Perimenopause Signs and Symptoms: What to Look For

You’ve probably heard of menopause, the transition leading up to it, which thankfully is getting more and more attention in conversations and in the media. But have you heard of the term perimenopause? ‘Peri’ comes from Greek, meaning ‘around’ or ‘close to,’ and ‘menopause’ means the end of menstruation.

Perimenopause is the transitional phase leading up to menopause. For some, it begins a few years before menopause, while others may experience increasing symptoms up to 10 years prior to its onset.

Menopause marks the transition from the fertile years to a new phase, characterized by a significant drop in the ovaries’ production of female hormones like estrogen, which also means fertility ends.

It’s often described metaphorically as entering the ‘wise woman’ stage – no longer driven or disrupted by reproduction, free from cyclical highs and lows. In menopause, we can be more raw, authentic, and wise. We’ve been through it all.
Menopause is defined as having gone 12 consecutive months without a period. In Denmark, it typically occurs around age 52, though anything between 45 and 55 is considered normal

Now, back to perimenopause – the transitional phase leading up to menopause. During this time, hormone levels start to fluctuate more, and you might not even notice the first symptoms. It’s a gradual process, and you may be affected by the changes, barely notice them, or find yourself somewhere in between. For some, it feels like gentle waves; for others, it’s a storm sweeping through daily life – nothing feels quite as it ‘used to.’

Perimenopause: What’s Happening in Your Body?

During your reproductive years, your hormones follow a relatively consistent pattern – estrogen rises and falls at predictable times throughout your cycle. Estrogen is primarily regulated by two hormones: follicle-stimulating hormone (FSH) and luteinizing hormone (LH).
FSH stimulates the follicles to produce estrogen. Once estrogen reaches a certain level, a signal is sent to the brain to decrease FSH and increase LH, which triggers the ovary to release an egg from the follicle – your ovulation. The remaining follicle then starts producing progesterone, which, together with estrogen, prepares the body for pregnancy. As these two hormones rise after ovulation, FSH and LH fall. If you’re not pregnant, progesterone levels drop sharply, and menstruation occurs. This cycle repeats month after month, year after year.

Over time, your ovaries’ function declines, with fewer eggs and gradually changing hormone levels.

Tip: If you can, ask your mother when she reached menopause – when her periods stopped and what symptoms she experienced during perimenopause. This can give you an idea of what to expect.

The Most Common Symptoms of Perimenopause

Everyone’s body is different, and so are the symptoms. But the most common include:

Irregular Periods
Your cycle starts to change. Some months may be shorter, others longer. Your bleeding pattern can also shift – from very light to heavy, or sudden spotting and abrupt stops. (Cue: hooray for absorbent underwear that feels like regular underwear!)

Hot Flashes and Night Sweats
You’ve probably heard about hot flashes – day and night. They’re one of the most classic symptoms, and the heat can be sudden and intense. At night, they can wake you up. Sometimes it even feels like a brief flu episode, with quick swings from HOT to COLD – yes, the name can be misleading – all within 5 minutes. Episodes usually last 1–5 minutes.

Interesting Perspective: Harvard research shows significant geographic differences in who experiences hot flashes. Far fewer occur in Japan, Korea, and Southeast Asia, and on Mexico’s Yucatán Peninsula, they apparently don’t occur at all. This suggests lifestyle, diet, and environment may influence symptoms. Despite 30 years of study, researchers still don’t fully understand why they happen.

Sleep Problems
It’s no wonder sleep is affected if you wake up drenched in sweat at 3 a.m. Hormones also impact sleep quality, which can leave you tired and irritable the next day.

Mood Swings
Feeling suddenly more irritable or down? You’re not alone. About 10–20% of people in perimenopause report mood changes. We don’t fully know why, though poor sleep and hot flashes likely contribute. Some studies link changes in estrogen levels to a higher risk of depression, while others show that women’s risk of depression decreases after age 45. Some are simply more sensitive to hormonal shifts.

Vaginal Dryness and Changes in Discharge
As estrogen drops, mucous membranes become thinner and drier, which can make sex uncomfortable and increase the risk of irritation or infection. The good news: penetration is only a small part of enjoyable intimacy. Spend more time on touching, kissing, and caressing, and use lubricant if needed. Have fun discovering what works for you. Dryness can also affect other mucous membranes – some experience dry eyes or a dry mouth.

Brain Fog
Another commonly reported symptom. According to researcher and physician Lisa Mosconi, up to 62% of people in perimenopause experience cognitive changes: forgetfulness, trouble concentrating, or walking into a room and forgetting why. This can be frustrating, especially in your 40s, a decade when many push their careers forward while juggling work, children, relationships, and social life.

Is brain fog due to stress, hormonal changes, or a bit of both? Both estrogen and progesterone affect brain function, but we’re only beginning to understand the changes that happen before and after menopause.

But there are far more symptoms than those mentioned here: muscle aches, joint pain, migraines, skin changes, weight fluctuations, feelings of fatigue, sadness, and anxiety.

What Can You Do to Reduce Symptoms?

According to the Danish Midwives Association, roughly one-third of people experience no perimenopause symptoms, another third have mild to moderate symptoms they can manage, and the last third experience severe symptoms that can significantly impact daily life.

Fortunately, there are ways to help – lifestyle changes, good sleep hygiene, reduced caffeine, maintaining regular exercise, and a balanced diet rich in vegetables. Hormonal treatments are also available, but these require consultation with your doctor.

Reach out to your healthcare provider if your symptoms are affecting you. This might include issues with sexual health due to vaginal dryness, severe mental symptoms like anxiety or depression, or irregular vaginal bleeding without a clear pattern. While cyclical changes are normal and natural, we don’t have to accept a reduced quality of life.

You’re not alone – talk with friends, family, colleagues, your partner, or your children. Let them know how you feel, what support you need, and together create a space that allows for both big and small changes.

References: Perimenopause: Rocky Road to Menopause, Harvard Health Publishing, 2022, sundhed.dk, Perimenopause and emergence of an Alzheimer's bioenergetic phenotype in brain and periphery, Dr. Lisa Mosconi, Valentina Berti et al., 2017