Is This Perimenopause?
For years, I (like many women) thought “menopause” was the name for everything. The hot flashes, the mood swings, the sleepless nights, the brain fog. I assumed all of those symptoms were menopause.
But that’s not quite right.
Most of what we think of as “menopause symptoms” are actually signs of perimenopause, the transitional phase leading up to menopause. It can begin in your late 30s or early 40s and last several years. And because so few of us are taught this, many women spend years confused, misinformed, and feeling like they’re falling apart for no reason.
That confusion isn’t just frustrating. It’s isolating. It keeps women from getting help when they need it most.
As a nurse practitioner who has survived perimenopause with over 25 years of experience as a healthcare provider and a lifelong commitment to women's sexual health, I have dedicated the past decade to working in an OB/GYN practice.
I’m here to help you understand what perimenopause actually is, what it looks like, and what you can do if you think you’re in it.
What is Perimenopause?
Perimenopause is the transitional phase leading up to menopause. It's when your body starts producing less estrogen, progesterone, and testosterone, making your hormone levels become unpredictable. One day, everything feels pretty normal, and the next day, you’re taking out your rage on that day’s yard work, sweating through your sheets in the middle of the night.
Clinically speaking, perimenopause is the phase before menopause when your hormone levels begin to shift and menstrual cycles (periods) become irregular. Hormones like estrogen, progesterone, and testosterone fluctuate during this time. Those shifts can affect everything from your mood to your metabolism to your sex drive. And while hot flashes get all the press, they’re just one of many possible symptoms.
Fun fact: menopause is the one day when you’ve gone one full year without a period. Perimenopause is the phase leading up to menopause; then, after your 1-year mark without a period, you are considered post-menopause.
When does Perimenopause start?
Most women enter perimenopause between the ages of 40 and 44, but it can begin as early as their late 30s. On average, perimenopause lasts between 4 and 8 years, but some women can experience symptoms for up to a decade.
And because perimenopause doesn’t come with a calendar invite or one specific result on a lab test, it often goes undiagnosed. Your bloodwork may come back “normal,” even though your body clearly doesn’t feel that way. That’s why it’s so important to work with a provider who understands the nuance and listens to your lived experience, not just your labs or dated beliefs about menopause.
Is Joint Pain Perimenopause?
Yes. Joint pain isn’t just a symptom of “getting old.” When we think about why our joints might hurt because of perimenopause, we can look to estrogen. Despite being very active–I love yoga, hiking, kayaking, and cycling in addition to chasing around my grandkids–my knees and hips suddenly became much less supple during perimenopause. I tried all sorts of new shoes, insole inserts, joint supplements, and stretches to help my pain and discomfort, but it wasn’t until I started treating my hormones that my knee and hip pain subsided.
Estrogen plays a role in reducing inflammation, so as estrogen levels decline, joint pain and stiffness can increase. Many women start noticing new aches, especially in their hands, knees, or hips, even if they’ve never had issues before. I’ve worked with women who have experienced symptoms like swollen knees or frozen shoulders during perimenopause who’ve been dismissed by other healthcare providers who blamed the symptoms on their lifestyle, such as activities like hiking or yoga.
If your body feels sore, creaky, tight, or puffy in a way that doesn’t match your physical activity level or medical or injury history, perimenopause could be the reason.
Are Irregular Periods Perimenopause?
Irregular periods are a classic sign of perimenopause. Because ovulation gets inconsistent during perimenopause, your menstrual cycle can get thrown off. If you were a consistent 28-day cycle with a 5-day period, and all of a sudden your cycles are 21 days or 30 days, that can be perimenopause.
Other menstrual cycle or irregular period symptoms you might notice include a heavier or lighter periods or more severe PMS symptoms.
Are Hot Flashes Perimenopause?
Hot flashes and night sweats are two of the most common and well-known perimenopausal symptoms, with up to 80% of women saying they experience them. A hot flash comes on quickly and usually feels like feeling very hot, breaking into a sweat, and sometimes having a racing heart.
