10 Signs You May Be in Perimenopause

Your periods are changing. You're waking up in the middle of the night. You're more tired than usual.

Maybe you've noticed changes in your weight or mood that you weren't expecting.

At some point, you may find yourself asking:

“Could this be perimenopause?”

If you're in your 40s—or sometimes younger—the answer may be yes.

Perimenopause is the transition leading up to menopause. During this time, estrogen and progesterone levels fluctuate, and ovulation becomes less predictable.

The changes don't happen in exactly the same way for every woman, and they can affect much more than your menstrual cycle.

 The National Institute on Aging explains that the menopausal transition can involve changes in periods, hot flashes, sleep, mood, memory, concentration, body composition, and sexual health.

So what should you look for?

Here are 10 signs that may point to perimenopause.

1. Your periods are becoming unpredictable

For many women, changes in their menstrual cycle are among the first signs.

Maybe your period used to arrive on a fairly predictable schedule, but now it comes earlier or later than expected. Your flow may be heavier one month and lighter the next. You may also skip a period and then have it return the following month.

This happens because ovulation becomes less consistent during perimenopause. As hormone levels fluctuate, the timing and flow of your periods can change. Mayo Clinic's guide to perimenopause describes irregular periods, changes in flow, and skipped periods as common changes during this transition.

There is an important caveat, though: not every change in menstrual bleeding should be attributed to perimenopause.

Talk with your healthcare provider if you have very heavy bleeding, bleeding between periods, periods that occur very close together, bleeding that lasts longer than seven days, or any bleeding after menopause.

2. You're having hot flashes or night sweats

You're sitting at your desk, cooking dinner, or getting ready for bed—and suddenly you feel a wave of heat move through your body.

Your face or neck may become warm. You may start sweating. A few minutes later, it may be gone.

That's a hot flash, one of the most familiar symptoms of the menopause transition. When the sweating happens during sleep, it's commonly referred to as a night sweat.

Hot flashes are among the most common menopause symptoms. The U.S. Office on Women's Health explains that as many as three out of four women experience hot flashes and describes their typical symptoms and available treatment options.

For some women, they're an occasional nuisance. For others, they interfere with work, sleep, exercise, or everyday activities. If they're affecting your life, there are treatment options to discuss with your healthcare provider.

3. Your sleep has changed

Maybe you're tired when you get into bed, but once you're there, you can't fall asleep.

Or you fall asleep easily but wake up at 2 or 3 a.m. and can't get back to sleep.

Sleep problems can become more common during perimenopause. Hot flashes and night sweats can interrupt sleep, but some women experience sleep changes even without noticeable hot flashes.

After several nights of disrupted sleep, you may notice that you're having a harder time concentrating, managing stress, exercising, or simply getting through the day with your usual energy.

If your sleep has changed significantly, it is worth looking at why—not just accepting poor sleep as another inevitable part of getting older.

4. Your mood feels different

Perhaps you're more irritable than usual. Maybe small things seem to bother you more, or you've noticed periods of anxiety or emotional ups and downs.

Mood changes can occur during perimenopause, but hormones aren't necessarily the whole explanation.

Sleep disruption, stress, medications, relationships, work, and other circumstances can affect how you feel, too. The Office on Women's Health notes that mood changes around menopause can be influenced by hormonal changes as well as stress, family circumstances, and fatigue.

If you're experiencing ongoing anxiety, depression, or significant changes in your mood, don't assume you simply need to “ride it out.” Talk with your healthcare provider so other possible causes can be considered and appropriate treatment can be discussed.

5. You're having trouble concentrating

You know the feeling: you walk into another room and can't remember what you went there to do.

Or you're in the middle of a conversation and the word you want just won't come to you.

Women often describe these experiences as “brain fog” during the menopause transition.

Still, it is worth looking beyond hormones. Poor sleep, stress, thyroid problems, nutritional deficiencies, medications, and other health conditions can affect concentration and memory.

If these changes are persistent or noticeably different from your usual experience, bring them up with your doctor.

6. Your weight or body composition is changing

This is one of the changes that can be particularly frustrating.

You may feel that you're eating and exercising much as you always have, yet your clothes fit differently or you're carrying more weight around your abdomen.

Midlife weight and body-composition changes can involve several factors. Hormonal changes during the menopause transition may contribute, but aging, changes in muscle mass, physical activity, sleep, nutrition, medications, stress, and metabolic health can also influence weight.

If this is happening to you, an extremely restrictive diet isn't necessarily the answer. It can be more useful to look at your overall health and identify the factors that may be affecting your weight.

7. Sex has become uncomfortable

Vaginal dryness can develop during the menopause transition, and you may notice irritation, burning, or discomfort during sex.

