7 Signs of Perimenopause and what you can do about them
Perimenopause is one of the most confusing seasons of a woman’s life—made worse by the fact that most healthcare providers don’t recognize it for what it is.
You might be in your late 30s, struggling with irregular cycles, fatigue, or brain fog, only to be told:
“You’re too young.”
“It’s just stress.”
“Your labs look normal.”
Sound familiar? For many women, that dismissal is more frustrating than the symptoms themselves. Even worse, some can’t even get in to see a hormone specialist because they “don’t fit the age criteria.”
But here’s what experts agree on: perimenopause can’t be diagnosed by age or labs alone. Hormone levels fluctuate daily, sometimes hourly, and there is no single blood test that can give a definitive answer. Standard labs are important, yes—because they rule out other issues like thyroid disorders or iron deficiency—but they aren’t the whole picture.
👉 That’s why the most important diagnostic tool is your story. If you’re experiencing the symptoms, you deserve to be taken seriously.
Because of this ongoing dismissal, I created the Perimenopause Action Plan—a free guide that helps you:
Understand what may be happening in your body.
Track your symptoms with clarity.
Prepare the right language to use with your doctor so you’re heard.
👉 Download it here and bring confidence to your next appointment.
Now, let’s dive into the most common signs you might be in perimenopause—and what you can actually do about them.
The Most Common Signs of Perimenopause
1. Hot Flashes & Night Sweats
Why it happens: As estrogen fluctuates, your hypothalamus (your body’s thermostat) becomes hypersensitive. Even tiny changes in temperature trigger a cascade: your blood vessels dilate, your heart rate increases, and you suddenly feel flushed or drenched.
What it feels like: Not just being “warm.” It can feel like an internal furnace flipping on—sometimes in public, sometimes in the middle of the night. These episodes leave many women embarrassed, exhausted, or both.
What to do:
Keep your bedroom cool (below 68°F).
Identify triggers—alcohol, caffeine, stress, and even spicy food.
Try moisture-wicking sheets or cooling pillows.
If night sweats wake you, have a frozen washcloth by the bed for quick relief.
💡 Why it matters: Interrupted sleep from hot flashes isn’t just inconvenient—it’s what drives fatigue, mood issues, and brain fog. Tackling this symptom first often improves everything else.
2. Brain Fog & Cognitive Changes
Why it happens: Estrogen supports neurotransmitters like acetylcholine (memory) and serotonin (focus). When levels swing, so does your mental clarity. This is hormonal—not you “losing it.”
What it feels like: Walking into a room and forgetting why. Struggling to find words in meetings. Reading the same paragraph three times before it sinks in.
What to do:
Start mornings with a “brain dump”—write down everything crowding your head.
Prioritize omega-3s (salmon, chia seeds, walnuts) for brain health.
Protect your sleep, as memory consolidates overnight.
Add in short mental challenges: puzzles, word games, or learning something new.
💡 Why it matters: Many women silently panic that brain fog = early dementia. Understanding the hormonal link calms that fear and helps you focus on strategies that restore clarity.
3. Mood Swings & Irritability
Why it happens: Estrogen and progesterone directly influence serotonin and GABA—the brain’s natural mood stabilizers. When these hormones fluctuate, your mood often swings with them.
What it feels like: Crying at commercials. Snapping at your partner over something small. Feeling emotionally raw or reactive in ways that surprise even you.
What to do:
Get 15 minutes of morning sunlight—it resets circadian rhythms and boosts serotonin.
Move daily (strength training, yoga, or even a walk) to regulate cortisol.
Use micro-reset tools: 2 minutes of deep breathing, journaling, or grounding exercises.
Track mood shifts alongside your cycle—it can reveal patterns and predictability.
💡 Why it matters: These aren’t “character flaws.” They’re biochemically driven shifts. Recognizing that takes away the shame and opens the door to solutions.
