You may feel more tired than usual.
Your emotions are on edge. Your cycle is slightly off. But everything looks “normal” on paper.
If you’re in your late 30s or 40s, these subtle shifts could be the first signs of menopause—specifically, perimenopause, the transition phase before your period stops completely.
The problem?
Most women don’t recognize the signs early enough to take control.
In this article, we’ll explore:
- The most common (but often missed) early symptoms
- Why they’re so easy to misinterpret
- When to take action—and how to get clarity
What Are the First Signs of Menopause?
Menopause doesn’t start the moment your period stops.
That’s the final stage.
It actually begins with perimenopause—a hormonal rollercoaster that can start 8 to 10 years earlier, often in your 30s or 40s. NAMS
During this time, estrogen and progesterone fluctuate wildly, causing a ripple effect throughout your body and brain.
But here’s the catch:
The first signs aren’t always physical. In fact, they often feel like stress or burnout. That’s what makes them so easy to miss.
Early Signs of Menopause Most Women Miss
1. Subtle Period Changes
Your cycle may still be regular—but just slightly “off.”
Maybe your period comes a few days early… or the flow is heavier than usual… or it lasts only two days instead of five.
These changes are often the first physiological signs of perimenopause, and they can start even when hormone levels appear “normal.”
2. Unexplained Fatigue
Not just tired—but wiped out.
Many women report a new kind of exhaustion that sleep doesn’t fix.
Estrogen helps regulate energy and cortisol. When it dips, you may feel like you’ve hit a wall—daily.
3. Increased Anxiety or Irritability
Feel like you’re overreacting to things that never used to bother you?
That’s not “just stress.”
Fluctuating estrogen impacts serotonin and dopamine, the brain’s mood regulators—leading to new or worsened anxiety, sadness, or rage.
➡️ NIH on hormonal mood shifts
4. Sleep Disruption
Even if you fall asleep fine, you may wake up at 2 AM, restless or drenched in sweat.
This isn’t just poor sleep hygiene—it’s likely tied to falling estrogen levels, which interfere with your body’s temperature regulation and melatonin.
5. Brain Fog
Can’t find the right word? Walk into rooms and forget why?
Cognitive changes like forgetfulness and concentration issues are often among the earliest symptoms—but they’re rarely linked to hormones by doctors or patients.
6. Breast Tenderness or Body Aches
New, unexplained tenderness in your breasts or joints can also be caused by hormonal shifts—especially if these symptoms appear outside of your usual cycle timing.
7. Low Sex Drive or Vaginal Changes
You may notice reduced libido or vaginal dryness—even if your relationship hasn’t changed.
Estrogen supports natural lubrication and blood flow. Its decline can impact sexual wellbeing even before your periods stop.
Why These Symptoms Are So Easy to Miss
- They overlap with PMS, burnout, parenting stress, and work fatigue
- They show up gradually—not all at once
- You may still be having periods, so menopause doesn’t even cross your mind
“But I still get my period… so this can’t be menopause.”
That’s one of the most common misunderstandings—and a major reason why diagnosis is often delayed by years.
Expert Tip
“Hormones are powerful messengers throughout the body. Even subtle fluctuations—especially in the brain—can change mood, memory, and sleep before you see changes in your period.”
— Dr. Lisa Mosconi, neuroscientist and author of The XX Brain
Myth vs Reality: Clearing the Confusion
| Myth | Reality |
| Menopause starts at 50 | It often begins in your 30s or 40s with perimenopause |
| Hot flashes are the first sign | Emotional and cognitive changes often come first |
| You need a blood test to confirm it | Hormones fluctuate daily—symptoms are more reliable |
| You can’t do anything about it | There are many ways to manage symptoms with care |
Symptom Timeline: Early to Late Perimenopause
| Symptom | Early Perimenopause | Late Perimenopause |
| Periods | Still regular | Irregular or skipped |
| Mood | New anxiety, irritability | Emotional swings |
| Sleep | Occasional insomnia | Chronic disruptions |
| Libido | Reduced desire | Vaginal dryness, discomfort |
| Energy | Fatigue, sluggishness | Exhaustion, burnout |
When to See a Doctor
If you’ve noticed 2 or more symptoms from the list above—and you’re in your late 30s or 40s—it’s time to consider perimenopause.
While there’s no single diagnostic test, your doctor can:
- Rule out other conditions (e.g., thyroid disorders)
- Offer guidance on lifestyle or treatment options
- Refer you to a specialist if needed
You can also start with a symptom quiz to understand where you are on your hormonal journey.
What You Can Do Next
You don’t have to wait until symptoms are unbearable.
Awareness is the first step—and there’s a lot you can do proactively.
- Track your symptoms with a journal or app.
- Consider talking to a menopause-trained practitioner.
- Explore lifestyle support: better sleep hygiene, stress management, and hormone-friendly foods.
- Take our quiz to see where you stand and get the next steps.
Sources
North American Menopause Society (NAMS)
Mayo Clinic – Perimenopause
NIH – Mood Shifts in Perimenopause
Anna Haotanto is the Founder of Zora Health and a passionate advocate for women’s empowerment. Anna’s personal experiences with egg-freezing, PCOS, perimenopause and the challenges of fertility have fueled her mission to provide high-quality information, financing, and support to help women and couples navigate their fertility journeys with confidence. She is also recognised for her achievements in finance, entrepreneurship, and women’s empowerment, and has been featured in various media outlets. You can also follow her on Linkedin or Instagram.