Night sweats are when you experience a hot flash while sleeping. It’s your body’s way of trying to regulate your temperature, but night sweats can disrupt sleep, often waking you up with soaked sheets, feeling frustrated and physically hot or cold.
Are Mood Swings Perimenopause?
Remember puberty mood swings? Yeah, perimenopause can include mood swings like that.
Many women report new or worsening mood swings like anxiety, irritability, or depression in perimenopause. Small things can get under your skin, you might be worried about activities you routinely face, or feel waves of sadness that are hard to shake. Perimenopause influences estrogen, and estrogen impacts the neurotransmitters that regulate your mood, like serotonin and dopamine. For some women who have a history of anxiety or depression, their previously well-controlled symptoms might start to flare up during perimenopause.
Is Decreased Sex Drive Perimenopause?
Yes, decreased sex drive can be a part of perimenopause. But it’s not just a decreased libido; there are usually other factors at play. With testosterone and estrogen levels fluctuating, it can impact your vagina’s natural lubrication, leading to pain during sex. Other sexual health-related symptoms of perimenopause can be avoidance of sex, less ability to “be spontaneous,” trouble reaching orgasm, or feeling less interested in sex overall.
Is Itchy Skin or Sensitive Skin Perimenopause?
I remember when a latex glove–something I came into contact with all the time as a nurse practitioner–left me with a weird rash during perimenopause. Itchy skin or heightened skin sensitivities can be a symptom of perimenopause. With perimenopause, there is a reduction in the production of oils and collagen, two things that contribute to keeping the skin hydrated and elastic. With less natural oil production, skin may become thinner, drier, and more sensitive than usual.
Is Sudden Weight Gain Perimenopause?
Maybe. It’s a tricky area associated with perimenopause. As we age, sometimes we become less active, which can cause our muscles to lose strength, which may lead to weight gain. On top of that, hormone fluctuation can impact appetite, leading to changes in cravings and appetite.
In short, it’s complicated and all connected. While we can’t definitely say “it’s perimenopause,” or “it’s menopause,” it’s worth talking to a qualified provider about your weight concerns during this phase of life.
Is Brain Fog or Forgetfulness Perimenopause?
If you’re finding your brain a little less reliable, such as having a hard time remembering names, double-booking your calendar, or struggling to remember your grocery list at the store, it could be brain fog from perimenopause.
One major contributor to brain fog is hormonal fluctuation. Estrogen and progesterone play key roles in cognitive function, including memory, focus, and mental clarity. As these hormone levels begin to shift during perimenopause, many women experience changes in how they think and process information. Forgetfulness, in particular, is one of the most common symptoms, especially trouble recalling names, losing words mid-sentence, or missing appointments you swear you wrote down.
Sleep disruption can also make things worse. During perimenopause, it’s common to experience more fragmented or poor-quality sleep. When the brain doesn’t get adequate rest, it simply doesn’t function as well, compounding issues with memory and focus.
Not sure if what you’re feeling is perimenopause?
Here’s a quick self-check to see if the symptoms you’re experiencing are perimenopause. While this checklist isn’t a replacement for a diagnosis from a trained menopause clinician, it’s a great starting point to find comprehensive care for perimenopause.
If you’re experiencing two or more of the symptoms below, it could be perimenopause:
Irregular menstrual cycles, including heavier or lighter than usual periods
Painful period cramps, or more PMS symptoms than usual for you
New or worsening anxiety, depression, or irritability
Brain fog or forgetfulness
Trouble sleeping or staying asleep
Hot flashes or night sweats
Vaginal dryness or discomfort
Lower sex drive
Aches or joint stiffness
New skin sensitivities or itchiness
Feeling “off” or not like yourself
How Do You Treat Perimenopause?
You treat perimenopause by treating the symptoms, because no two women experience it the same way. Research has found that with targeted testing, bioidentical hormone replacement therapy, supplement support, and lifestyle tweaks, perimenopause symptoms can be treated.
