What Is Perimenopause? Symptoms, Signs & What to Expect

You feel off—but can’t quite explain why.

Your sleep is disrupted. Your moods are unpredictable. And your period? Playing hide-and-seek.
If this sounds familiar, you might be in perimenopause—a hormonal transition most women go through but few are prepared for.

This guide explains perimenopause, how to spot the signs early, and what to expect.

What Is Perimenopause?

Perimenopause is the time leading up to menopause when your hormones begin to shift—most notably, estrogen and progesterone start to fluctuate. It’s your body’s gradual transition toward the end of your reproductive years.

Unlike menopause, which is defined as 12 consecutive months without a period, perimenopause is the messy middle. It can last for years and shows up differently for every woman.

Think of it like a dimmer switch—not an on/off button. The changes are subtle at first, then more noticeable over time. This is a natural biological process, not a disease. But its effects are very real—and often misunderstood.

When Does Perimenopause Start?

For most women, perimenopause begins between the ages of 40 and 44, though it can start as early as the mid-30s.

According to the North American Menopause Society (NAMS), the average age of menopause is 51, and perimenopause can begin 8 to 10 years before that.

Factors that influence the onset include:
– Genetics (your mother’s menopause age is often a clue)
– Smoking (linked to earlier menopause)
– Autoimmune or thyroid conditions
– Chemotherapy or radiation treatments

Some women notice symptoms even while their periods remain regular. Others experience erratic cycles and sudden shifts in mood, sleep, or energy.

If you’re in your 40s and “don’t feel like yourself”—this could be why.

What Hormonal Changes Happen?

Estrogen and progesterone—your two main reproductive hormones—begin to rise and fall unpredictably.This hormonal turbulence impacts nearly every system in your body, including:

• • Brain (affecting mood, memory, focus)
  • Skin (leading to dryness or breakouts)
  • Metabolism (making weight gain more likely)
  • Sleep regulation (contributing to insomnia)

During perimenopause, your body may also become more sensitive to cortisol (the stress hormone), which can exacerbate anxiety or fatigue.Key symptoms linked to hormonal shifts:

• Irregular or heavier periods
• Hot flashes and night sweats
• Anxiety or depression
• Fatigue and low motivation
• Brain fog and memory lapses
• Vaginal dryness or discomfort during sex

A study published in Obstetrics & Gynecology Clinics of North America found that 60–80% of women report mood disturbances during perimenopause, often tied to these hormonal swings.

How Long Does Perimenopause Last?

On average, perimenopause lasts 4 to 8 years. Some women experience symptoms for just a couple of years, while others may feel the effects for a decade.
You officially reach menopause when you’ve gone 12 consecutive months without a period.
The transition typically happens in two phases:
Early perimenopause: Periods are still regular, but symptoms like mood shifts or sleep issues appear.

Late perimenopause: Menstrual cycles become increasingly irregular or skipped entirely, and hot flashes intensify.

One of the most confusing aspects is that symptoms don’t always align neatly with your cycle changes—which is why many women don’t realize they’re in perimenopause until much later.

Is There a Test for Perimenopause?

There’s no single diagnostic test to confirm perimenopause. Hormone levels fluctuate daily, making blood tests unreliable.
Instead, diagnosis is based on symptoms, age, and menstrual changes. A doctor may order tests to rule out other causes, like thyroid issues.
Tracking your symptoms over time is one of the best ways to get clarity.

Managing Perimenopause: What Can Help?

There’s no “cure” for perimenopause—it’s a natural process—but there are many tools that can help you manage the transition.

Lifestyle changes:

Regular exercise (especially strength training and walking)
A balanced diet with calcium, magnesium, and protein
Sleep hygiene practices
Stress management: meditation, journaling, therapy

Supplements and treatment options:

Black cohosh, ashwagandha, or magnesium (check with your doctor)
Hormone replacement therapy (HRT), if symptoms are severe
SSRIs or other medications for mood and sleep

Support systems matter, too. Many women find comfort in peer communities or speaking to a women’s health specialist.

Common Myths About Perimenopause

• “It only happens after 50.”
  Not true. Many women begin perimenopause in their 30s or early 40s.
• “You’ll definitely get hot flashes.”
  Hot flashes are common, but not universal. Some women experience sleep issues or mood changes first.
• “You can confirm it with a single blood test.”
  Hormones fluctuate too often for one test to tell the full story.
• “If you still get your period, you’re not in perimenopause.”
  Many women experience hormonal symptoms while still menstruating regularly.
• “Nothing can help—you just have to suffer through it.”
  There are many evidence-based ways to ease the transition, from lifestyle changes to medical support.

Visual Guide: Early vs. Late Perimenopause

Final Thoughts

Perimenopause can feel confusing, unpredictable, and even isolating.
But it’s also the start of an important new chapter—and you don’t have to go through it blindly.
The more you understand what’s happening in your body, the more empowered you’ll feel to navigate it.
Whether you’re just noticing changes or knee-deep in symptoms, the best time to get clarity is now.

Sources:

• North American Menopause Society (NAMS)

• Mayo Clinic

• Obstet Gynecol Clin North Am. 2018; Mood and Hormones

Anna Haotanto

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.