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Signs of Perimenopause: 15 Early Symptoms to Know

Perimenopause is the gradual transition before menopause when your ovaries start producing fewer hormones—primarily estrogen and progesterone. It can begin years before your final period and often brings a mix of physical and emotional changes. Here are the most common early signs, what they mean, and when to get help.

The Most Common Early Signs of Perimenopause

Irregular periods (shorter/longer cycles, skipped periods)
Heavier or lighter bleeding (including clotting)
Hot flashes & night sweats
Sleep changes (trouble falling or staying asleep)
Mood shifts (irritability, anxiety, low mood)
Brain fog (trouble concentrating or word-finding)
Breast tenderness
Headaches or migraines
Vaginal dryness or discomfort
Libido changes (up or down)
Joint or muscle aches
Weight redistribution (especially abdominal)
Skin & hair changes (dryness, thinning)
Urinary urgency or leakage
Thyroid-like symptoms (fatigue, cold intolerance)—worth ruling out medically

Quick tip: Track what you notice and when it happens. Pattern = power.

Why These Symptoms Happen

Hormonal Ups & Downs

Estrogen and progesterone fluctuate, not just decline. These swings affect the brain’s thermoregulation (hot flashes), sleep, mood, vaginal tissue, and even collagen.

Cycle Changes Are Often the First Clue

Shorter cycles (<21 days), longer cycles (>35 days), or skipped periods often show up before hot flashes. A clinician can rule out other causes (e.g., fibroids, thyroid).

When to See a Clinician

Bleeding so heavy you soak through a pad/tampon every 1–2 hours
Bleeding after sex or between periods regularly
New or worsening depression or anxiety
Hot flashes that interrupt daily life
Symptoms that mimic thyroid issues (ask for labs)

Evidence-Based Relief Strategies

Sleep hygiene: consistent schedule, cool bedroom, reduce late caffeine/alcohol
Nutrition: protein with each meal, fiber for blood sugar, calcium + vitamin D
Movement: strength training + low-impact cardio for mood, bones, and sleep
Stress care: breathwork, CBT strategies, journaling
Medical options: Low-dose birth control, menopausal hormone therapy (MHT), or non-hormonal meds—discuss benefits/risks with your clinician.

Track & Personalize Your Journey

A simple system to track cycles, symptoms, sleep, and triggers can make patterns obvious—and your appointments more productive. Apps like MenoBloom help you log symptoms, get self-care tips, and bring clear summaries to your clinician. Add your hyperlink where “YOUR_LINK” goes.