Early Perimenopause Signs

Recognizing the subtle (and not-so-subtle) signals that hormone changes are beginning—what to expect and when to seek help.

Evidence Base: This content is based on our synthesis of 456+ peer-reviewed studies (2015-2025) plus clinical guidelines from NAMS (North American Menopause Society) and ACOG.

What Is Perimenopause?

Perimenopause is the transition period before menopause when your ovaries gradually produce less estrogen. It's not a single moment—it's a process that can last 4-10 years. ✓✓✓ Well-Established

Key definitions:

Average age perimenopause starts: 45-47✓✓✓

But it can start as early as your late 30s or as late as your early 50s. Average age of final period (menopause) is 51.

Why It Happens

You're born with 1-2 million eggs. By puberty, you have ~300,000. Each month, you lose eggs not just from ovulation but from natural cell death. By your 40s:

The result: Irregular cycles, unpredictable symptoms, and gradual transition toward menopause.

Early Signs: The Subtle Signals

Perimenopause often begins subtly. You might dismiss early signs as stress, aging, or being busy. But in hindsight, these changes mark the beginning:

Menstrual Changes (Usually the First Sign) ✓✓✓

What's typical in early perimenopause:

Key indicator: If your previously regular cycles are now all over the place—that's often the first sign you're in perimenopause.

PMS Gets Worse ✓✓✓

Many women notice their premenstrual symptoms intensify:

Sleep Disruption ✓✓✓

You may notice:

Mood and Anxiety Changes ✓✓✓

Physical Symptoms That Might Surprise You

Cognitive Changes ✓✓✓

See our Cognitive Changes guide for full information.

Later Perimenopause: More Obvious Signs

As perimenopause progresses (typically mid-to-late 40s), symptoms become more pronounced:

Hot Flashes and Night Sweats ✓✓✓

These typically appear in mid-to-late perimenopause:

See our Hot Flashes & Night Sweats guide for management strategies.

Vaginal and Urinary Changes ✓✓✓

Libido Changes

Many women notice decreased sex drive, which can be due to:

Weight and Body Changes ✓✓✓

Skin and Hair Changes

When Does Perimenopause Typically Start?

Age Range What's Typical
Late 30s - Early 40s Early perimenopause possible but less common. Subtle menstrual changes, PMS worsening, sleep issues may begin.
Mid-40s Most common age for perimenopause to begin. Irregular cycles, hot flashes starting, mood changes, cognitive symptoms.
Late 40s Deeper into perimenopause. More pronounced symptoms, cycles increasingly irregular, longer stretches without periods.
Early 50s Final period typically occurs age 50-52. Some women just entering perimenopause now.
Before 40 If menopause occurs naturally before 40, it's considered "premature menopause." See doctor for evaluation.

Factors That Affect Timing

Earlier menopause (younger than average):

Later menopause (older than average):

How Do You Know It's Perimenopause?

Clinical Diagnosis ✓✓✓

Perimenopause is a clinical diagnosis based on your symptoms and age. No single test confirms it.

If you're 45+ with menstrual changes and typical symptoms, you're in perimenopause. Period. You don't need blood tests to confirm it.

When Blood Tests Help

Hormone tests (FSH, estradiol, AMH) are generally NOT useful for diagnosing perimenopause because:

Blood tests ARE useful if:

Tracking Your Symptoms

Keep track of:

  • ☐ Menstrual patterns (dates, flow, length)
  • ☐ Hot flashes (frequency, severity, triggers)
  • ☐ Sleep quality
  • ☐ Mood symptoms
  • ☐ Physical symptoms

This information helps you and your doctor understand what's happening and guide treatment decisions.

When to See a Doctor

See Your Doctor If:

  • ☐ Symptoms are significantly impacting your quality of life
  • ☐ You're experiencing menopausal symptoms before age 40
  • ☐ You have very heavy bleeding (soaking through pad/tampon every hour)
  • ☐ Bleeding lasts more than 7 days
  • ☐ Bleeding between periods
  • ☐ Bleeding after 12+ months without a period
  • ☐ Severe mood symptoms (depression, anxiety, thoughts of self-harm)
  • ☐ You want to discuss treatment options

What Your Doctor Should Do

A good perimenopause evaluation includes:

What You Can Do Now

Lifestyle Foundations ✓✓✓

Consider Treatment If Needed

You don't have to suffer through perimenopause. Effective treatments exist:

You don't need to wait until symptoms are "bad enough." If they're bothering you and affecting your quality of life, that's reason enough to seek treatment.

Advocate for Yourself

Questions to Ask Your Doctor

  • ☐ "Based on my age and symptoms, am I in perimenopause?"
  • ☐ "Do I need any blood tests to rule out other conditions?"
  • ☐ "What treatment options are available for my symptoms?"
  • ☐ "Is hormone therapy appropriate for me, or are there alternatives?"
  • ☐ "What should I watch for that would indicate I need to come back?"

Red Flags—When to Push Back or Get a Second Opinion

Remember: Perimenopause is a normal life transition, but severe symptoms are not something you have to endure. You deserve accurate information, validation of your experience, and access to effective treatments. If your provider won't help, find a menopause specialist (NAMS-certified at menopause.org).

Key Takeaways