4. Sleep Disturbances & Fatigue
Why it happens: Progesterone is a natural calming hormone, and its decline makes it harder to stay asleep. Add in night sweats or anxious thoughts, and restorative rest becomes rare.
What it feels like: Falling asleep fine, but waking at 2 or 3am—wide awake, restless, or sweating. Fatigue becomes “bone-deep,” not fixed by a coffee or nap.
What to do:
Keep a strict bedtime/wake time (your body craves consistency).
Use a calming ritual: magnesium glycinate, stretching, warm shower.
Remove alcohol close to bedtime—it fragments REM sleep.
If you wake up, don’t scroll—journal or use a calming breathwork exercise.
💡 Why it matters: Sleep loss fuels every other symptom—brain fog, irritability, cravings, and even weight changes. Protecting sleep is the foundation of perimenopause care.
5. Weight Gain & Metabolism Shifts
Why it happens: With declining estrogen, insulin sensitivity drops and muscle mass decreases. Your metabolism slows, and fat storage shifts to the belly—often without any change in your habits.
What it feels like: Clothes fitting differently, especially around the midsection. Frustration that your “usual” workouts or eating style no longer work.
What to do:
Prioritize 25–30g of protein at every meal.
Add strength training 2–3x a week—muscle is your metabolic powerhouse.
Balance meals (protein + healthy fat + fiber) to blunt glucose spikes.
Avoid grazing—structured meals stabilize blood sugar better.
💡 Why it matters: This isn’t just about jeans. Belly weight gain is tied to higher cardiovascular risk, which climbs after menopause. Addressing it now is about long-term health.
6. Anxiety & Feeling “Not Like Yourself”
Why it happens: Estrogen shifts disrupt cortisol regulation (your stress hormone). Many women feel “revved up” or anxious for no clear reason—even when life circumstances haven’t changed.
What it feels like: Restlessness, racing thoughts, or a sense of being “on edge.” For some, it’s a subtle hum of unease; for others, it’s panic attacks seemingly out of nowhere.
What to do:
Daily nervous system resets: 4-7-8 breathing, meditation, or stretching.
Track caffeine—what you tolerated at 30 might spike anxiety at 42.
Connect with supportive communities—shared experience reduces isolation.
If anxiety is persistent, consider therapy options like CBT (cognitive-behavioral therapy).
💡 Why it matters: Anxiety during perimenopause is often dismissed as “stress” or “in your head.” Knowing the hormonal link validates your experience and opens real avenues for support.
7. Vaginal & Sexual Health Changes
Why it happens: Estrogen decline thins vaginal tissue and reduces natural lubrication, leading to dryness, discomfort, or higher risk of UTIs.
What it feels like: Pain during intimacy, irritation, or changes in libido that feel sudden or unexplained.
What to do:
Use vaginal moisturizers or lubricants (different from over-the-counter KY gels).
Explore pelvic floor therapy, which supports blood flow and comfort.
Discuss medical options with your provider—safe, localized treatments can make a huge difference.
💡 Why it matters: Many women silently endure these changes. But sexual health is part of overall health—and deserves care, not embarrassment.
Bottom Line
Perimenopause doesn’t always announce itself with a skipped period. For many women, the earliest clues are whole-body symptoms—from hot flashes to brain fog to anxiety—that slowly build until you realize: something is shifting.
The challenge? Too often, these symptoms are dismissed by healthcare providers, especially if you’re under 45. That’s why tracking your symptoms, understanding the “why,” and speaking up are essential.
That’s exactly why I created the Perimenopause Action Plan:
A clear tracker for your symptoms.
Guidance on what labs do (and don’t) show.
The right language to use so your doctor listens.
👉 Download it here and start advocating for yourself with confidence.
If you’d love ongoing support, practical tips, and real talk about perimenopause (the kind you won’t find in a quick Google search), join my monthly newsletter. Each issue brings you:
Science-backed strategies for managing symptoms.
Stories and encouragement from women in this same season.
Tools to help you thrive—not just survive—midlife transitions.