The Restaurant Realisation: Perimenopause Symptoms We Didn’t See Coming
Last month I was out for dinner with a group of friends.
We’re all in our 40s and early 50s, that stage where we’re juggling kids, ageing parents, careers, and trying to remember why we walked into a room.
The conversation, as it often does with women our age, turned to health.
“I’ve developed this frozen shoulder out of nowhere,” said one friend. “Physio can’t work out why.”
“My periods have gone mental,” said another. “Every three weeks now, and so heavy I’m practically housebound.”
“I’ve started getting anxious about driving,” someone else added quietly. “Especially on motorways. It came from nowhere and I feel ridiculous.”
“My plantar fasciitis is killing me.”
“The headaches are constant.”
“I can’t sleep past 3am anymore.”
“I’ve put on a stone around my middle and I’m eating LESS.”
I looked around the table at these capable, intelligent women, all convinced they had separate, unrelated health problems.
And I said: “You do realise that could all be perimenopause?”
The silence was deafening.
The Perimenopause Gap
Here’s what shocked me most about that conversation: not one of them had connected their symptoms to perimenopause.
Not their GPs. Not their friends. Not Dr Google.
They thought perimenopause was hot flushes and missed periods. Maybe some mood swings.
Nobody told them about the anxiety. The joint pain. The 3am wake-ups. The inexplicable fear of everyday activities.
And this is the problem with perimenopause: we’re told to expect certain symptoms, so when we get completely different ones, we don’t make the connection.
We go to the GP with our frozen shoulder. Or our anxiety. Or our plantar fasciitis. Each symptom gets looked at in isolation. We get sent to different specialists, given different diagnoses, prescribed different medications.
But nobody steps back and says: “Actually, all of this might be your hormones.”
My Wake-Up Call
I need to be honest about my own experience.
My first perimenopause symptom wasn’t a hot flush. It was waking at 2am.
Every. Single. Night.
Wide awake, mind racing, heart pounding slightly. Not needing the toilet. Not a small child who had woken up and needed me. Not uncomfortable. Just... awake. And unable to get back to sleep for hours.
The second symptom? Anxiety about driving.
I’d been driving for over 20 years. Confident, capable, never had an issue. Then suddenly, motorways felt terrifying. My heart would race. My hands would grip the steering wheel. I’d feel this overwhelming sense of dread and was convinced I’d drive down the exit slip road the wrong way.
I felt absolutely ridiculous. What kind of capable adult develops a sudden fear of driving?
But when I started researching perimenopause properly (because the sleep disruption was making me desperate), I discovered that anxiety, including specific phobias that appear from nowhere, is a classic perimenopause symptom.
Nobody warns you about this.
Why This Happens
Let me explain the science briefly, because understanding WHY this happens makes you feel less like you’re losing your mind.
Progesterone drops first
Progesterone is your calming hormone. It helps produce GABA, a neurotransmitter that keeps you relaxed and helps you sleep.
When progesterone drops (which happens early in perimenopause, often before periods become irregular), you lose that calming effect.
Result: Anxiety, racing thoughts, sleep disruption, feelings of panic.
Oestrogen fluctuates wildly
Oestrogen doesn’t just drop, it goes up and down like a rollercoaster. Some days high, some days low, completely unpredictable.
Oestrogen affects:
Your mood and emotional regulation
Pain perception (yes, really)
Inflammation levels
How your body distributes fat
Your sleep cycle
When it’s fluctuating wildly, everything feels unpredictable.
Cortisol gets dysregulated
Your stress hormone (cortisol) is supposed to be low at night and high in the morning.
But when your sex hormones are all over the place, cortisol rhythm gets disrupted too.
Result: Waking at 2-5am when cortisol spikes inappropriately.
This isn’t “just stress.” This is hormonal.
