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First Signs of Perimenopause to Look Out For

Dr. Alyssa Dweck

Written by Dr. Alyssa Dweck, MS, MD, FACOG, Chief Medical Officer

Medically reviewed by Alyssa Dweck MS, MD, FACOG, Chief Medical Officer

Dr. Alyssa Dweck

Written by Dr. Alyssa Dweck, MS, MD, FACOG, Chief Medical Officer

Medically reviewed by Alyssa Dweck MS, MD, FACOG, Chief Medical Officer

The thing with perimenopause is that it often takes women by surprise. Just when you least expect it, periods become wonky, moodiness is out of control, sleep is an often-interrupted luxury, and you find yourself gaining weight from just looking at a piece of bread.  Since menopause, defined as 12 consecutive months of no menstrual flow with no other obvious cause, is a hindsight realization, it is no wonder why recognizing the signs of perimenopause is tough. That said, there are some first signs you can look out for to help prepare for perimenopause as it starts.

First, let’s define what perimenopause really is.

What is Perimenopause?

Perimenopause is defined as the years prior to your last period. The time frame can vary from four to eight years, give or take. During this transition, ovulation occurs irregularly and typically less frequently than once per month. Translation? The typical monthly synchronized release of hormones like estrogen, progesterone and even testosterone, becomes erratic during perimenopause.

There are various perimenopause stages, and genetic, environmental, and lifestyle factors can influence when perimenopause starts as well as the nature of the transition. For example, smokers typically have an earlier and more notable experience during perimenopause, and not in a good way. Women on hormonal contraception for birth control and/or cycle control, may not recognize any changes at all. All else being equal, one’s perimenopausal experience typically mirrors her mom’s or sister’s in both timing and severity.

The Difference Between Perimenopause and Menopause

So, how do you know if you’re in perimenopause vs. menopause, especially in the early stages? You may have even asked yourself, at what age does perimenopause start? This is often tough to gauge, as there is unfortunately no definitive age or test for perimenopause; rather there is a range. In general, the early stages of menopause, where estrogen and progesterone levels decline, may start near age 40. If you’re starting to experience what you think are the first symptoms of perimenopause, or if you have questions, it’s always a good idea to check in with your healthcare provider.

Menopause, on the other hand, is actually only one, single moment in time – it’s when you’ve gone a full 12 months without a period. Following that, you’re considered to be postmenopausal.

Check our a quick video on understanding perimenopause, from Chief Medical Officer, Dr. Alyssa Dweck, below: 

What Are the First Signs of Perimenopause?

Irregular, skipped or unusual periods are typically one of the first signs of perimenopause, and in truth, anything goes. One might skip an occasional menses or miss their period for many months at a time. Bleeding might be lighter or heavier, longer in duration or only a day, clotty and painful or barely there; this is all fair game in the perimenopause manual. When is there cause for concern?  Bleeding more frequently than every three weeks, random bleeding in between flows or a super heavy flow with large clots during perimenopause (like more than two super tampons per hour heavy) or really any bleeding concerns should prompt a check-in with your gynecologist.

Common Early Perimenopause Symptoms

The physical symptoms associated with perimenopause can last from a few months to many years. In addition to the loss of a regular monthly period, the common perimenopause symptoms you experience can impact your life in a variety of ways, some of which may come as a surprise. Irregular bleeding and other symptoms can be incredibly disruptive—both emotionally and physically. And common perimenopause symptoms that are more physical in nature, can run the gamut and can include: 

  1. Hot flashes (which many women associate with menopause)
  2. Gastrointestinal changes
  3. Headaches
  4. Mood swings
  5. Fatigue
  6. Weight gain
  7. Hair loss
  8. Decrease in sexual satisfaction and/or drive

Some women experience a litany of other random symptoms and signs of perimenopause including, difficulty falling or staying asleep, heart palpitations, anxietyjoint pain, and difficulty maintaining or losing weight. Once other medical issues are ruled out, it’s fair to associate these signs with perimenopause.

How to Manage Your Perimenopause Experience at Any Stage

To start preparing for your transition through perimenopause, leading up to menopause, it’s important to commit to some lifestyle changes, particularly associated with your nutrition and exercise habits. Try to follow a Mediterranean diet. This heart healthy, low glycemic diet is naturally low in carbs, processed foods, and salt. Consider intermittent fasting and exercise regularly. Ideally, this should include 150 minutes a week of cardiovascular activity, in addition to strength training. Optimize flexibility and balance with yoga and stretching. Finally, and admittedly a difficult task, try your best to reduce stress. Try mindfulness, meditation or breathing exercises. Your mental health and your waistline will thank you.

Vitamins for Early Signs of Perimenopause

Increasingly, women are turning to hormone-free solutions to manage the first signs of perimenopause. Vitamins and supplements are available to treat everything from hot flashes to mood swings with hormone-free ingredients like Swedish flower pollen. If you’re considering a prescription-free option for managing your perimenopause symptoms, do your research: look for companies that use high quality ingredients, and offer products backed up by thorough research and development. Your healthcare provider’s input can be valuable when it comes to vitamins and supplements as well, so be sure to ask if they have any specific recommendations for addressing some common perimenopause symptoms. 

Other Treatments for Perimenopause

Hormone replacement therapy, antidepressants or other prescription medications might be in order for managing certain perimenopause symptoms, but this varies on a patient-to-patient basis. Additionally, hormone-free vaginal moisturizers containing hyaluronic acid, may prove to be helpful for addressing the vaginal dryness experienced during this time. Talk to your healthcare provider about your perimenopause symptoms and possible treatments, and keep in mind that you may need to try out a few different options before finding the treatment that works best for you.




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      Thank you for this article. I recommend people read the book, Your Body and Balance by Dr Neal Barnard. He recommends a low fat plant-based diet for menopause and balancing hormones. Carbs are fine. Your brain needs the glucose from carbs. The hormones, cholesterol and fat in meat, dairy, eggs and fish can be problematic.

      Kathleen Kastner on

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