10 Early Signs of Perimenopause You Might Be Ignoring

Perimenopause and the flurry of symptoms that come with it often coincide with other external challenges at midlife. The “pressure cooker” of this stage can include growing career demands, family responsibilities, aging parents, and health concerns. It’s no wonder many women attribute poor sleep, brain fog, or mood changes to life stressors alone. While stress certainly plays a major role in overall health, women in their 40s and 50s should also consider whether their hormones may be contributing (Thurston et al., 2025).

So how do you know if it’s life stressors or hormone changes?

Here are the top 10 signs of perimenopause to watch for:

1. Menstrual cycle changes – irregular periods, such as menstruation coming 7 days early or late on multiple occasions when cycles have typically been regular (Soules et al., 2001; Harlow et al., 2012).

2. Hot flashes, flushes, and night sweats.

3. Cognitive changes – “brain fog,” forgetfulness, difficulty with recall, or poor short-term memory (Thurston et al., 2025).

4. Sleep disturbance – trouble falling or staying asleep.

5. Mood changes – increased anxiety, restlessness, panic, low mood, or loss of motivation.

6. Fatigue – feeling more worn out and less resilient to stress.

7. Weight gain and body composition changes.

8. Vaginal dryness or pain with intercourse.

9. Joint and muscle aches and pains.

10. Decreased libido – loss of sexual desire or interest.

If you’re in your late 30s or early 40s and experiencing new menstrual cycle changes along with hot flashes or night sweats, that alone may be a tell-tale sign that you’ve entered the menopause transition (Soules et al., 2001; Harlow et al., 2012).

But what if you don’t have a cycle, or your cycles have never been regular? For women with conditions such as PCOS, those using hormonal IUDs, or those who have had a hysterectomy or uterine ablation, menstrual cycle criteria cannot be applied. In these cases, hormone evaluation can be useful. The most reliable markers of ovarian reserve—and therefore reproductive staging—include cycle day 3 FSH and estradiol. If a day 3 sample isn’t possible, random FSH and estradiol measurements may still help support a suspected diagnosis of perimenopause (Soules et al., 2001; Harlow et al., 2012).

Perimenopause, the reproductive phase leading up to the last menstrual period (which marks the start of postmenopause), is typically the most symptomatic stage of the menopause transition. Large studies confirm that symptoms such as vasomotor changes, mood fluctuations, and fatigue are most prevalent during this phase (Islam et al., 2025). With so much already happening in midlife, hormonal fluctuations can leave many women feeling as though they don’t have what it takes to move through this stage with ease and confidence.

The good news? With the right tools, education, and support, midlife can be not only challenging but also rewarding—adding to your accomplishments, resilience, and overall happiness.

My goal is to help women move through midlife with greater ease and confidence. If you’re experiencing symptoms of perimenopause and feel unheard,

to explore how we can work together to support your health.

References

• Thurston, R. C., Thomas, H. N., Castle, A. J., & Gibson, C. J. (2025). Menopause as a biological and psychological transition. Nature Reviews Psychology, 1-14.

• Islam, R. M., Bond, M., Ghalebeigi, A., Wang, Y., Walker-Bone, K., & Davis, S. R. (2025). Prevalence and severity of symptoms across the menopause transition: cross-sectional findings from the Australian Women's Midlife Years (AMY) Study. The Lancet Diabetes & Endocrinology, 13(9), 765-776.

• Soules, M. R., Sherman, S., Parrott, E., Rebar, R., Santoro, N., Utian, W., & Woods, N. (2001). Executive summary: stages of reproductive aging workshop (STRAW). Climacteric, 4(4), 267-272.

• Harlow, S. D., Gass, M., Hall, J. E., Lobo, R., Maki, P., Rebar, R. W., Sherman, S., Sluss, P. M., & de Villiers, T. J. (2012). STRAW+10: addressing the unfinished agenda of staging reproductive aging. Climacteric, 15(2), 105–114.