Introduction

Many women begin noticing changes in their mood, sleep, energy, or concentration during their forties and wonder what is happening. You might feel more anxious than usual, struggle to focus at work, feel unusually irritable, or find yourself exhausted even after a full night in bed. For some women, these changes appear gradually. For others, they seem to arrive suddenly.

These experiences are very common during perimenopause, the transition stage before menopause. Understanding the wide range of symptoms associated with this stage of life can help women feel less confused and more empowered to seek appropriate support.

This article provides a perimenopause symptom checklist to help you recognise patterns in your physical, emotional and cognitive health. Many women find that simply naming these changes can bring a sense of relief and clarity.

Understanding Perimenopause

The word menopause is often used broadly to describe this entire life stage, but medically menopause refers to a specific point in time. Menopause occurs 12 months after a woman’s final menstrual period. In Australia, the average age of menopause is approximately 51 years, although it may occur earlier or later for some women (Australasian Menopause Society, 2023).

Before menopause occurs, most women experience a transition phase known as perimenopause. This stage can begin from around the age of 40, sometimes earlier, when hormone levels such as oestrogen, progesterone and testosterone begin to fluctuate and gradually decline (Davis et al., 2015).

These hormonal shifts influence many systems in the body including mood regulation, sleep, metabolism, cognitive functioning and overall energy levels. According to the Australasian Menopause Society, symptoms during this transition can last between five and ten years for many women (Australasian Menopause Society, 2023).

Because hormones influence both the brain and body, perimenopause can present with a wide range of physical, emotional and cognitive symptoms (Soares, 2014).

Why Symptoms Vary So Much

One of the most confusing aspects of perimenopause is that symptoms do not appear the same for everyone. Some women experience only a few mild symptoms, while others experience several that significantly affect daily life.

You do not need to experience every symptom to be in perimenopause, and some symptoms may occur for reasons unrelated to menopause. However, recognising patterns can help you and your healthcare provider determine whether hormonal transition may be contributing to what you are experiencing (Hale & Burger, 2009).

Many women find it helpful to track their symptoms and bring this information to appointments with their GP or healthcare professional.

Perimenopause Symptoms Checklist

The following checklist includes symptoms commonly associated with the perimenopausal years. You may recognise some of these experiences in your own life.

Emotional and Psychological Symptoms

Many women first notice changes in their emotional wellbeing.

Common experiences include:

• Anxiety or panic attacks
• Crying more easily than usual
• Feeling depressed, unhappy, or emotionally flat
• Irritability or reduced patience
• Mood swings
• Feeling tense or constantly on edge
• Loss of confidence
• Loss of interest in activities you once enjoyed

Hormonal fluctuations influence brain systems involved in mood regulation, which can increase vulnerability to emotional symptoms during the menopausal transition (Bromberger & Epperson, 2018; Soares, 2014).

For example, you might notice that situations you previously handled calmly now feel overwhelming, or that small frustrations trigger stronger emotional reactions than before.

Cognitive Symptoms

Hormonal changes can also affect cognitive function.

Women often report experiencing:

• Brain fog
• Poor memory
• Difficulty concentrating
• Feeling mentally slower or easily distracted

You may find yourself rereading emails, forgetting appointments, or losing your train of thought during conversations. These cognitive changes are common and are thought to be associated with hormonal influences on brain functioning (Maki & Jaff, 2022).

Energy and Physical Symptoms

Changes in hormones can influence overall energy levels and physical wellbeing.

Common symptoms include:

• Fatigue or exhaustion
• Low energy levels
• Feeling dizzy or faint
• Breathing difficulties
• Heart palpitations
• Pressure or tightness in the head

Hormonal shifts can affect the nervous system, cardiovascular system and metabolism, which may contribute to these experiences (Davis et al., 2015).

Some women describe feeling physically drained even when their routine has not changed.

Sleep and Temperature Symptoms

Sleep disturbance is one of the most commonly reported symptoms during perimenopause.

You may experience:

• Difficulty falling asleep
• Waking during the night
• Restless sleep
• Night sweats
• Hot flushes

Sleep disruption can significantly affect mood, concentration and resilience during the day. Research shows that sleep difficulties are strongly associated with emotional distress during the menopausal transition (Freeman, 2015).

Pain and Body Symptoms

Many women report increased physical discomfort during this stage.

