Perimenopause Signs & Symptoms + Tips to Find Relief

Perimenopause is the time leading up to menopause, when a woman’s body is preparing for the end of menstruation. It usually begins in a woman’s late 40s or early 50s, but it can start anytime from your mid-30s to early 60s, which is why it’s important to recognize the signs. This can be a time of a lot of physical and emotional upheaval for many women, especially if you don’t have the right support. In this blog post, we will discuss the signs and symptoms of perimenopause, as well as how to cope with them. We will also offer holistic solutions that can help make this transition easier for you!

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What Is Perimenopause?

Perimenopause is the time between a woman’s reproductive years and menopause. It literally translates to “around menopause”.

Think of perimenopause as a transition period. Your body is winding down from making babies (or preparing to make babies), and gradually shifting resources away from focusing so heavily on reproduction. But, your period is probably still making regular appearances, though symptoms you thought were over in your teenage years might be popping up here and there. Cue the acne, mood swings, and a little extra body fat around your middle.

During perimenopause is when many women begin to feel the first symptoms indicating that menopause is on the horizon, as your body prepares to stop ovulating and decreases hormone production. This process happens in three main stages.

Watch: Perimenopause Symptoms (& How to Find Relief)

Stages of Menopause

You’ve likely heard the word menopause, and maybe have a basic understanding about what it is: Your period stops, sex hormones like estrogen decrease, and you can no longer become pregnant. But these shifts don’t happen overnight, and often begin several years before the actual onset of menopause.

Perimenopause: Stage 1; Hormone levels begin to decline; periods become erratic/irregular.

Menopause: Stage 2; Hormones continue to decline; symptoms like hot flashes may increase; periods become more and more infrequent; ovaries stop releasing eggs.

Post-menopause: Stage 3; Occurs the day after the one-year mark of no period.

After the one year mark of no period, a woman is said to have completed menopause and is now considered post-menopausal.

Read: What to Expect During Perimenopause

Signs & Symptoms of Perimenopause

Perimenopause symptoms often resemble other hormone imbalance issues. And though hormonal changes are normal during perimenopause, they can still cause some unpleasant side effects. Perhaps your cycle is heavier or light, you feel more annoyed at little things, or you’re not sleeping as great as you used to. Here are some common perimenopausal symptoms:

Mood changes (depression, anxiety, irritability)
Low libido and/or vaginal dryness
Irregular menstrual cycles (shorter periods, longer cycles, etc.)
Hot flashes or night sweats
Insomnia or difficulty sleeping
Fatigue
Weight gain (often around the abdomen)
Hair loss or thinning

At this point, you might be thinking “Yikes! perimenopause sounds terrible!” and for many women it can truly be a struggle. But there’s actually a lot more that can ease this transition time than you’d likely been led to believe. More on how to navigate perimenopause symptoms shortly!

The most common symptom of perimenopause is irregular periods. Cycles will become increasingly irregular until your period stops happening altogether.

Read: Is It Perimenopause or a Thyroid Problem?

Perimenopause usually begins in your 40s.

The average age in the U.S. for menopause is 51 (1). Perimenopause can begin as little as a few months before menopause, or as long as several years. The average age for perimenopause is about 47.

For most women, perimenopause lasts about four years, but it can be shorter or much longer. If it seems overwhelming right now, you’re not alone in this feeling—even celebrities need extra support right now!

If you’re experiencing significant perimenopause symptoms prior to age 40, this could mean you’re dealing with early menopause. And while early menopause does happen, it’s not common, so it’s important to contact your doctor to rule out other more serious causes of menopausal symptoms.

Listen: Gwyneth Paltrow x Taz Bhatia: Understanding Perimenopause and Menopause

How Do You Know If You’re Perimenopausal?

Some women can begin to experience perimenopausal symptoms in their mid-to-late 30s, though they’re often subtle enough that they’re easy to miss. So, learning the signs and symptoms early can help give you a clearer indication that your hormones have begun their natural shift.

A qualified integrative or holistic doctor can also test your estrogen levels, along with another hormone called follicle-stimulating hormone (FSH).

If estrogen is low, and FSH is elevated, it can mean your ovaries are producing less estrogen, and your body is making more FSH to try to correct this, indicating that you’re approaching menopause.

Normal FSH levels in adult women range from 4.7 to 21.5, with anything above 30 indicating the ovaries are decreasing their production of estrogen (2,3).

Whether you’re approaching perimenopause or not, I recommend patients have their hormones tested about once a year. This is the only way to really know what’s going on beneath the surface. You can do this easily at an integrative practice like CentreSpringMD.

Is Insomnia a wake-up call?

One of the first subtle signs that perimenopause symptoms are on their way is difficulty sleeping. For some, this first comes on as trouble staying asleep, with frequent waking during the night, or waking up between the hours of 2 to 4 am, unable to go back to sleep.

At this time, you may or may not be experiencing other perimenopausal symptoms like irregular periods. Getting a good night’s sleep becomes elusive during this time due to a decrease in progesterone (4). This decline is often subtle, but it’s enough to disrupt sleep, as progesterone is needed to help calm your mind and body, and balance out cortisol during the evening.

