H2: What Is Pe
The Symptoms and Signs of Perimenopause
Is it stress…or something else? It can be confusing, as the symptoms and signs of perimenopause can look like something else. So, if your once-predictable cycle is suddenly irregular, your mood or temperature swings from normal to fiery in seconds, and your jeans fit differently? You’re probably looking for answers.
Although menopause may be a few years away, perimenopause is a part of the transition and often has the same symptoms as menopause, as they both signify a change in your body’s hormones. Additionally, because perimenopause isn’t as well-defined as menopause, you might not be aware that the physical and emotional changes you’re experiencing may be related to this process.
Knowing what to expect can help you identify and understand these changes, and a Genesis OBGYN provider can help you navigate this new phase in your life.
Everything leading up to that point is perimenopause, and it can start years before your final menstrual cycle.
What Is Perimenopause?
Perimenopause literally means “around menopause.” It’s the transitional phase when your ovaries gradually make less estrogen, your cycles become irregular, and you may start noticing symptoms similar to those of menopause. In contrast, menopause officially begins when you’ve gone 12 months without a period.
During this time, your body’s production of estrogen and progesterone rises and falls unevenly, causing a wide range of symptoms of perimenopause that so many women experience. This transition is not “all in your head.” It’s a natural, biological process that affects nearly every system in your body.
When does perimenopause start?
Most women enter perimenopause in their early to mid-40s, but it can begin as early as the late 30s—especially if your mother started early. Additionally, the length of the perimenopausal stage will be unique to your body: on average, it is between three and four years, but for others, it can last a decade. Depending on genetics, lifestyle, and health factors.
What Are the First Symptoms of Perimenopause?
In terms of a perimenopause symptoms list, many women first notice:
- Irregular periods—shorter, longer, heavier, or skipped entirely
- Hot flashes or night sweats
- Subtle mood changes, sleep issues, or brain fog
First symptoms of perimenopause can appear long before your final period, and sometimes, they’re easy to mistake for stress or aging.
Perimenopause Symptom Guide
You’ve probably heard that perimenopause causes hot flashes, but there’s much more to it. Here’s a comprehensive list of perimenopause symptoms, grouped by system, to help you understand what’s happening and why.
Menstrual Changes
Often, one of the first signs of the impending menopausal transition, menstrual changes include:
- Irregular periods, such as shorter or longer cycles
- Heavier bleeding or light spotting
- Skipped periods or unpredictable timing
Your cycle may start feeling completely different from what you’ve known. And while most of these changes are normal, if bleeding lasts longer than seven days, is unusually heavy, or includes large clots, it’s smart to check in with your doctor to rule out fibroids, thyroid issues, or other conditions.
Vasomotor Symptoms
Vasomotor symptoms are those sudden waves of heat that can leave you feeling flushed, sweaty, and uncomfortable.
- Hot flashes (sudden instances of heat and flushing)
- Night sweats that disrupt sleep
- Chills that follow the heat
About 75% of women experience hot flashes during the menopausal transition. These can last seconds to minutes and range from mild to intense. You might notice triggers like caffeine, alcohol, spicy food, or stress.
Sleep + Fatigue
Vasomotor symptoms + stress from career, family and other responsibilities may cause sleep issues, including:
- Difficulty falling or staying asleep
- Waking up sweaty or restless
- Feeling tired or foggy despite a whole night’s rest
Nearly half of women in perimenopause report sleep problems. Hormone fluctuations can interfere with your body’s temperature regulation and affect melatonin, making it harder to get deep, restorative sleep.
Mood + Mind
If you feel persistently low, anxious, or overwhelmed, it’s not a sign of weakness; it’s a hormonal and neurological shift that deserves care and attention. Some signs are:
- Irritability, mood swings, or anxiety
- Depression or feeling emotionally flat
- Brain fog, trouble concentrating, or forgetfulness
Estrogen influences serotonin, dopamine, and other brain chemicals that regulate mood and memory. When those levels fluctuate, so can your emotions and focus. About 20% of women experience new or worsening depression during this phase.
Genitourinary + Sexual Health
One of the most persistent complaints from perimenopause to postmenopause, vulvovaginal issues can range from uncomfortable to painful:
- Vaginal dryness, tightness, or pain with sex
- Lower libido or changes in sexual response
- Urinary urgency, frequency, or recurrent UTIs
These issues occur because estrogen keeps vaginal and urinary tissues supple and resilient. As it declines, you may notice discomfort or increased infections—collectively called genitourinary syndrome of menopause (GSM). Despite its big name, GSM is very treatable.
Body & Wellness Changes
Changes to weight, skin and other health indicators aren’t completely the fault of perimenopause–they’re a natural part of aging. However, hormonal changes do contribute, such as:
- Weight gain, especially around the abdomen
- Joint stiffness or muscle aches
- Heart palpitations
- Headaches or migraines
- Skin and hair changes, such as dryness or thinning
Hormone shifts slow metabolism and change where your body stores fat. Many women gain weight around the midsection even without changing their diet. While frustrating, this is normal.
