Unexpected perimenopause symptoms (and when to consider a menopause coach)
Experiencing heart palpitations, brain fog, or anxiety? These could be perimenopause symptoms, and many women never connect the dots. Here’s what’s actually going on and when to consider a menopause coach.
You’re in midlife. Something feels off — your sleep, your moods, your energy, your body. You’ve been to the doctor. Everything looks fine.
So you carry on. You put it down to stress, or a busy life, or just getting older. You find a reasonable explanation for each thing, file it away, and keep going.
What nobody tells you is that there’s often another explanation running quietly underneath all of those. One that rarely gets named until much later, if it gets named at all.
This post covers the perimenopause symptoms that catch women off guard, why they’re so often missed, and what’s actually driving them, and when it might be time to look beyond managing each symptom on its own and consider working with a menopause coach.
Why perimenopause symptoms get missed
Most of us grew up thinking menopause meant hot flushes in your early 50s, and then it was done.
What we weren’t taught is that perimenopause can start much earlier, often in your mid to late 30s or 40s, and can last for several years.
During that time, hormones like oestrogen and progesterone don’t decline steadily. They fluctuate, sometimes significantly.
And because these hormones affect almost every system in the body, the symptoms don’t always look hormonal.
So instead:
- anxiety gets labelled as stress
- poor sleep gets blamed on lifestyle
- joint pain gets put down to ageing
Each symptom gets explained in isolation.
And no one joins the dots.
I had heart palpitations at night. I put them down to anxiety, which, given what was happening in my life at the time, felt completely reasonable.
Around the same time, my blood pressure crept up. I was told it was genetic.
Both explanations made sense.
What I didn’t realise — what no one mentioned — was that both can also be linked to perimenopause.
It wasn’t that I was wrong. There was just more to the story.
Research reflects this. Many women experience symptoms for years before they’re correctly identified as hormonal. One study found that only 1 in 5 women aged 40–60 receives a menopause diagnosis, despite the vast majority experiencing symptoms.
That’s a long time to feel like something isn’t quite right, without a clear answer.
The symptoms nobody mentions
Hot flushes get most of the attention.
But for many women, especially in early perimenopause, the first symptoms are the ones you don’t expect.
1. Heart palpitations
A racing or fluttering heart. A skipped beat feeling. Often at night or first thing in the morning.
Oestrogen helps regulate the cardiovascular system. When it fluctuates, your heart rhythm can feel off — usually harmless, but unsettling if you don’t know why it’s happening.
2. Anxiety that feels out of nowhere
Not always linked to external stress.
More like:
- waking at 4am with your heart pounding
- a sudden sense of dread
- feeling constantly on edge
Oestrogen influences serotonin and GABA — the chemicals that help regulate mood. When it drops, your nervous system becomes more reactive.
3. Brain fog
Forgetting words mid-sentence. Walking into a room and blanking. Reading the same thing multiple times.
Oestrogen supports memory and cognitive function. When it fluctuates, mental clarity can too.
4. Joint pain and muscle aches
Stiffness or aches, especially in the hands, knees, or hips.
Oestrogen has an anti-inflammatory effect. When levels decline, inflammation can increase — which is why these symptoms often appear seemingly overnight.
5. Digestive changes
Bloating, constipation, or changes in digestion.
Hormones influence gut health and motility, so shifts during perimenopause can affect your digestive system even if your diet hasn’t changed.
6. Itchy skin or unusual sensations
Itching, particularly at night, or a crawling sensation under the skin.
This is linked to changes in histamine and skin sensitivity as oestrogen declines.
7. Temperature changes that aren’t quite hot flushes
Not always the classic hot flush.
You might notice:
- night sweats
- feeling warmer than usual
- subtle heat in the chest or face
This is your body’s temperature regulation becoming more sensitive.
8. Low mood that feels different
Not always depression — more a flatness.
A lack of motivation, enjoyment, or emotional resilience, often alongside fatigue and poor sleep.
Why everything feels more intense
One piece that’s often overlooked is the nervous system.
As oestrogen fluctuates, your stress response becomes more reactive.
Which means:
- anxiety feels stronger
- sleep is harder to recover from
- symptoms feel more overwhelming
And if life is already stressful, it amplifies everything.
This isn’t about coping less well.
It’s about your body working with a different set of inputs.
When to consider support from a menopause coach
For many women, there comes a point where:
- symptoms don’t seem connected
- medical tests come back “normal”
- each issue is being managed separately, but nothing fully improves
This is often where a menopause coach can help.
Instead of looking at symptoms in isolation, menopause coaching focuses on the bigger picture:
- identifying patterns across symptoms
- supporting your nervous system
- improving sleep, nutrition, and stress in a realistic way
- helping you feel more in control of what’s happening
It’s not a replacement for medical care, but it can be a missing piece alongside it.
If you’re unsure what that looks like, this guide on what to expect from a menopause coach explains how that support works in practice.
What to do if this sounds like you
1. Stop blaming yourself for not coping
What you’re experiencing is real, it has a name, and it has reasons.
The fact that it went unrecognised, by you, by doctors, by everyone around you, is not a failure of perception. It’s a gap in the information most women are given.
2. Start tracking patterns
Notice:
- when symptoms happen
- how intense they are
- where you are in your cycle
This helps you see the bigger picture more clearly.
3. Go into appointments informed
Many women find they need to raise perimenopause themselves — rather than waiting for it to be suggested.
4. Consider structured support
If everything feels fragmented or overwhelming, having support that looks at the whole picture can make a real difference.
At Fabulous in Midlife, I work with women navigating perimenopause and menopause through:
- nutrition
- sleep support
- movement
- nervous system regulation (including breathwork)
- practical, sustainable changes
You can book a free consultation here if you’d like to explore that further.
You’re not falling apart.
You’re in perimenopause.
Slightly different situation. Considerably better prognosis.
Frequently asked questions
What are the first signs of perimenopause?
The first signs are often the ones women least expect.
Instead of hot flushes, early perimenopause symptoms can include:
- anxiety
- poor sleep
- heart palpitations
- brain fog
- joint pain
- low or flat mood
Hot flushes may not appear until later — if at all.
Many women don’t connect these symptoms to perimenopause at first, because each one has a plausible explanation on its own.
Can perimenopause cause heart palpitations?
Yes. Hormonal fluctuations can affect heart rhythm. It’s common, but always worth checking if it’s new.
Why do perimenopause symptoms get missed?
Because many symptoms have other plausible explanations, and perimenopause isn’t always considered early on.
Can a menopause coach help with symptoms?
Yes. A menopause coach helps you understand patterns, manage symptoms holistically, and feel more in control of what’s happening, often alongside medical support.
How do I know if I need support?
If symptoms feel confusing, persistent, or not fully resolved through standard approaches, it may be worth exploring additional support.
About the author
Paola is a certified women’s health and nutrition coach and breathwork practitioner at Fabulous in Midlife, helping women navigate perimenopause and menopause with practical, evidence-based support.
