Ask most women what menopause looks like and they will describe hot flushes. The classic image is familiar: a sudden wave of heat, perhaps a flushed face, the need to open a window. What is far less discussed is everything else — the wide constellation of symptoms that can arrive years before periods actually stop, and that often get misattributed to stress, depression, thyroid problems, or simply getting older.

Perimenopause is the transitional phase that precedes menopause, and it can begin as early as the late thirties. During this time, oestrogen and progesterone levels fluctuate unpredictably. Those fluctuations affect almost every system in the body, which is why the symptom list is so much longer and stranger than most women expect.

Sleep disruption is among the most commonly reported but least discussed symptoms. Women describe lying awake between two and four in the morning, their mind racing, unable to get back to sleep however tired they are. This pattern is hormonally driven, and it has a downstream effect on everything else: mood, concentration, patience, and the ability to cope with daily stress.

"Cognitive symptoms are another area where women are routinely left confused and frightened. Brain fog — the sense that words are slipping away, that concentration has become effortful, that you walked into a room for a reason you can no longer remember — is one of the most distressing aspects of perimenopause for many women."

It can feel alarmingly like the beginning of something more serious. In the vast majority of cases, it is not. It is hormonal, it is recognised, and it is worth discussing with a GP.

Joint and muscle pain, skin changes, heart palpitations, urinary urgency, and changes in libido are all documented symptoms of hormonal transition. Anxiety that arrives seemingly without cause, low mood that lifts and returns with no obvious pattern, a feeling of dread that is hard to name — these too can be perimenopause, particularly in women with no previous history of mental health difficulties.

Knowing this does not make the symptoms disappear. But it does change everything about how you respond to them. A woman who knows her racing heart at 3am is a recognised feature of hormonal change can take a breath and reach for information. A woman who does not know that can spend years frightened and unheard.

This is precisely why the information evenings run by Vibrant Health Advocates – Sirius exist. Not to replace medical care, but to close the gap between what women are experiencing and what they know — so that when they do seek help, they do so with confidence and clarity.