Some women don't mention these symptoms because they assume they're simply part of aging.

They don't have to be ignored.

The National Institute on Aging explains that vaginal dryness around menopause can make intercourse uncomfortable and provides information about treatment options.

Mayo Clinic also notes that declining estrogen can cause vaginal tissues to become drier and less elastic, which may lead to pain during sex and other vaginal or urinary symptoms.

If sex has become uncomfortable, tell your healthcare provider. There are several ways these symptoms can be evaluated and treated, depending on what's causing them and your individual health needs.

8. Your sex drive has changed

Changes in sexual desire can happen during perimenopause, but there isn't one universal experience.

Some women notice less interest in sex. Others notice no meaningful change.

Hormonal fluctuations may play a role, but so can vaginal discomfort, sleep, stress, mood, medications, relationships, and your general health.

Sexual desire and feelings about sex may change around menopause, and recommends discussing concerns about sexual health with a healthcare professional.

If a change in libido is bothering you, it's appropriate to discuss it with your healthcare provider. You don't need to be uncomfortable bringing it up.

9. You're more tired than usual

Maybe you're getting through your normal routine, but everything seems to take more effort.

You may wake up tired, run out of energy earlier in the day, or feel like you aren't recovering from a night's sleep the way you used to.

Perimenopause can contribute to fatigue, particularly when hot flashes, night sweats, or other symptoms interfere with sleep.

But persistent fatigue can also have many other explanations.

Anemia, thyroid disorders, sleep disorders, nutritional deficiencies, medications, mood disorders, and other medical conditions can all cause fatigue.

So if you're consistently exhausted, it's worth finding out what's behind it rather than assuming it's simply a menopause symptom.

10. Several smaller changes are happening at the same time

Sometimes there isn't one symptom that makes you think, “This must be perimenopause.”

Instead, you notice a pattern.

Your periods are less predictable.

You're waking up during the night.

You've started having hot flashes.

Your mood seems different.

You're having more trouble concentrating.

Your body is changing in ways you didn't expect.

Individually, none of these changes necessarily tells you what's happening. Taken together, though, they may be worth discussing with your healthcare provider.

Perimenopause doesn't follow one specific script. Some women have very few symptoms, while others experience several changes that affect their daily lives.

Could something else be causing your symptoms?

Yes.

This is an important part of the conversation.

Many symptoms associated with perimenopause can also occur for other reasons. Your healthcare provider may consider your age, menstrual history, symptoms, medications, medical history, and overall health when evaluating what's going on.

You also don't necessarily need to wait for a laboratory test to tell you that you're entering perimenopause. For many women in the typical age range, the combination of menstrual changes and symptoms provides important clinical information. Your provider can determine whether testing or evaluation for another condition is appropriate.

And remember that perimenopause is different from menopause.

Menopause is defined as going 12 consecutive months without a menstrual period, when there is no other explanation for the absence of your periods.

When should you talk with your doctor?

You don't need to wait until your symptoms are severe.

Consider making an appointment if changes in your periods, sleep, mood, energy, sexual health, or weight are affecting your daily life or simply leaving you concerned about what's happening.

And don't overlook changes in bleeding. Very heavy bleeding, bleeding between periods, unusually frequent periods, or bleeding after menopause should be evaluated by a healthcare professional.

A good appointment can be more than a conversation about whether you're “in menopause.” It's an opportunity to look at your symptoms in context and consider whether anything else may be contributing.

How LifeviewMD Can Help

Women's health during midlife can involve several overlapping areas, from hormonal changes and sleep to nutrition, weight, and lifestyle.

Dr. Elisabeth Aponte is a fellowship-trained glaucoma specialist, board-certified ophthalmologist, cataract surgeon, and Board-Certified in Lifestyle Medicine. She also has focused training in women's health-related conditions, including perimenopause and menopause.

At LifeviewMD, Dr. Aponte considers the broader health picture when working with women experiencing changes during this stage of life. Her approach incorporates lifestyle, nutrition, metabolic health, hormonal concerns, sleep, and other factors that may be relevant to an individual's symptoms and goals.

If you're noticing changes and aren't sure whether they're related to perimenopause, a conversation with a healthcare professional can help you sort through the possibilities and determine what, if anything, needs further evaluation or treatment.

Trusted Resources & Further Reading

• National Institute on Aging (NIH): What Is Menopause?

• Office on Women's Health, U.S. Department of Health & Human Services: Menopause Symptoms and Relief

• American College of Obstetricians and Gynecologists (ACOG): The Menopause Years

• Mayo Clinic: Perimenopause — Symptoms and Causes

This article is for educational purposes and is not a substitute for individualized medical advice, diagnosis, or treatment.