How do I know if I’m starting perimenopause?

Have you noticed your periods becoming erratic lately? Maybe you’re waking up drenched in sweat, feeling moody for no reason, or just not sleeping well? These might be signs you’re entering perimenopause. This transitional phase that leads to menopause can begin several years before your periods stop completely. Recognizing the early signs can help you manage this natural life change more effectively.

What is perimenopause, and when does it typically start?

Perimenopause is the start of the menopause transition. During this time, your body slowly makes less estrogen. This change prepares your body to end its reproductive years. While the average perimenopause age is mid-40s, some women notice early perimenopause signs in their 30s.

This isn’t a quick process—it can drag on for a few months to 10 years. Most women are in the perimenopause stage for about 4 years before reaching menopause. Menopause is when your period stops for 12 months in a row.

Common symptoms

The shift in hormone levels during perimenopause can trigger various physical and emotional changes. Most women don’t experience every symptom, and the symptoms can come and go as hormone levels fluctuate.

Menstrual changes

Irregular periods are often the first noticeable sign of perimenopause. Your menstrual cycles might become longer or shorter, and the flow may be heavier or lighter than usual. You might skip periods entirely or have them closer together.

Hot flashes and night sweats

That sudden wave of heat, especially in your face, neck, and chest, can cause you to break out in a sweat and may be followed by chills. When they occur at night (night sweats), they can significantly disrupt your sleep, leading to fatigue and irritability.

Mood swings and emotional changes

The hormonal changes in perimenopause can affect your emotions. You may experience mood swings, irritability, or increased anxiety. Some women have difficulty concentrating, memory problems, and brain fog.

Sleep disturbances

Disrupted sleep patterns or insomnia can lead to poor sleep quality. Along with night sweats, these disturbances can make other symptoms worse—like mood changes and concentration difficulties.

Other physical symptoms

• Vaginal dryness and discomfort during intercourse
• Decreased fertility
• Changes in sex drive
• Increased belly fat
• Less bone density
• Headaches or worsening migraines
• Heart palpitations
• Joint pain
• Weight gain despite no changes in diet or exercise

Perimenopause diagnosis: Is there a test?

Unlike pregnancy or many other health conditions that have positive or negative results, there is no definitive perimenopause test that can confirm you’re in this transition. Health care providers mainly diagnose perimenopause by evaluating your age, symptoms, and medical history.

While blood tests measuring follicle-stimulating hormone (FSH) and estradiol levels exist, hormone levels fluctuate greatly during perimenopause, making these tests often unreliable for diagnosis. However, your healthcare provider might recommend that they rule out other conditions that can cause similar symptoms.

Your provider may want to order thyroid function tests or other tests for symptoms that are severe or concerning.

When to see a healthcare provider

Perimenopause is a natural transition, but some symptoms may warrant medical attention from our specialized women’s health team. Our multidisciplinary approach ensures you receive comprehensive care for symptoms such as:

• Extremely heavy bleeding or periods lasting longer than usual
• Spotting after sex or between periods
• Periods that occur very close together (less than 21 days apart)
• Severe hot flashes that significantly impact your daily life
• Intense mood changes, including depression or anxiety
• Persistent sleep problems

Managing perimenopause symptoms

You can’t prevent perimenopause, but you can take steps to minimize its impact on your life.

Lifestyle adjustments

• Maintain a healthy diet rich in fruits and veggies, whole grains, and calcium-rich foods
• Regular physical activity helps manage weight, improves mood, and strengthens bones
• Practice stress-reduction techniques like meditation, yoga, or deep breathing
• Establish good sleep habits
• Limit alcohol and caffeine, which can trigger hot flashes
• Quit smoking, which increases your risk of early menopause and heart disease

Medical treatment options

If your symptoms significantly affect your quality of life, your healthcare provider might recommend:

• Hormone therapy to help stabilize fluctuating hormone levels
• Low-dose birth control pills to regulate periods and reduce hot flashes
• Antidepressants for mood symptoms or certain types of hot flashes
• Vaginal lubricants or moisturizers for dryness
• Calcium and vitamin D supplements to protect bone health

Is it perimenopause or something else?

Several conditions can cause symptoms similar to perimenopause, including:

• Thyroid disorders
• Pregnancy
• Certain medications
• Stress
• Primary ovarian insufficiency (a condition where the ovaries stop functioning normally before the age of 40)

This is why discussing your symptoms with a healthcare provider rather than self-diagnosing is important.

Perimenopause marks a significant life transition, but it doesn’t have to be a negative experience. Many women find this time offers opportunities for reflection, self-care, and personal growth.

With Mount Nittany Health’s women’s health specialists, you don’t have to navigate it alone. Our team of board-certified OBGYNs provide personalized care at every stage of your journey, combining compassionate support with advanced medical expertise.

Remember that perimenopause is temporary, and symptoms will eventually resolve as you move into menopause. With awareness, support, and appropriate care, you can navigate this natural transition with confidence and well-being.

If you are experiencing symptoms that may indicate perimenopause, schedule an appointment with our women’s health team at Mount Nittany Health to discuss your concerns.