This article is part of our comprehensive series on menopause. For a complete overview, we recommend starting with our Complete Guide to Reclaiming Your Body and Pleasure.
You feel... different. Your periods are suddenly unpredictable, you're waking up in the middle of the night for no reason, and your mood feels less like your own. If you're in your 40s (or even late 30s), you're not going crazy—you are likely entering perimenopause, the natural transition leading up to menopause.
Perimenopause means "around menopause" and it's a phase that can last for several years. During this time, your ovaries gradually begin to make less estrogen. This hormonal fluctuation is the root cause of the changes you're experiencing. Recognizing the early signs is the first step toward managing this transition with grace and confidence. Here are the 10 most common early signs to watch for.
1Irregular Periods
This is the hallmark sign of perimenopause. The fluctuating hormone levels disrupt your regular cycle. You might notice your periods are closer together or further apart, the flow could be heavier or lighter than usual, or you might skip a period altogether.
2Hot Flashes & Night Sweats
The classic menopause symptom can start years before your periods stop. A hot flash is a sudden feeling of intense heat, often with a flushed face and sweating. When these happen at night, they're called night sweats and can severely disrupt sleep.
3Sleep Problems
Even without night sweats, you might find it harder to fall asleep or stay asleep. Estrogen and progesterone are sleep-promoting hormones, so as their levels fluctuate and decline, your natural sleep architecture can be disturbed.
4Mood Swings & Irritability
If you feel more irritable, anxious, or prone to sudden mood shifts, you can thank your hormones. Estrogen has a significant effect on brain chemicals like serotonin and dopamine, which regulate mood. When estrogen is erratic, your emotional equilibrium can be too. We explore this further in our guide to managing mood swings and weight gain.
5Vaginal Dryness & Discomfort
This is one of the most common—and undertreated—symptoms. As estrogen declines, the vaginal tissues can become thinner, drier, and less elastic. This can lead to itching, irritation, and discomfort during intimacy. Addressing this early is key to maintaining a healthy sex life. Learn more about the specific causes and solutions for menopausal vaginal dryness.
"Perimenopause is not a waiting room for menopause; it's an active phase of change. I encourage my patients to see these early signs as a wake-up call to prioritize their health—to clean up their diet, manage stress, and start supporting their bodies for the journey ahead."
— Dr. Emily Carter, OB-GYN
6A Dip in Libido
A decrease in sex drive is very common, resulting from a combination of hormonal changes (including a drop in testosterone), sleep disruption, mood changes, and the physical discomfort of vaginal dryness. It's a complex issue with actionable solutions, which we cover in our 5-step plan to increase libido.
7Brain Fog & Forgetfulness
Difficulty concentrating or feeling more forgetful? This is a real physiological symptom. Estrogen plays a role in cognitive function, so the fluctuating levels during perimenopause can lead to temporary "brain fog."
8Changes in Skin & Hair
As estrogen declines, so does collagen production. You might notice your skin is drier and less firm, and your hair may become thinner or more brittle. Supporting your body's collagen becomes increasingly important during this time.
9Weight Gain, Especially Around the Middle
Hormonal shifts can slow your metabolism and change where your body stores fat, often leading to an increase in abdominal fat. This is a common frustration for many women in their 40s and 50s.
10Worsening PMS
For some women, premenstrual syndrome (PMS) can get worse during perimenopause before it gets better. The more dramatic hormonal swings can lead to more intense breast tenderness, bloating, and headaches in the days leading up to their period.
Recognizing these signs is the first step toward navigating perimenopause with empowerment. By understanding what's happening in your body, you can seek out the right support and strategies to manage your symptoms and thrive through this transition.