How to spot the signs of perimenopause - the unknown symptoms and what to do about it

Dr Rebecca Poet is a former NHS GP who saw first-hand how many women were falling through the cracks when it came to hormone health. In 2019, she founded The Women’s Hormone Clinic - a private practice offering longer consultations, deeper testing, and a more holistic approach to supporting women through perimenopause, menopause, and beyond. What started as a one-woman operation has grown into a five-clinician team helping women across the UK feel informed, empowered, and in control of their health. 

Pausa Pilates founder Abi Jacks, talks to Rebecca about one of the key things for mid-life women - how on earth do you know when you're in perimenopause, and what can you do when you are?

“Perimenopause can be a chance to reset. It can be empowering. But you deserve to be supported, informed, and listened to.” Dr Rebecca Poet 

Abi: Let’s start from the top - what exactly is perimenopause, and when does it begin? 

Dr Rebecca Poet: Perimenopause is the phase before menopause - and it can last years. Officially, menopause is one year after your last period. But perimenopause is the hormonal rollercoaster that can begin much earlier. On average, it lasts about seven years. But some women can experience symptoms for ten years or more before their periods stop. 

Abi: So it can start in your 30s? 

Rebecca: Absolutely. We see women in their late 30s with very real symptoms, and they’re often told they’re too young. Even women with totally regular periods can be perimenopausal. A big part of the issue is that we assume it’s all about periods or hot flushes. It’s not. 

“Many women are still having regular periods and don’t realise they’re already in perimenopause. Hormone changes - especially progesterone - can start much earlier.” 

The lesser-known perimenopause symptoms nobody talks about 

Abi: We always hear about the hot flushes and mood swings, but what are the less obvious symptoms women should know about? 

Rebecca: There are so many. The big ones we see are: 

• Sudden anxiety 

• PMT getting worse or starting earlier 

• Low mood or irritability 

• Trouble sleeping or staying asleep 

• Libido dropping off 

• Vaginal dryness, dry eyes or dry mouth 

• Skin changes and joint pain 

You can also see flare-ups in things like IBS, migraines, or even ADHD symptoms. 

“One of the big misconceptions is that if you’re not having hot flushes or your periods are still regular, it can’t be perimenopause.” 

Abi: I’ve spoken to so many women who thought they were losing it, like suddenly their brain just wouldn’t work like it used to. 

Rebecca: It’s incredibly common. What used to be manageable suddenly isn’t. That’s when women start questioning everything - their mood, their memory, even their careers. And without the right support, it can feel terrifying. 

Why so many women miss it 

Abi: Why do you think so many women don’t realise they’re in perimenopause? 

Rebecca: Lots of reasons. One, if you’re on birth control, it might be masking your cycle. Two, if you’re still having regular periods, people assume everything’s fine. And three, if you’re in your 30s or early 40s, many GPs still think it’s too early. If you’re under 40 and missing periods - that’s a red flag. If you’re under 45 and something just feels off, it’s worth looking into.

Abi: That was me. I spent years being told I was too young. But I knew something wasn’t right. I wish I’d tracked it sooner. 

Rebecca: Exactly. Keeping a simple symptom diary, even just in a notebook, can be so powerful. You’ll start seeing patterns you might have missed. There are many apps out there that can support this but pen to paper often works just as well.

"Take note of how you’re feeling, symptoms and anything else you want to note, and you may start to see patterns you can take to a professional. "

The emotional toll of perimenopause symptoms (and why it matters) 

Abi: One thing that really hit me was how much it impacted my confidence. I didn’t feel like me anymore. Is that something you hear a lot? 

Rebecca: Constantly. We see women who were high-functioning and suddenly feel like they’re falling apart. It’s not just hormones - it’s identity, career, family, everything layered on top of each other. And the lack of sleep? That just amplifies everything. 

“Progesterone is like nature’s anti-anxiety hormone. When it drops, you feel it in your body, your mind, and your mood.” 

HRT: personalised, not perfect 

Abi: Let’s talk HRT. Is it the right solution for everyone? 

Rebecca: No, but it can be life-changing for many. It’s not a one-size-fits-all fix. We usually start with the basics - oestrogen and progesterone - but even within that, the dose, the delivery method, the timing… it all matters. And it needs reviewing regularly. Some women feel better within weeks. Others take months to find what works. It’s about listening to your body and adapting.

Abi: And what about testosterone? 

Rebecca: Testosterone might have a reputation as a “male hormone,” but it’s actually really important for women too. It can make a big difference to things like energy, mood, focus, stamina -and yes, libido. For some women in perimenopause or menopause, it’s that missing puzzle piece that helps them feel like themselves again. It’s not routinely available on the NHS, but it can be prescribed to certain menopausal women with low libido. That said, it’s an off-licence treatment, so access can be a bit hit and miss depending on your doctor and local NHS policy. If do start testosterone, it’s important that it’s prescribed and monitored by someone who really knows what they’re doing, testosterone needs regular reviews to make sure it’s working well and being used safely. But for some women, the benefits can be genuinely life-changing. 

So what can women in perimenopause do? 

Alongside hormone support, Rebecca encourages a whole-life approach: 

• Prioritise movement - like Pilates -for balance, strength and stress relief 

• Look at nutrition, hydration and rest 

• Reduce overwhelm wherever you can 

• Use CBT or talking therapy for emotional support 

• Lean on trusted communities (like Pausa!) 

  
  

Abi: That’s a big part of what we do at Pausa. Our menopause pilates classes start with a check-in. It’s movement, yes, but it’s also connection. That’s what helps people feel safe and supported. 

“The prescription is one part. But so is the conversation. So is the community. So is the care.” Dr Rebecca 

The bottom line? 

Abi: If there’s one thing you’d want every woman to know about perimenopause, what would it be? 

Rebecca: That it’s real. That it can be disruptive. But it’s also an opportunity. So many women use this moment to prioritise their health for the first time. And that’s powerful. 

Sound familiar? Here’s what to do next: 

✅ Keep a symptom diary - paper or app, whatever works for you 

✅ Don’t dismiss yourself - if something feels off, ask questions 

✅ See if your GP surgery has a women’s health lead 

✅ Explore private care if you’re not getting answers 

✅ Find a support space that gets it (Pausa’s a good start) 

Want to go deeper? Check out the Women’s Hormone Clinic at womenshormoneclinic.co.uk and explore Pausa Pilates sessions at pausapilates.co.uk for movement, support and real-life conversation