Symptoms may include:

• Headaches or migraines
• Joint pain
• Muscle tension
• Restless legs

These symptoms may fluctuate alongside hormonal changes and can also be influenced by sleep quality and stress levels (Hale & Burger, 2009).

Digestive and Metabolic Symptoms

Hormonal changes can influence digestion and metabolism.

Some women experience:

• Digestive discomfort
• Nausea
• Bloating
• Weight gain

Changes in hormone levels can influence appetite regulation, insulin sensitivity and stress hormones, which may affect metabolism and digestive function (Davis et al., 2015).

Hormonal and Reproductive Symptoms

Changes in the reproductive system are often the most visible signs of perimenopause.

These may include:

• Changes in menstrual cycle patterns
• Heavier or lighter periods
• Irregular timing of periods
• Low libido
• Reduced sexual pleasure
• Difficulty reaching orgasm
• Pain during sex

These changes are associated with declining ovarian hormone production and changes in vaginal and pelvic tissue health (Australasian Menopause Society, 2023).

Skin, Hair and Sensory Changes

Some symptoms may be less widely discussed but still commonly experienced.

These include:

• Skin changes
• Hair thinning or dryness
• Tingling sensations in hands or feet
• Pins and needles sensations
• Tinnitus or ringing in the ears

These changes are thought to be linked to hormonal shifts affecting circulation, nerve sensitivity and skin elasticity (Hale & Burger, 2009).

Urinary and Pelvic Symptoms

Some women experience changes in urinary health during perimenopause.

Symptoms may include:

• Increased urinary urgency
• Urinary tract infections
• Urinary incontinence

Hormonal changes can affect the tissues of the urinary tract and pelvic floor, contributing to these symptoms (Davis et al., 2015).

What To Do If You Recognise These Symptoms

If you recognise several of the symptoms in this checklist, it may be helpful to begin tracking when they occur and how they affect your daily life.

Recording information such as frequency, severity and possible triggers can provide useful insights. Bringing this information to a consultation with a GP or healthcare professional can support assessment and discussion about possible treatment or management options.

A healthcare professional can help determine whether symptoms may be related to perimenopause, another health condition, or a combination of factors.

Emotional Wellbeing During Perimenopause

Many women find that the emotional and cognitive symptoms of perimenopause are just as challenging as the physical changes.

Low mood, anxiety, irritability, emotional overwhelm and cognitive fog can affect confidence, relationships and work performance. These experiences are sometimes mistaken for depression or burnout when hormonal transition may also be contributing (Bromberger & Epperson, 2018).

Psychological therapy can help women better understand these experiences, develop emotional regulation strategies and build resilience during this stage of life.

Support from Kristie Clarke Psychology

Kristie Clarke is a Clinical Psychologist who supports women navigating the psychological impact of perimenopause and menopause.

She works with women experiencing symptoms such as anxiety, low mood, irritability, emotional overwhelm and cognitive fog. Through psychological therapy and supportive counselling, Kristie helps women understand these changes and develop practical strategies to support wellbeing during this life transition.

If you would like support understanding or managing perimenopause related changes, you can contact Kristie Clarke Psychology to learn more or enquire about an appointment.

Important Note

This checklist is designed as an informational tool to help women recognise patterns in their symptoms. It is not intended to diagnose medical or psychological conditions and should not replace professional medical advice, diagnosis or treatment.



If you have concerns about your symptoms, please consult your GP or qualified healthcare professional.

References

Australasian Menopause Society. (2023). Perimenopause and menopause information for women. https://www.menopause.org.au

Bromberger, J. T., & Epperson, C. N. (2018). Depression during and after the menopausal transition. Current Psychiatry Reports, 20(7), 55.

Davis, S. R., Lambrinoudaki, I., Lumsden, M., Mishra, G., Pal, L., Rees, M., Santoro, N., & Simoncini, T. (2015). Menopause. Nature Reviews Disease Primers, 1, 15004.

Freeman, E. W. (2015). Associations of depression with the transition to menopause. Menopause, 22(11), 1143–1150.

Hale, G. E., & Burger, H. G. (2009). Hormonal changes and biomarkers in the menopausal transition. Best Practice & Research Clinical Obstetrics & Gynaecology, 23(1), 7–23.

Maki, P. M., & Jaff, N. G. (2022). Cognitive changes during the menopausal transition. Obstetrics and Gynecology Clinics of North America, 49(3), 431–444.

Soares, C. N. (2014). Mood disorders in midlife women. Obstetrics and Gynecology Clinics of North America, 41(3), 565–578.