Think of perimenopause as the on-ramp to menopause. Until very recently, people weren’t openly talking about it, so many women weren’t fully aware of what to expect. To make matters worse, perimenopause can hit women in their 30s and 40s, who are often busy in their lives and careers. And some of the symptoms are so vague (sleep problems, anyone?), they could literally be anything. 

So how do you know if you’re in perimenopause? 

Awareness goes a long way. Understanding what’s happening in your body and knowing what you’re looking for are the first steps toward figuring out how to help yourself.

What is Perimenopause?

Perimenopause is essentially premenopause. As you age, your ovaries do, too. Because the ovaries make estrogen, an important reproductive hormone, the slowdown and resulting hormonal fluctuations trigger physical symptoms. Over time, you have fewer unfertilized eggs, and your period becomes irregular. Ovarian aging has a domino effect; beyond your period, perimenopause can cause mood swings, brain fog, and more. 

How Long Does Perimenopause Last?

Perimenopause can last anywhere between four and ten years, but lasts about 3-4 years on average. Women can start having symptoms as early as their late 30s and early 40s. Menopause officially starts when you haven't had a period for 12 consecutive months with no other underlying cause; on average, women in the US reach menopause at age 51.

7 Signs of Perimenopause

Perimenopause is different for everyone. Some women have just a handful of symptoms. Others, the whole gamut. We’ve compiled some of the most common so you have an idea of what to expect:

• Irregular periods: Cycles may become shorter, longer, heavier, lighter, or skip entirely as hormone levels fluctuate.
• Hot flashes & night sweats: Sudden waves of heat during the day or night can leave you flushed, sweaty, and sometimes wide awake.
• Mood changes: Irritability, anxiety, or sudden dips in mood can pop up, even if you've never struggled with them before.
• Sleep problems: Trouble falling asleep, staying asleep, or waking up too early can become more common.
• Vaginal and bladder changes: Vaginal dryness, discomfort during sex, or increased urgency to urinate may develop as estrogen levels drop.

Sign #1: Irregular Periods and Cycle Changes

Menstrual cycle changes are often one of the telltale first signs of perimenopause.

What it feels like: When you're no longer regularly ovulating, your period can go off the rails. It might be shorter or longer, or your flow could be lighter or heavier. You may see spotting or skip periods entirely. If your cycle is consistently off by seven days or more, you may be in early perimenopause.

Why it happens: Women are born with all the eggs they'll ever have—and they age with you, and that aging is accompanied by a drop in estrogen. When the ovaries make less estrogen, it affects progesterone levels. These hormones play a key role in ovulation, and your ovaries release fewer eggs and more sporadically, which causes irregular periods.

What can help: Track your periods and rule out pregnancy (Fertility during perimenopause? Yes, you can still get pregnant) or any other conditions like PCOS. If you have any concerns, call your OB/GYN They may prescribe progesterone pills or birth control pills to help regulate your hormones and get your cycle under control.

Sign #2: Vasomotor Symptoms (Hot Flashes & Night Sweats)

Hot flashes and night sweats affect 3 out of 4 women and can impact your quality of life.

What it feels like: Without warning, you may break out in sweat with flushed cheeks, clammy hands, and chest pounding—lasting seconds to minutes. For others, symptoms may be so mild that you think the room just got warmer.

Why it happens: Fluctuating hormones affect the hypothalamus, which regulates body temperature. During perimenopause, your body becomes overly sensitive to temperature changes, triggering sudden bouts of heat.

What can help: For frequent, uncomfortable symptoms, doctors might suggest hormone therapy. For milder cases:

• Keep your core temperature low by dressing in layers
• Drink cold beverages when you sense a hot flash starting
• Avoid spicy foods, caffeine, and alcohol
• Practice stress reduction through mindfulness or meditation

Sign #3: Mood Changes and Emotional Shifts

If you feel more tearful or anxious during perimenopause, you're not alone. Nearly 40% of perimenopausal women deal with mood swings, irritability, and emotional sensitivity.

Why it happens: Declining estrogen affects serotonin, the neurotransmitter linked to mood and sleep, creating a close link between perimenopause and mental health.

What can help: Reach out for support from family, friends, or a mental health professional. Engaging in at least 50 minutes of exercise four times a week has been shown to help alleviate mood swings. 

Perimenopause vs PMS

Perimenopause and Premenstrual syndrome (PMS) have similar symptoms like mood swings and irritability, and anecdotally, women report an increase in PMS symptoms during perimenopause.. Though there may be a link between both conditions, they’re different: PMS is tied to your menstrual cycle, occurring about two weeks before your period. Perimenopause is part of the menopause transition..

