How do you know when you are perimenopausal?  If only there was a simple NHS perimenopause test for this much misunderstood and often-missed 'change before the change', women in their 30s and 40s up and down the land would be breathing sighs of relief. Yes, it's our hormones. No, we're not going mad. Perimenopause, if you haven't experienced it, can be the ultimate gas-lighter.

While private hormone tests are available, they're not universally accessible and so many of us are entering this life stage without realising. We might still be having periods and therefore not see ourselves as menopausal, but for several years before our periods actually stop, our fluctuating hormones play havoc with everything from our sleep, to our mood to our weight, our memory and our confidence. It's not surprising since we have hormone receptors, including oestrogen  receptors, all over our body, and when our hormone levels change, it can affect so many parts of us from our skin to our brain.

That's why we've enlisted the help of Emma Bardwell, a registered nutritionist with a special interest in perimenopause and menopause, to shed light on some of the more common but often missed signs of perimenopause – symptoms such as aches and pains, those nasty cystic chin spots  or unexplained anxiety – that we can so often ascribe to simply being busy, tired or simply growing older.

Emma recently co-authored the brilliant book on The Perimenopause Solution , £11.65 with GP Dr Shazadi Harper. If you think you might be 'peri', this is one of the best books on perimenopause and menopause  we've read.

It's agreed that there are 34 symptoms connected to perimenopause and menopause, but Emma, like many women's health professionals, believes there are probably many more.

"If you want to get a full list of menopause symptoms," she says, "look at the Greene Climacteric Scale  scale. You can check off all the symptoms that apply to you, which could be quite useful if you are going to talk to your GP. We talk a lot about symptoms of menopause such as hot flushes, but the ones I’m mentioning here are those that don't really get much airtime."

8 little-known but all too common signs of perimenopause

1. You are in your late 30s or in your 40s

"There's a misnomer that this life stage happens in our 50s. For many of us, it happens much, much sooner. If you are in your 40s or even your late 30s, you may well be easing into the perimenopause transition. It's something definitely to be aware of."

2.  Your periods are more erratic

"You may find that your periods have started to be a little bit less predictable, a little bit more erratic. They might be heavier, they might be lighter, they might be further apart, then you might have two very close together. This is very often the kind of the very first kind of initial stages of perimenopause."

3. You're getting unexpected aches and pains

"You might have some unexplained symptoms, such as UTIs – something that perhaps you didn't use to get, such as cystitis . Maybe you're getting them more frequently. You might get things like pins and needles in your fingers. You might get tinnitus, you might have palpitations or joint pains."

4. Penetrative sex is more painful

"In perimenopause, your oestrogen levels start to decline or fluctuate quite wildly. Oestrogen isn't just used for reproductive health, it has so many different uses throughout the body. One of these is to hold on to water. When your levels start to decline, you may find that particularly your mucosal tissues - things like your mouth, your eyes and your vagina -  start to get a bit drier and this can make sex much more painful.

"There are lots of things that you can do for vaginal dryness. You can talk to your GP about something called Vagifem (vaginal oestrogen), which is very safe and very effective. There are lots of lubes and vaginal care  products on the market. A very good one I recommend quite often to my clients is called Sylk Intimate Lubricant, £9.99  It’s definitely worth checking out. "

5. Your skin is dry, itchy, sensitive and spotty, especially around your jawline

"You might become more aware of changes in your skin in perimenopause. This is connected to my previous point about oestrogen being responsible for holding on to moisture. You may find that your skin becomes much drier, it might be itchier, it might be more sensitive. You may find that you start to experience acne, maybe around your jaw, quite often it's hormonal or cystic acne. Again, it's due to fluctuating hormone levels, particularly in the case of acne, it means that your oestrogen perhaps is dipping below your natural testosterone levels."

MORE GLOSS: How to treat hormonal acne in perimenopause and menopause

6. You used to be confident - now you're unsure of yourself

"Loss of confidence is one of the symptoms of perimenopause that doesn’t get talked about very much. Many women will put it down to overwhelm or juggling, dealing with kids and so on. I have women in clinic who say that they can no longer stand up and do a presentation at work or that they can’t get in a car and drive on the motorway things that they would ordinarily have done without a second thought. That is definitely the psychological side of perimenopause. definitely needs to be talked about and understood a lot more than it currently is.

MORE GLOSS: "Menopause made me suddenly terrified of driving"

"Why does it happen? Again, this is quite often down to that common theme when it comes to perimenopause and menopause - fluctuating hormone levels. We have oestrogen receptors [meaning they need oestrogen to work normally] all over our brain, particularly in the hippocampus [responsible for learning and memory] and the amygdala, responsible for fear. Changes in that area of the brain can really knock women's confidence and self-esteem.

7.  Middle age spread - you can't shift the weight around the middle

Putting on weight, particularly around your belly is such a common lament - and the fact that it’s really hard to shift. Whereas in your 20s you would have perhaps cut back on calories or upped your level of exercise, now the things you used to do just aren't working anymore. This is down to multiple factors. Firstly stress - quite often women aren't sleeping very well. Plus your resting metabolism slows down as you age. And also the fact that your fat cells actually produce and hold on to oestrogen. So even if it's in small amounts, your body still recognises that oestrogen levels are dipping and so tries to hold on to them for all it's worth.

MORE GLOSS: 11 reasons you're not losing belly fat.

"That’s why it's so hard to shift that middle-age spread, but it is doable and I have lots of tips on my Instagram grid. My book The Perimenopause Solution has a whole chapter talking about ways to lose weight that don't involve calorie counting."

8. Brain fog? It could be a sign of perimenopause

Again, this can feel very worrying. You may feel like you are experiencing early signs of dementia. Don’t worry, it's very different. Again it is down to your hormones fluctuating.

There are many things that you can do to combat brain fog:

• Stay really well hydrated. 
• Look at the amount of alcohol that you're consuming - it has a massive knock-on effect and is actually neurotoxic. 
• Concentrate on getting lots of healthy fats, particularly omega 3s  into your diet from oily fish. Eat a couple of portions a week to hit your quota. If you don't particularly enjoy eating oily fish or maybe your veggie or vegan you can take an omega 3 supplement .  There are lots of brilliant fish oils on the market. My favourite is Bare Biology, Life & Soul Pure Omega 3 Fish Oil  capsules, £28.50, If you're vegan I would look to something like an algae oil supplement, which gives you that EPA and that DHA [components of omega 3] which is really important for brain health and cognition. Try Bare Biology Vim  Vim & Vigour Vegan Omega 3 & Astaxanthin Capsules,  £35.

Find Emma at  Emmabardwell.com.  What are your perimenopause symptoms? Let us know in the comments below.

MORE GLOSS: What happens to your skin in menopause by Dr Sophie Shotter

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