9 Signs of Hormonal Imbalance in Menopause & Perimenopause
Have you been feeling more tired than usual, struggling to find the right words or wondering why your usual routines no longer seem to work?
Perhaps your sleep has changed, your mood feels less predictable or your body is responding differently to habits that once felt straightforward.
For many people, these changes can begin during perimenopause, the transition leading up to menopause. Fluctuating hormone levels can contribute to a wide range of physical, emotional and cognitive symptoms, and these can look different from one person to another.
But there isn't always one obvious explanation. Stress, disrupted sleep, medical conditions and other factors can cause similar symptoms, too.
So how do you begin to make sense of what you're experiencing?
Here are nine signs worth understanding, along with practical next steps and guidance on when to seek professional advice.
1. Persistent Fatigue and Low Energy
Do you wake up tired, struggle to concentrate during the afternoon or find that everyday tasks take more effort than they used to?
Changes in sleep, night sweats, stress and the hormonal transition can all contribute to fatigue during perimenopause and menopause.
You might notice that you have less energy for exercise, socialising or the activities you previously enjoyed. You may also find that a busy day takes longer to recover from.
What may help
Start by looking at your overall routine rather than assuming that hormones are the only explanation. Consider your sleep, eating patterns, movement, stress levels and opportunities to rest.
If fatigue is persistent, unexplained or affecting your everyday life, speak to your GP. They can assess your symptoms and consider whether another health issue may be contributing.
For a broader overview of the changes that can occur during this stage, read my guide to menopause symptoms and how they can affect you.
2. Brain Fog and Memory Blips
Have you ever walked into a room and forgotten why you went there? Or struggled to find a word that you know perfectly well?
Some people experience changes in concentration, memory and mental clarity during perimenopause and menopause. These experiences are often described as brain fog.
They can feel particularly frustrating if you're used to managing a busy workload, keeping track of multiple responsibilities or feeling mentally sharp.
Hormonal changes may contribute, but sleep disruption, stress, low mood and other health factors can also affect concentration and memory.
What may help
Notice when these difficulties are most apparent. Are they worse after a poor night's sleep, during particularly stressful periods or when you're juggling too many demands?
Taking regular breaks, simplifying your task list and protecting time for rest may help you manage your day more comfortably.
Don't automatically attribute new or significant cognitive changes to menopause. If symptoms are persistent, worsening or concerning, discuss them with your GP.
3. Weight Gain, Particularly Around Your Middle
You may have noticed that your clothes fit differently or that your weight is changing despite no obvious change in your usual habits.
Body composition and fat distribution can change during midlife. Ageing, changes in activity, sleep, stress and the menopausal transition may all play a part.
This can be frustrating if you've spent years following routines that previously felt effective.
But the answer isn't necessarily to eat less or exercise harder. Restrictive approaches can leave you feeling depleted and may be difficult to sustain.
What may help
Focus on habits that support your health over time: eating regular, balanced meals, including adequate protein and fibre, moving in ways you enjoy and making strength training part of your routine where appropriate.
It's also worth considering the quality of your sleep and how much recovery time you have.
For more practical guidance, explore my page on menopause and weight gain.
The aim is to find an approach that supports your wellbeing and fits your life, rather than chasing a quick fix.
4. Mood Swings, Anxiety and Increased Irritability
Do you find yourself becoming frustrated more quickly, feeling unexpectedly tearful or worrying more than you used to?
Mood changes can occur during perimenopause and menopause. Fluctuating hormones may contribute, while poor sleep, work pressures, caring responsibilities and other life changes can add to the strain.
You might feel that your reactions are out of character or wonder why situations you previously handled comfortably now feel overwhelming.
These experiences deserve attention, not self-criticism.
What may help
Try noticing what happens before your mood shifts. Look for patterns involving sleep, stressful situations, your workload, physical symptoms or the time of your menstrual cycle, if you're still having periods.
Small pauses, realistic expectations and opportunities to recover after demanding days may help you respond more deliberately when frustration builds.
For more on this topic, read the emotional rollercoaster of menopause.
If low mood or anxiety is persistent, severe or affecting your relationships or everyday life, speak to your doctor or an appropriate mental health professional. You don't need to assume that menopause is the only cause or manage these symptoms alone.
5. Disrupted Sleep and Early-Morning Waking
Are you struggling to fall asleep, waking repeatedly during the night or finding yourself wide awake at 3am?