Sign #4: Sleep Problems

Research shows that as many as 47% of perimenopausal women experience some sort of sleep disorder, including trouble staying or falling asleep. Poor sleep is tied to a myriad of other issues, such as brain fog, weight gain, poor mood and even cardiovascular disease. 

Why it happens: Estrogen and progesterone help regulate sleep. Along with other midlife stressors, these shifting hormones can disturb your sleep patterns. 

What can help: Practice good sleep hygiene by going to bed at the same time every night, shutting down devices an hour before bed, and keeping your bedroom cool and dark. Avoid alcohol and caffeine later in the day. If these don't help, discuss hormone replacement therapy or melatonin supplements with your doctor.

Sign #5: Vaginal & Bladder Changes

Perimenopause can cause vaginal tissues to lose moisture and elasticity, leading to painful sex,  an increase in urinary tract infections (UTIs) and inflammation. Increased urination urgency and frequency are also common.

Why it happens: Estrogen helps keep vaginal tissues lubricated. When it wanes, vaginal walls become drier and less elastic.

What can help: Vaginal lubricants or moisturizers can provide immediate relief. If over-the-counter products don't work, ask your doctor about low-dose estrogen creams, rings, or suppositories. Staying sexually active maintains blood flow and vaginal health.

For bladder concerns, pelvic floor therapy can help with leakage - if that doesn’t work, ask your healthcare provider about possible treatments.

Genitourinary Syndrome of Menopause (GSM)

GSM is a condition that describes the ‘sexual, genital, and urinary’ changes women experience during the menopausal transition. Symptoms include vaginal dryness, irritation, pain during sex, and bladder changes. If these symptoms affect your comfort or quality of life, speak with your healthcare provider about treatment options.

Sign #6: Changes in Libido

Waning sexual desire is often connected to physical discomfort and pre-menopausal hormonal changes.

Why it happens: Changes in estrogen and testosterone directly affect desire. At the same time, mood shifts, coupled with discomfort around aging and stress, can all contribute to a loss of interest in sexual intercourse. 

What can help: Address physical discomfort with hormonal treatments or lubricants. Practice open communication with your partner, and consider scheduling intimacy around times when you know you feel your best. 

Sign #7: Brain Fog and Concentration Issues

You may notice general forgetfulness, issues completing tasks that were previously easy, or trouble remembering names. Brain fog and memory loss are mostly related to concentration issues. While they can be a pain to deal with, they usually clear up once you’re postmenopausal.

Why they happen: Estrogen function affects neurotransmitters like serotonin (mood), dopamine (motivation/reward), and glutamate (learning/memory). As levels fluctuate during perimenopause, it affects your ability to concentrate, among other symptoms.

What can help: Stay physically and socially active, do mental exercises (yes, Wordle!), prioritize sleep, and eat healthily. If memory gaps are concerning, speak with your doctor.

Could It Be Something Else?

Perimenopause symptoms can mimic other conditions, so it’s not uncommon to have a later diagnosis or have to eliminate other possibilities:

• Thyroid disorders: Fatigue, weight changes, and mood swings
• Anemia: Exhaustion, dizziness, and irregular periods
• Pregnancy: Missed periods, breast tenderness, and fatigue
• Depression: Persistent low mood, sleep problems, and loss of interest
• PCOS: Irregular periods and hormonal shifts

When to See Your Doctor

Seek medical advice for worsening symptoms or red flags, including heavy bleeding, severe depression, unexplained weight changes, and persistent pelvic pain.

Managing Perimenopause Symptoms

You don't have to simply "put up with" pesky symptoms. Minor, consistent lifestyle adjustments during perimenopause can make a significant difference.

Lifestyle Adjustments

• Regular activity helps with mood, sleep, and bone health. Aim for 150 minutes of moderate exercise every week.
• A balanced diet rich in fruits, vegetables, whole grains, and lean protein helps stabilize energy and can help ward off perimenopause weight gain and metabolic changes.
• Focus on stress reduction through yoga, meditation, or deep breathing, which can help lower cortisol levels and potentially alleviate symptoms. Even 10 minutes daily helps.

Medication

Wondering when to talk to a doctor about perimenopause symptoms? If symptoms are interfering with your everyday life, there are treatments you can try: 

• Hormone therapy: Helps relieve hot flashes and vaginal dryness at the lowest effective dose.
• Non-hormonal treatments: Certain antidepressants or blood pressure medications can reduce symptoms.
• Hormonal contraception: Birth control can regulate cycles and reduce bleeding.

The Takeaway: Track Symptoms & Get Help From a Perimenopause Doctor

Perimenopause symptoms are often the result of a combination of hormonal fluctuations, aging, and life stressors. These changes are common, highly manageable, and often improve significantly after menopause. Start tracking your symptoms so you can note any changes or potential triggers. If your symptoms worsen or start to interfere with your daily life, schedule an appointment with your healthcare provider.