Read: If This Hormone Is Waking You Up At Night, Here’s What to Do

Yes, you can still get pregnant during perimenopause

Since a woman can still be ovulating during perimenopause, there is still a chance you can become pregnant. Irregular menstrual periods might be your new normal, but that doesn’t mean you’re not ovulating at some point—just less predictably.

Most perimenopausal women are still cycling, although periods may become longer, with shorter bleeds during this time.

Related: How to Reduce Hormonal Acne

Perimenopause and Weight Gain

Weight gain in perimenopause is common, and many women report a change in how their weight is distributed. For example, if you normally gain weight around your hips and thighs, you might notice more fat now around your belly than before.

This is mostly due to two factors (5):

A drop in the hormone estrogen
A decrease in muscle mass

This decrease in muscle mass, coupled with changing hormones, means your calorie furnace isn’t burning quite as hot as it once was, resulting in a gradual slowing-down of your overall metabolism. Plus, without estrogen telling your body to send fat to your lower body, it often camps out around your midsection.

Read: Leptin Resistance Causes Weight Gain, Increased Appetite

Mood Swings

If you feel like perimenopause (or menopause) is making you crazy, you’re not alone! Your body is making some significant hormonal transitions and this can have a very noticeable effect upon your mood.

During perimenopause, hormones like estrogen are decreasing, and FSH increases, but they often don’t do so in an organized manner—sometimes fluctuating drastically from cycle to cycle (6). This creates mood swings like many women have never felt before.

A decrease in progesterone can cause you to feel irritable, while decreases in testosterone and estrogen can zap your energy and libido.

Preparing for perimenopause (and menopause)

Though perimenopause isn’t a medical problem, but a natural process, there are many reasons why women need extra support during this time. By optimizing diet, supporting the adrenals, and leveraging the right functional medicine treatments, perimenopause can be a much more comfortable time.

Diet & lifestyle changes to help you get through perimenopause

How to care for hormones in your mid-30s

Clean up your diet. Eat a whole foods diet with lots of vegetables (aim for half your plate at each meal), some fruit, high-quality protein, healthy fats, and moderate amounts of healthy carbs like starchy vegetables, quinoa, and sprouted grain bread. Avoid processed foods, sugar, and inflammatory foods like gluten and dairy.

Get regular exercise. Exercise helps to improve sleep quality, which is often compromised in perimenopause. It also helps to reduce stress levels, balances hormones, and builds muscle mass—all of which can help offset some of the changes happening in your body.

Support your adrenals. Cortisol, the stress hormone, is released by the adrenal glands. When we’re constantly under stress, our adrenals can become fatigued, and this can lead to a whole host of problems, including hormonal imbalances. Make sure to get enough sleep, exercise, and manage stress with relaxation techniques like yoga or meditation.

Consider supplements. There are a few key supplements that can help to balance hormones and support the body during perimenopause. These include:

Adaptogens are incredibly beneficial for supporting the body during times of stress, and cover a wide range of options such as rhodiola and eleuthero, two botanicals which are useful to promote a stable mood and stress response within the HPA axis.
Natural anti-inflammatories like omega-3s and turmeric help to reduce inflammation, support gut health, antioxidant protection—all things that can help perimenopause symptoms (7)
Natural support for balanced hormones.

Maca. This ancient Peruvian root supports a healthy libido, and a healthy hormone balance. In one study, supplementation with 2 grams of maca daily significantly reduced FSH levels, while increasing estrogen and progesterone. These women reported “substantially reduced feelings of discomfort” during menopause (8).
Magnesium. This mineral is important for relaxation, sleep, and managing stress levels.
DIM supports metabolism of estrogen in the liver, and can reduce symptoms of estrogen dominance like sore breasts, irritability, and heavy periods. Since progesterone declines with the stopping of ovulation, estrogen can often dip and rise wildly in perimenopause.
Methylated B vitamins. B vitamins play a crucial role in supporting the adrenal glands before and during perimenopause. In times of stress, metabolic demand for B vitamins increases, as adequate amounts of methylated B vitamins can help support optimal adrenal function.

Lastly, avoid endocrine disruptors and environmental toxins. Many common chemicals, like BPA, phthalates, PFOAs, heavy metals, and pesticides are bad news for hormone balance.

What about Hormone Replacement Therapy?

HRT is a treatment intended to replace the drop in sex hormones with a small dose of hormones normally administered in a pill, patch, injection, or cream. It’s one option available to address menopause symptoms, but it may not be right for everyone. An integrative medicine doctor who is knowledgeable in HRT can help you weigh the benefits and risks.

Hormone replacement therapy involves synthetic or bioidentical hormone replacement, although many functional medicine doctors choose bioidentical hormones, which are more similar to the body’s own hormones. Bioidentical hormones reportedly lead to greater patient satisfaction and the reduction in potential side effects and risks posed by synthetic hormone replacement.

Perimenopause Support with Holistic Medicine

Perimenopause can be a trying time, but with the right information and tools, you can make the journey much more comfortable. If you’re looking for more personalized advice or want to learn about other ways to support your hormones, reach out to a qualified integrative physician to help you navigate this change. Stay tuned for more posts about perimenopause and menopause! What has been your biggest challenge during perimenopause?

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