The Symptoms Nobody Talks About
Here are the perimenopause symptoms that genuinely shocked my friends:
Anxiety (especially new, specific fears)
Not just general worry. We’re talking:
Fear of driving (especially motorways or unfamiliar routes)
Social anxiety that wasn’t there before
Health anxiety
Fear of being alone or fear of crowds
Panic attacks out of nowhere
This was one of my first symptoms. I’d been a confident driver for decades, then suddenly motorways felt overwhelming.
It’s not “in your head”, it’s dropping progesterone affecting your GABA levels and making your nervous system more reactive.
Sleep disruption (the 2-5am wake-up)
This is SO common but rarely connected to perimenopause.
You fall asleep fine. Then wake between 2-5am, mind racing, heart pounding slightly, unable to get back to sleep.
It can often be a blood sugar crash triggering a cortisol spike. Your hormones are affecting how your body regulates blood sugar overnight.
Heavy, frequent periods
Everyone expects periods to get lighter and less frequent as you approach menopause.
But often the opposite happens first.
Periods every 3 weeks instead of 4. Bleeding so heavy you’re using super-plus tampons every hour. Clots. Flooding. Being scared to leave the house on heavy days.
This is oestrogen surging without enough progesterone to balance it out.
Joint pain and stiffness
Frozen shoulder. Tennis elbow. Plantar fasciitis. Achilles tendonitis. Aching knees, hips, hands.
“I feel like I’m falling apart,” one friend said.
Oestrogen is anti-inflammatory. When it drops, inflammation increases. Your joints hurt more. Injuries take longer to recover from. You wake up stiff.
This is why so many women in their 40s suddenly develop joint issues that physios can’t explain.
Weight gain around the middle (despite eating LESS)
This is perhaps the most frustrating one.
You haven’t changed your eating. In fact, you’re probably eating less and exercising more. But your body is storing fat around your abdomen like never before.
This isn’t about willpower. It’s about changing hormones affecting:
Where your body stores fat (shifts from hips/thighs to abdomen)
Your insulin sensitivity (gets worse, makes fat storage easier)
Your metabolic rate (can drop significantly)
Restricting calories further often makes this worse because it increases cortisol.
Headaches and migraines
Especially if they’re:
Worse at certain times of your cycle
Worse than they used to be
Accompanied by neck and shoulder tension
Not responding to usual painkillers
Fluctuating oestrogen affects blood vessels and can trigger migraines or tension headaches.
Rage
Not just irritability. RAGE.
The kind where you want to throw your phone across the room because someone breathed too loudly.
Where you fantasise about walking out of your life and never coming back.
Where you feel like a stranger in your own body.
Low progesterone and fluctuating oestrogen affect your emotional regulation. You’re not a bad person. You’re not “difficult.” Your hormones are making your nervous system reactive.
Brain fog and memory issues
Forgetting words mid-sentence. Walking into rooms and having no idea why. Losing your train of thought constantly.
“I thought I was getting early dementia,” one friend admitted.
Oestrogen affects cognitive function. When it’s fluctuating, so is your brain’s ability to function optimally.
Changes to hair, skin, nails
Thinning hair (especially at temples). Dry, crepe-y skin that appeared seemingly overnight. Brittle nails. Adult acne.
Your skin has oestrogen receptors. When oestrogen drops, your skin changes.
Digestive issues
Bloating that won’t shift. Constipation. IBS-like symptoms that appeared from nowhere.
Oestrogen and progesterone affect gut motility and the gut microbiome. Hormonal changes can trigger digestive chaos.
Electric shock sensations
This one sounds bizarre, but it’s real.
Brief electric shock feelings, often in your head or limbs. Sometimes before a hot flush, sometimes randomly.
It’s oestrogen affecting your nervous system.
Burning mouth syndrome
Your mouth feels like you’ve burned it on hot coffee. Constantly.
Again, oestrogen receptors in your mouth. Hormonal changes can cause this sensation.
The Realisation
By the end of that evening, my friends were looking at their “separate health problems” completely differently.
One friend pulled out her phone and started googling “perimenopause joint pain.”
