12 Signs of Perimenopause (and What to Do About Them)

The most common signs of perimenopause are irregular periods, hot flashes, night sweats, poor sleep, mood changes, brain fog, vaginal dryness and a lower sex drive. Perimenopause is the transition before menopause, when estrogen and progesterone rise and fall unpredictably. It usually starts in your 40s, though some women notice changes in their late 30s, and it lasts about four years on average. It ends with menopause, which is 12 months in a row without a period. This guide covers the early and later signs, how perimenopause is diagnosed, and which treatments help.

What is perimenopause?

Perimenopause means “around menopause.” During these years your ovaries make estrogen and progesterone less predictably. Some months estrogen spikes higher than usual; other months it drops. Progesterone tends to fall earlier, because you ovulate less often.

Those swings, not just low hormone levels, cause many of the symptoms. That is why you can feel fine one week and awful the next, and why a single blood test often looks “normal.”

For most women in the United States, menopause arrives around age 51. Perimenopause can start anywhere from 4 to 10 years before that.

Early signs of perimenopause

The first changes are often subtle and easy to blame on stress, a busy schedule or getting older.

1. Changes in your menstrual cycle

Irregular periods are the hallmark of perimenopause. Your cycle may get shorter (periods every 21 to 25 days), longer, heavier, lighter or start skipping months. A persistent change of seven days or more in cycle length is a common early marker.

2. Worse PMS and breast tenderness

When estrogen runs high relative to progesterone, premenstrual symptoms can get stronger: breast tenderness, bloating, irritability and headaches.

3. Sleep problems

Many women start waking at 2 or 3 a.m. and cannot fall back asleep, even before hot flashes begin. Falling progesterone, which has a calming effect, plays a part.

4. Mood changes and anxiety

Irritability, anxiety, low mood and a shorter fuse are common. Women with a history of depression or severe PMS are more likely to notice mood symptoms in perimenopause.

Later signs of perimenopause

As you get closer to menopause and estrogen stays lower for longer, other symptoms show up.

5. Hot flashes and night sweats

A hot flash is a sudden wave of heat across the chest, neck and face, often with flushing and sweating, lasting a few minutes. At night, the same thing causes night sweats that soak sheets and break up sleep. Hot flashes are the most common symptom of the menopause transition.

6. Brain fog and trouble concentrating

Forgetting words, losing your train of thought and feeling less sharp are real and common. Poor sleep makes them worse. For most women, memory improves after the transition.

7. Vaginal dryness and painful sex

Lower estrogen thins and dries the vaginal tissue. Sex can become uncomfortable, and some women get more urinary urgency or urinary tract infections.

8. Lower sex drive

Libido often drops, from a mix of hormone changes, poor sleep, vaginal discomfort and stress.

9. Weight gain around the middle

Many women gain weight in perimenopause, and more of it settles around the waist. Muscle loss, poor sleep and hormonal changes all play a role.

10. Joint aches and muscle stiffness

Aching joints and stiffness, especially in the morning, are common and often overlooked.

11. Skin and hair changes

Skin can get drier and thinner, and hair may thin or shed more. Some women notice more facial hair.

12. Heart palpitations and headaches

Some women notice a racing heartbeat during hot flashes or more frequent headaches and migraines. New or worsening palpitations should always be checked by a provider.

How long does perimenopause last?

Perimenopause lasts about four years on average, but it can be as short as a few months or as long as ten years. Smoking is linked to an earlier menopause. Once you go 12 months without a period, you have reached menopause, and the years after are called postmenopause. Some symptoms, such as hot flashes, can continue for several years after the last period.

How is perimenopause diagnosed?

For most women over 45, perimenopause is diagnosed from your age, your symptoms and changes in your periods. There is no single blood test that confirms it, because hormone levels change from day to day.

Lab work is still useful. A provider may check:

• Thyroid function (TSH), because thyroid problems cause similar symptoms
• Iron and a complete blood count, especially with heavy periods
• FSH and estradiol, in some cases, such as symptoms before age 45
• Vitamin D, blood sugar and cholesterol, as part of a full checkup

Read more in our guide to hormone testing for women.

When to see a provider

Book a visit if symptoms affect your sleep, work or relationships. See someone promptly for very heavy bleeding (soaking a pad or tampon every hour), bleeding between periods, bleeding after sex, any bleeding after you have reached menopause, or palpitations with chest pain or shortness of breath.

Treatment options for perimenopause symptoms

Lifestyle changes

• Strength training two to three times a week to protect muscle and bone
• Protein at every meal, plus fiber from vegetables, beans and whole grains
• A cool, dark bedroom and a steady sleep schedule
• Less alcohol, which often triggers hot flashes and poor sleep

Hormone therapy

For most healthy women under 60 or within 10 years of menopause, hormone therapy is the most effective treatment for hot flashes and night sweats, and it helps protect bone density. Estradiol through the skin (a patch, gel or cream) carries less risk of blood clots than a pill. Women who still have a uterus also need progesterone. Low-dose vaginal estrogen treats dryness and painful sex with very little absorption into the body.

Hormone therapy is not right for everyone, including some women with a history of breast cancer, blood clots or stroke. A provider should review your personal history first.

Non-hormone options

Some non-hormone prescription medications reduce hot flashes for women who cannot or prefer not to use estrogen. Vaginal moisturizers and lubricants help with dryness.

Perimenopause care in Owasso

At Pathway Health & Beauty in Owasso, Tia Christ, APRN-CNP, sees women for perimenopause and menopause symptoms. Your first visit is up to 60 minutes, so there is time to go through your cycle history, sleep, mood and labs, then build a plan that may include bioidentical hormone replacement, nutrition and strength work. Call or text 918-973-4575 for a free discovery call.