naturally. Together.
Located Lithgow | 0490 335 602 | info@innerpeacehealth.com.au
NHAA Member 155639 | ABN: 30874985213