Why These Symptoms Happen
The rollercoaster of perimenopause symptoms comes from fluctuating estrogen and progesterone.
Here’s how those changes show up in your body:
- Temperature control: Estrogen affects the hypothalamus, which regulates body heat, leading to hot flashes and night sweats.
- Sleep cycles: Progesterone supports relaxation; lower levels can increase the risk of insomnia.
- Mood and memory: Estrogen interacts with serotonin and dopamine, impacting mood, focus, and energy.
- Urogenital health: Lower estrogen levels thin vaginal and bladder tissues, leading to dryness and UTIs.
- Body composition: A combination of slower metabolism and less muscle mass can cause weight gain
Understanding why these things happen helps you take back a sense of control and create a plan so you can seek support if necessary.
What’s Typical vs. When to Call Your Doctor
Everyone’s perimenopausal experience is different, but there are red flags that warrant medical attention.
Call your provider or visit an emergency room if you experience:
- Bleeding lasting more than 7–8 days
- Heavy bleeding (soaking pads/tampons hourly)
- Bleeding after sex or after 12 months without a period
- Chest pain, severe palpitations, or fainting
- Intense depression, panic attacks, or suicidal thoughts
These can signal anemia, thyroid disease, fibroids, clotting disorders, or, rarely, malignancy. Never hesitate to get checked.
Perimenopause Diagnosis: What to Bring to Your Appointment
Doctors usually diagnose perimenopause based on your symptoms and menstrual history, not a single blood test. This is because blood tests can only measure a single moment in time, and hormone levels can vary from week to week or even day to day.
Use the list below to help prepare for your appointment:
- 2–3 weeks of symptom notes (cycle, mood, sleep, hot flashes)
- A list of medications and supplements
- Personal goals: better sleep, energy, or intimacy
- Questions about nonhormonal vs. hormonal options, contraception, and risk factors (family history of breast cancer, blood clots, etc.)
Why You May Not Need Hormone Tests for a Diagnosis
Tests like Follicle-Stimulating Hormone (FSH) fluctuate daily and aren’t always useful for diagnosis. Your provider might order labs only to rule out thyroid disorders or early menopause (before age 40). In most cases, your symptoms and age tell the story more clearly than a single lab result ever could.
Hot flashes, irregular periods, and sleep changes are strong clues that your body is transitioning naturally. Instead of chasing fluctuating numbers, your provider will likely focus on how you feel—and tailor treatment or lifestyle advice to help you manage symptoms effectively.
What Actually Helps: Managing Perimenopause Symptoms
There’s no way to “stop” perimenopause—it’s a natural process, but there are several ways to manage perimenopause symptoms so you can continue to live your life and feel your best.
Lifestyle Changes
When it comes to perimenopause care, minor lifestyle adjustments make a big difference:
- Prioritize sleep: Keep your room cool, avoid caffeine late in the day, and try meditation before bed.
- Exercise: Weight-bearing and aerobic activities boost mood and metabolism.
- Eat mindfully: Emphasize lean proteins, fiber, and hydration.
- Limit alcohol and caffeine: Both can trigger hot flashes and disturb sleep.
- Manage stress: Deep breathing, yoga, and connecting with friends all help balance cortisol levels.
These habits can ease fatigue, weight gain, and mood swings.
Nonhormonal Medications for Hot Flashes & Night Sweats
If lifestyle changes aren’t enough, nonhormonal treatment options for perimenopause can help:
- SSRIs/SNRIs (e.g., paroxetine, venlafaxine) – reduce hot flashes and anxiety
- Gabapentin: Helps with night sweats and sleep
- Oxybutynin: Reduces vasomotor symptoms
- Fezolinetant (VEOZAH): A recently FDA-approved nonhormonal medication targeting hot flashes
These can be great choices if you prefer to avoid hormones or want to target vasomotor symptoms specifically.
Hormonal Treatments
Combined hormonal contraception can be especially helpful during perimenopause, as it helps regulate menstrual cycles, manage heavy bleeding, and prevent pregnancy. Once in menopause, menopausal hormone therapy (MHT or HRT) can safely and effectively relieve common symptoms such as hot flashes and vaginal dryness for most healthy women under 60 and within 10 years of the start of menopause.
Your OBGYN will help balance benefits and risks based on personal and family history.
Local Therapies for GSM
For vaginal dryness during perimenopause, nonhormonal moisturizers and lubricants can provide relief and improve comfort. For many women, low-dose vaginal estrogen, available as a cream, tablet, or ring, is a safe and effective option that helps restore moisture, comfort, and confidence in their intimate lives.
Managing Perimenopause Symptoms in Phoenix
Perimenopause is a transitional stage between your fertile years and menopause, which is when your ovaries no longer produce certain hormones and you can no longer get pregnant. Due to the hormonal changes in your body, you may experience both physical and mental symptoms that can be mild or severely impact your quality of life.
If you are experiencing any of these symptoms, contact your Genesis OBGYN provider. We’ll recommend and provide compassionate healthcare services to support your physical and emotional well-being. Contact us to request an appointment today.