Sleep difficulties are common during the menopausal transition. Night sweats, hot flushes, changes in mood, stress and other factors can interrupt your sleep and leave you feeling exhausted the next day.
When poor sleep continues, it can become harder to concentrate, manage stress and maintain the routines that usually support your wellbeing.
What may help
Start by looking at your sleep patterns and the factors that may be disrupting them. Consider your bedroom environment, evening routine, caffeine and alcohol intake, stress levels and whether night sweats or other symptoms are waking you.
Rather than trying to overhaul everything at once, choose one manageable change and see whether it helps.
For practical ideas, download my free 3AM Wake-Up Guide.
You can also read more about menopause, stress and sleep.
If sleep problems are ongoing or significantly affecting your quality of life, discuss them with your GP. There may be treatment options worth considering.
6. Hot Flushes and Night Sweats
Hot flushes are among the best-known symptoms of menopause, but their frequency and intensity vary considerably.
You might experience a sudden wave of heat, flushing or sweating during the day. At night, sweating can disturb your sleep and leave you feeling uncomfortable or exhausted.
These symptoms are associated with changes in the body's temperature regulation during the menopausal transition.
What may help
It can be useful to notice whether particular situations or factors appear to trigger your symptoms. Warm environments, alcohol, stress or certain foods may be relevant for some people, although triggers vary.
Practical adjustments to clothing, bedding and room temperature may improve comfort.
If hot flushes or night sweats are affecting your sleep, work or everyday life, speak to your GP about the options available. You don't have to rely on lifestyle changes alone.
For an overview of the wider range of symptoms that may occur, visit my menopause symptoms guide.
7. Lower Libido or Vaginal Dryness
Changes in sexual desire, vaginal dryness or discomfort during sex can occur during perimenopause and menopause.
Lower oestrogen levels can contribute to changes in vaginal and urinary tissues, which may cause dryness, irritation or discomfort. Libido can be influenced by many factors, including sleep, mood, stress, relationships, medication and physical comfort.
These symptoms are common, but that doesn't mean you should feel obliged to put up with them.
What may help
The most appropriate approach depends on what's causing the symptoms and how they're affecting you.
Vaginal moisturisers and lubricants may help with dryness and discomfort. Other treatments may also be suitable, so speak to your GP or another qualified healthcare professional about your options.
If changes in sexual desire are bothering you, it can help to consider the wider picture, including physical symptoms, stress, sleep and emotional wellbeing.
You deserve support that takes your concerns seriously and helps you understand your options.
8. Changes in Muscle Strength and Physical Resilience
Have you noticed that everyday physical tasks feel harder, your strength has changed or you're finding it more difficult to maintain your usual level of activity?
Muscle mass and strength can change with age. Changes in activity, nutrition, recovery and the menopausal transition may all contribute to how you feel physically.
It's worth paying attention to these changes because maintaining muscle strength supports everyday function and long-term health.
What may help
If appropriate for your health and ability, regular resistance or strength training can help you build or maintain muscle. A balanced diet with sufficient protein, along with adequate recovery, can support your efforts.
You don't need to begin with an intense exercise programme. A realistic starting point that you can build on is often more useful than doing too much and struggling to maintain it.
Explore my guide to strength training during menopause for more information.
If you experience a sudden or unexplained loss of strength, significant pain or other concerning symptoms, seek medical advice rather than assuming that menopause is responsible.
9. Urinary Leakage or Changes in Bladder Control
Do you leak a little urine when you laugh, cough, sneeze, lift something or exercise?
Urinary leakage can become more noticeable during midlife. Changes associated with menopause may contribute to urinary and pelvic health symptoms, but leakage can have several causes.
Although it can feel embarrassing to talk about, it's a common reason to seek support—and it's not something you simply have to accept.
What may help
Pelvic floor muscle training can help some people, depending on the type of leakage and their individual circumstances. A pelvic health physiotherapist can assess your needs and help you find an appropriate approach.
Your GP can also assess urinary symptoms and discuss possible causes and treatment options.
Seek medical advice if leakage is new, worsening or accompanied by other symptoms, such as pain or blood in your urine.
Remember, urinary symptoms are not a reliable way to identify a hormone problem on their own.
Could These Symptoms Be Related to Perimenopause?
If several of these signs sound familiar, you may be wondering whether they're connected.
Perimenopause can involve a wide range of symptoms, and not everyone experiences the same combination. Some people notice changes in their periods first; others become aware of sleep problems, mood changes or difficulties with concentration.
However, there is no single symptom - or combination of symptoms - that proves you have a hormonal imbalance.
