Disclaimer: This information isn’t a substitute for professional medical advice, diagnosis, or treatment. You should never rely upon this article for specific medical advice. If you have any questions or concerns, please talk to your doctor.
You’re years away from menopause, but here’s how to know if the hormonal changes and transition into menopause have begun.
You may think about menopause as the time to deal with hot flashes and other symptoms typically associated with that part of midlife, but these can actually be signs of the transition into menopause, aka perimenopause. Menopause is the finite moment when you’ve gone 12 months without a period — which means perimenopause is actually longer than menopause.
“During perimenopause, your ovaries are starting to slow down their production of estrogen, and progesterone,” says Melynda Barnes, M.D., Clinical Director at Rory. “These hormonal changes affect each woman differently and the changes can range from subtle to down right disruptive.”
There are common signs and symptoms you may be in perimenopause, and these can be loosely grouped by the first and second halves of perimenopause. However, you can experience any of these throughout perimenopause.
Signs and symptoms of the first half of perimenopause:
This is one of the first signs of perimenopause. Your estrogen levels start to fluctuate, which means your cycle may become longer or shorter than usual. You may skip periods and your flow may become lighter or heavier than what’s been normal for you.
During perimenopause and menopause, you may have atypical spotting or bleeding. If you haven’t had your period in a year or more and experience spotting, it’s important to talk to a doctor because it could be a sign of something serious, including endometrial or uterine cancer.
Your hormones are fluctuating, which means you might be experiencing mood changes like irritability, sadness, fatigue, or even anxiety and depression.
When you wake up in the middle of the night, dripping in sweat or laying in sheets soaked in sweat, you’re having night sweats. The sudden heat from the overnight hot flash usually doesn’t wake you up, it’s the drenched pajamas and chills from sweating that does.
Signs and symptoms of the second half of perimenopause:
Hot flashes are the most common symptom of perimenopause. They start with a sudden sensation of heat, usually in the core, that rises towards the face and top of the head. Most women feel instantly overheated and can sometimes have palpitations. These sudden bursts of heat can go for a few seconds or several minutes, or longer.
There’s no norm for how often women experience hot flashes— it could be multiple times in one day, or a few times a month. Typically, women experience hot flashes for 5 to 7 years while in perimenopause, but they can continue past menopause (in postmenopause) and even last up to 15 years (1). You can also have hot flashes in the first half of perimenopause.
When estrogen levels drop, the vaginal lining becomes thinner, drier, and less elastic. This vaginal dryness can cause irritation, burning, and pain during sex.
Changes in libido
During the different stages of perimenopause, you may become less interested in sex. But for some women, their sex drive increases during perimenopause (2). Your sexual desire may drop due to uncomfortable sex related to vaginal dryness or because your fluctuating hormones have led to decreased libido.
Your libido is a complex blend of your physical, psychological, and emotional health, so talk to a doctor and your partner to find a solution that works for you.
If you’ve experienced headaches around the time of your period or when taking birth control, you may be at an increased risk for hormonal headaches during perimenopause. These usually stop when you reach menopause and your hormone levels are consistently low.
You may have started to notice that the waistband of your favorite jeans is starting to feel snug. Perimenopause may be related to changes in body shape. Some women who carried more of their weight below their waist (“pear-shaped”) start to carry more weight above their waist (“apple-shaped”) at this time.
The fluctuations in hormones can increasingly make it hard to sleep well and cause sleep problems to increase during perimenopause. If you have trouble staying and falling asleep, you’re not alone— over 25 percent of perimenopausal women are dealing with it, according to the Centers for Disease Control and Prevention (CDC) (3). You may also sleep fewer hours than you used to, which is also normal because perimenopausal women sleep less than pre- and post-menopausal women.
Problems with urinary function
You might have started having to pee more frequently, noticing leakage issues, and/or getting urinary tract infections (UTI) more often. That’s because lowered estrogen levels can lead to your urethra becoming dry, inflamed, or irritated.
Cognitive changes are a normal sign of perimenopause (4) — it’s like the “pregnancy brain” of this phase of your life. These may include not being able to calculate the tip at dinner, having a hard time adding up numbers in your head, or opening the fridge and forgetting what you meant to grab. You might also feel like you can’t stay focused on challenging tasks, such as doing taxes, paying attention during a long drive, or getting through a particularly challenging book.
Steiner AZ and AM Jukic. The impact of female age and nulligravity on fecundity in an older reproductive aged cohort. Fertil Steril 2016;105:1584-8
1. Avis N, Crawford S, Greendale G. Duration of menopausal vasomotor symptoms over the menopause transition. Jama Intern Med. 2015;175(4):531-539.
2. Woods NF, Mitchell ES, Smith-Di Julio K. Sexual desire during the menopausal transition and early postmenopause: observations from the Seattle Midlife Women’s Health Study. J Womens Health. 2010;19(2):209–218
3. Vahratian A. Sleep Duration and Quality Among Women Aged 40–59, by Menopausal Status. NCHS; 2017. Accessed February 22, 2019.
4. Weber MT, Mapstone M, Staskiewicz J, Maki P. Reconciling subjective memory complaints with objective memory performance in the menopausal transition. Menopause. 2012;19(7):735-41.