12 Early Signs of Perimenopause You Shouldn't Ignore

Perimenopause — the transition to menopause — can begin in your late 30s or early 40s, sometimes even earlier. Many women don’t recognize the signs because they don’t expect hormonal changes until their 50s.

What is Perimenopause?

Perimenopause is the transitional period leading up to menopause (defined as 12 consecutive months without a period). It typically lasts 4-10 years and involves fluctuating hormone levels that can cause various symptoms.

12 Early Signs to Watch For

1. Irregular Periods

This is often the first sign. Your cycle may become shorter, longer, heavier, lighter, or more unpredictable.

2. Sleep Disturbances

You might experience difficulty falling asleep, staying asleep, or waking up earlier than usual. Night sweats can also disrupt sleep.

3. Hot Flashes and Night Sweats

Sudden feelings of warmth, especially in the face, neck, and chest. Night sweats are hot flashes that occur during sleep.

4. Mood Changes

Increased anxiety, irritability, or depression. Existing mood disorders may worsen.

5. Brain Fog

Difficulty concentrating, memory lapses, or feeling mentally “fuzzy.” This is due to fluctuating estrogen levels affecting the brain.

6. Changes in Libido

Sex drive may decrease due to hormonal changes, vaginal dryness, or other symptoms affecting intimacy.

7. Vaginal Dryness

Lower estrogen levels can cause vaginal tissues to become thinner, drier, and less elastic.

8. Weight Changes

Especially weight gain around the midsection, even without changes in diet or exercise.

9. Hair and Skin Changes

Thinning hair, dry skin, or loss of skin elasticity. Some women notice increased facial hair.

10. Breast Tenderness

Fluctuating hormones can cause breast pain or tenderness, similar to premenstrual symptoms.

11. Headaches

Migraines may worsen or appear for the first time, often related to hormonal fluctuations.

12. Heart Palpitations

Occasional racing heart or fluttering sensations, often related to hot flashes.

What Causes These Symptoms?

During perimenopause, your ovaries gradually produce less estrogen and progesterone. But this decline isn’t linear — hormones can fluctuate wildly, sometimes reaching higher levels than in your younger years before dropping again.

This hormonal roller coaster is what causes most perimenopausal symptoms.

When Does Perimenopause Start?

• Average age: Mid-40s
• Range: Late 30s to early 50s
• Duration: 4-10 years

Factors that may cause earlier perimenopause:

• Smoking
• Family history
• Cancer treatments
• Hysterectomy (even if ovaries are kept)

Managing Perimenopause Naturally

Lifestyle Changes

• Regular exercise (especially strength training)
• Stress management
• Adequate sleep
• Limiting alcohol and caffeine
• Maintaining a healthy weight

Nutrition

• Phytoestrogen-rich foods (soy, flaxseeds)
• Calcium and vitamin D for bone health
• Omega-3 fatty acids
• Limiting processed foods and sugar

Supplements (Consult Your Provider)

• Black cohosh for hot flashes
• Magnesium for sleep and mood
• Vitamin E for hot flashes
• Evening primrose oil

When to See a Doctor

Consult a healthcare provider if:

• Symptoms significantly impact quality of life
• You’re experiencing very heavy bleeding
• Bleeding occurs between periods
• Periods are less than 21 days apart
• You’re concerned about bone health

Hormone Therapy

For some women, hormone therapy (HT) may be appropriate. Modern HT is safer than once thought and can effectively manage symptoms. Discuss the risks and benefits with your healthcare provider.

Track Your Symptoms

Perimenopause symptoms can be confusing because they vary so much. Tracking your symptoms, cycle changes, and what helps can empower you to:

• Identify patterns
• Communicate effectively with healthcare providers
• Find what works for your unique situation

Ona can help you track these changes and provide insights during this transitional time.