The term hormonal imbalance is often used broadly, but symptoms such as fatigue, weight changes, anxiety and brain fog can have many different explanations. It's important not to assume that hormones are responsible without considering other possibilities.
If symptoms are new, persistent, worsening or interfering with everyday life, arrange an appointment with your GP. They can assess your circumstances and advise whether further investigation or treatment is appropriate.
You may find it useful to keep a brief record of your symptoms, when they occur, how they affect you and any patterns you've noticed. This can help you explain what's happening when you seek advice.
Why Can This Stage Feel So Unsettling?
One of the hardest parts of perimenopause and menopause is that you may not immediately recognise yourself in the changes you're experiencing.
You might be trying to eat well, stay active, manage your responsibilities and get enough rest, yet still feel more tired, less focused or less resilient than before.
You may also be receiving conflicting advice about what you should eat, how you should exercise or which supplements you should take.
It can become difficult to know where to begin.
Rather than trying to change everything at once, start by identifying what is affecting you most.
Ask yourself:
Which symptoms are having the biggest impact on my everyday life?
When did I first notice them?
What seems to make them better or worse?
What have I already tried?
Is there anything I need to discuss with my GP?
These questions won't provide a diagnosis, but they can help you organise your thoughts and decide on a sensible next step.
A More Holistic Approach to Menopause
Your wellbeing is influenced by more than one factor. Sleep, nutrition, movement, stress, daily routines and individual circumstances can all affect how you feel.
That doesn't mean lifestyle changes can resolve every menopause symptom or replace medical treatment. It means there may be several areas worth considering alongside appropriate healthcare.
My approach brings together five interconnected pillars:
Nutrition: building balanced, sustainable eating habits.
Gut health: understanding digestive wellbeing and the habits that support it.
Movement: finding realistic ways to stay active and maintain strength.
Behaviour change: turning health intentions into routines that fit your life.
Stress and sleep: identifying practical ways to support recovery and everyday wellbeing.
You don't need to tackle all five areas at once. The most useful starting point depends on your symptoms, priorities, health and circumstances.
Read more in A Holistic Approach to Menopause: Five Pillars for Midlife Health.
Start With a Free Menopause Resource
If you're recognising several of these signs and want help making sense of the bigger picture, you don't need to commit to a major lifestyle overhaul.
A useful first step is to build your understanding, identify what matters most to you and decide what support would be helpful.
Start with the free Menopause Blueprint
My free Menopause Blueprint is a starting point for exploring the wider picture of menopause and your wellbeing.
Use it to begin thinking about what has changed, which areas you'd like to focus on and where you might want to learn more.
You can work through the information at your own pace and decide which next step feels right for you.
When You're Ready for More Structured Support
Sometimes, understanding what's happening is enough to help you identify a few practical changes to try.
At other times, you may want more structure and guidance to help you put those changes into practice.
Explore Menopause Essentials
If you'd like a structured way to explore the foundations of menopause wellbeing, take a look at Menopause Essentials.
It's an option to consider if you want to develop a clearer understanding of your wellbeing and explore practical changes at a manageable pace.
Consider personalised one-to-one coaching
If you're looking for support tailored to your own circumstances, my one-to-one menopause coaching offers another route.
Coaching can help you identify priorities, explore realistic lifestyle changes and work on building routines that fit your life. It doesn't diagnose or treat medical conditions, and it isn't a replacement for medical or psychological care.
If you're unsure whether coaching is right for you, read five signs you may benefit from a menopause coach or find out what working with a menopause coach involves.
You Don't Have to Work It All Out at Once
If your energy, mood, sleep or physical wellbeing has changed, it's understandable to want answers.
You don't have to work out the cause of every symptom by yourself, and you don't need to change everything at once.
Start by taking persistent or concerning symptoms to your GP, then consider which practical steps could support your day-to-day wellbeing.
If you'd like to explore whether personalised coaching could help you turn your health goals into realistic changes, you can book a free 30-minute Menopause Clarity Call.
We can discuss what you're experiencing, what you'd like help with and whether coaching is an appropriate next step.
The goal isn't to chase a perfect routine or assume every change is caused by hormones. It's to understand your circumstances, make informed choices and find a way forward that works for you.
References
National Institute for Health and Care Excellence (2015, updated 2024) Menopause: identification and management. NICE guideline NG23. Available at: https://www.nice.org.uk/guidance/ng23 .
