Irregular periods, hot flashes, and more — how to recognise perimenopause.
Perimenopause — the transition phase before menopause — can last anywhere from 2 to 10 years. It typically begins in the mid-40s, though it can start as early as the mid-30s. Many women don't recognise it for months or years because the symptoms are varied, start gradually, and often get attributed to stress or other causes. Here's what to look for.
The first and most universal sign of perimenopause is a change in cycle regularity. Your cycles may shorten (to 21–24 days) before eventually lengthening and becoming unpredictable. You might skip periods entirely for 1–2 months, then have them again. No two perimenopausal cycles are identical.
Hot flashes — sudden, intense feelings of heat usually concentrated in the upper body, chest, neck, and face — affect about 75% of women in perimenopause. They typically last 1–5 minutes and may occur multiple times a day or week. They're caused by falling estrogen affecting the hypothalamus's temperature regulation.
Night sweats are hot flashes that occur during sleep. They often cause women to wake drenched in sweat, disrupt sleep, and cause fatigue. They can begin before other perimenopause symptoms are obvious.
Beyond night sweats, falling progesterone (which promotes sleep) causes difficulty falling asleep and poor sleep quality. Many women in perimenopause report waking frequently or feeling unrested despite adequate hours in bed.
Estrogen fluctuations directly affect serotonin and dopamine. Increased anxiety, irritability, low mood, and mood swings are common in perimenopause — particularly in women who have previously experienced PMS or depression. These symptoms are often misdiagnosed as depression without the underlying hormonal context being considered.
Difficulty concentrating, forgetfulness, and "word-finding" difficulties are commonly reported in perimenopause. Estrogen plays a role in cognitive function — its fluctuation and eventual decline affects memory and processing speed for many women.
Declining estrogen reduces vaginal lubrication and tissue thickness. This causes vaginal dryness, itching, and — eventually — discomfort during sex. Unlike hot flashes, vaginal symptoms tend to worsen over time without treatment rather than improving after menopause.
A combination of falling testosterone, vaginal dryness making sex uncomfortable, disrupted sleep, and mood changes all contribute to reduced sex drive in perimenopause.
Paradoxically, many women experience heavier-than-usual periods in early perimenopause — even as cycles become irregular. This is caused by irregular ovulation, leading to estrogen-dominant cycles with thicker uterine lining. Heavy bleeding on its own warrants investigation to rule out fibroids or other causes.
Estrogen has anti-inflammatory effects throughout the body, including in joints. As estrogen falls, joint aching and stiffness become more common — particularly in the fingers, knees, and hips.
The same tissue changes that cause vaginal dryness affect the bladder and urethra — causing increased urgency to urinate, more frequent urination, and in some women, stress incontinence (leaking with coughing, sneezing, or exercise).
Declining estrogen reduces skin collagen and moisture retention, causing dryness and increased wrinkling. Hair may thin or become drier. Some women experience increased facial hair growth as the ratio of androgen to estrogen changes.
Many women gain weight in perimenopause — particularly in the abdomen — even without changes in diet or exercise. This is driven by shifting fat distribution patterns as estrogen declines, along with metabolic changes and reduced muscle mass.
Estrogen affects heart rate regulation. Many women in perimenopause experience occasional palpitations or a racing heart — usually benign, but worth mentioning to a doctor to rule out thyroid or cardiac causes.
Breast tissue composition changes as estrogen fluctuates. Breasts may feel lumpier (fibrocystic changes) or more tender at certain cycle points. Any new lump should always be checked by a doctor regardless of perimenopause status.
Log cycles, hot flashes, mood, sleep, and all your perimenopause symptoms in one place. Export a report for your doctor.
Start free →The first signs are usually irregular periods (cycles that shorten, lengthen, or become unpredictable) and sometimes hot flashes or sleep disturbances. These typically appear in the mid-40s, though can start earlier.
Perimenopause typically lasts 2–10 years. Menopause is defined as 12 consecutive months without a period — the phase after this is post-menopause.
Yes — estrogen fluctuations directly affect serotonin and other neurotransmitters. Increased anxiety, mood swings, and low mood are common perimenopause symptoms, particularly in women with a history of PMS or depression.
Perimenopause typically begins in the mid-40s (average 47), but can start in the late 30s or early 40s. Starting perimenopause before age 40 (premature menopause or POI) warrants medical investigation.