Another said quietly: “I’ve been to three different specialists and nobody mentioned hormones.”
Someone else said: “I thought I was falling apart. But actually, this is just... perimenopause?”
Yes. Yes it is.
Why GPs Often Miss This
It’s not that GPs don’t care. It’s that:
1. They’re trained to look at symptoms in isolation Frozen shoulder? Send to physio. Anxiety? Offer antidepressants. Heavy periods? Maybe a scan.
Nobody’s stepping back to see the pattern.
2. Blood tests are misleading Your GP might test your hormones and say “everything’s normal.”
But in perimenopause, hormones fluctuate wildly day-to-day. A snapshot blood test doesn’t show you the rollercoaster.
You can have “normal” results and still be in perimenopause.
3. You’re “too young” Many GPs think perimenopause starts in your late 40s and a lot will say you have to be at least 45. I was 44 and my GP told me it couldn’t be perimenopause…
But it can start in your early 40s, even late 30s. If you’re told you’re “too young,” push back.
4. Perimenopause education is lacking Most GPs get minimal training on menopause and perimenopause. They know the “classic” symptoms but not the full picture.
What To Do If This Sounds Familiar
1. Track your symptoms
Keep a diary for 2-3 months (the Balance app is great for tracking symptoms):
What symptoms you’re experiencing
When they happen in relation to your cycle (if you still have one)
Severity and patterns
This helps you (and your GP) see the bigger picture.
2. Consider talking to your GP about MHT (HRT)
Menopause Hormone Therapy isn’t just for severe symptoms.
If perimenopause is affecting your quality of life, your sleep, your mood, your ability to function, HRT can help.
Body-identical HRT (oestrogen and progesterone) can:
Stabilise mood and reduce anxiety
Improve sleep
Reduce joint pain and inflammation
Help with brain fog
Reduce heavy bleeding (progesterone especially)
It’s not for everyone, but it’s worth a conversation. For me it helped the fog lift enough that I could start making changes to my diet and start exercising again.
3. Support your body nutritionally
While you’re working out the hormone piece, you can support your body through:
Blood sugar balance - crucial for the 2am wake-ups and anxiety. Protein and fat with every meal and snack.
Anti-inflammatory foods - for joint pain. Oily fish, colourful vegetables, turmeric, berries.
Magnesium-rich foods - for sleep, anxiety, and muscle tension. Leafy greens, nuts, seeds, dark chocolate.
Gut health support - your gut and hormones are connected. Fibre, fermented foods, staying hydrated.
Reducing alcohol and caffeine - both make symptoms worse, especially anxiety and sleep issues.
Small changes. Consistent support. It helps.
You can download my Micro-habits guide for 10 small changes that have a big impact - download here!
4. Find a menopause-specialist GP or practitioner
If your GP isn’t helpful, you can:
Ask to see a different GP in your practice
Find a menopause specialist (British Menopause Society has a directory)
See a registered nutritional therapist who specialises in perimenopause (hello!)
You deserve support, not dismissal.
The Relief of Understanding
After that evening, one of my friends messaged me:
“I can’t tell you what a relief it is to know I’m not falling apart. I’m just in perimenopause.”
And that’s what I want for you.
If you’re experiencing seemingly random health issues, anxiety, joint pain, sleep disruption, heavy periods, weight gain, rage, brain fog; and you’re in your 40s or early 50s, consider that it might all be connected.
You’re not falling apart.
You’re not losing your mind.
You’re not “too young” or “too old” or imagining it.
Your hormones are changing, and it’s affecting your entire body in ways nobody warned you about.
But once you understand what’s happening, you can do something about it.
Need Support?
If you’re struggling with perimenopause symptoms and want personalised nutritional support to help you feel better, I can help.
I specialise in supporting women through perimenopause using evidence-based nutrition, lifestyle strategies, and functional testing where needed.
Book a free 20-minute discovery call
No pressure, just a conversation about whether personalised support could help you navigate this transition more easily.
Catherine x
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