National Institute for Health and Care Excellence (2017) Menopause: quality standard. NICE quality standard QS143. Available at: https://www.nice.org.uk/guidance/qs143 .
Harlow, S.D., Gass, M., Hall, J.E. et al. (2012) ‘Executive summary of the Stages of Reproductive Aging Workshop +10: addressing the unfinished agenda of staging reproductive aging’, Climacteric, 15(2), pp. 105–114. doi:10.3109/13697137.2011.650656. PMID: 22338612.
British Menopause Society (2024) Menopause: identification and management—from guideline to practice. Available at: https://thebms.org.uk/ (Accessed: 16 October 2026).
Gold, E.B., Colvin, A., Avis, N. et al. (2006) ‘Longitudinal analysis of the association between vasomotor symptoms and race/ethnicity across the menopausal transition: Study of Women’s Health Across the Nation’, American Journal of Public Health, 96(7), pp. 1226–1235. doi:10.2105/AJPH.2005.066936. PMID: 16735632.
Baker, F.C., Willoughby, A.R., Sassoon, S.A. et al. (2024) ‘Sleep disturbance associated with the menopause’, Sleep Medicine Reviews. PMID: 38916279.
Gibson, C.J. et al. (2024) ‘Menopause and sleep disorders’, Sleep Medicine Clinics. PMID: 35707298.
Weber, M.T., Maki, P.M. and McDermott, M.P. (2014) ‘Cognition and mood in perimenopause: a systematic review and meta-analysis’, Menopause, 21(9), pp. 990–1005. doi:10.1097/GME.0000000000000163. PMID: 23770320.
Epperson, C.N. et al. (2022) ‘Systematic review and narrative synthesis of cognition in perimenopause: the role of risk factors and menopausal symptoms’, Menopause, 29(10), pp. 1195–1209. PMID: 35878526.
Davis, S.R., Castelo-Branco, C., Chedraui, P. et al. (2012) ‘Understanding weight gain at menopause’, Climacteric, 15(5), pp. 419–429. doi:10.3109/13697137.2012.707385. PMID: 22978257.
Bromberger, J.T., Assmann, S.F., Avis, N.E. et al. (2003) ‘Persistent mood symptoms in a multiethnic community cohort of pre- and perimenopausal women’, American Journal of Epidemiology, 158(4), pp. 347–356. doi:10.1093/aje/kwg155. PMID: 12915500.
Maki, P.M., Kornstein, S.G., Joffe, H. et al. (2018) ‘Guidelines for the evaluation and treatment of perimenopausal depression: summary and recommendations’, Journal of Women’s Health, 27(2), pp. 106–117. doi:10.1089/jwh.2018.27099. PMID: 29283333.
Portman, D.J. and Gass, M.L.S. (2014) ‘Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the International Society for the Study of Women’s Sexual Health and the North American Menopause Society’, Menopause, 21(10), pp. 1063–1068. doi:10.1097/GME.0000000000000329. PMID: 25178658.
Gandhi, J., Chen, A., Dagur, G. et al. (2016) ‘Genitourinary syndrome of menopause: an overview of clinical manifestations, pathophysiology, etiology, evaluation, and management’, American Journal of Obstetrics and Gynecology, 215(6), pp. 704–711. doi:10.1016/j.ajog.2016.07.045. PMID: 27475776.
Nappi, R.E. et al. (2021) ‘Genitourinary syndrome of menopause: a systematic review on prevalence and treatment’, Climacteric, 24(3), pp. 231–241. doi:10.1080/13697137.2021.1894512. PMID: 33739315.
Dumoulin, C., Cacciari, L.P. and Hay-Smith, E.J.C. (2018) ‘Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women’, Cochrane Database of Systematic Reviews, Issue 10, CD005654. doi:10.1002/14651858.CD005654.pub4. PMID: 30299727.
Nunes, E.A. et al. (2022) ‘Systematic review and meta-analysis of protein supplementation and/or higher protein intake on lean body mass and strength in older adults’, The American Journal of Clinical Nutrition, 115(4), pp. 1095–1110. doi:10.1016/j.ajcnut.2021.12.004. PMID: 34673936.
Sherratt, S. et al. (2023) ‘Comparative efficacy of different resistance training protocols on bone mineral density in postmenopausal women: a systematic review and network meta-analysis’, Journal of Bone and Mineral Metabolism, 41(4), pp. 482–495. PMID: 36824476.
NHS (2024) Menopause. Available at: https://www.nhs.uk/conditions/menopause/ .
