5 Signs of Perimenopause Every Woman Needs to Know

Get the cold, hard facts about hot flashes and what else you can expect during the transition.

By Karla Walsh, Woman's Day

Puberty isn’t the only time in your life when you'll experience rapid changes in your body and your reproductive system. Perimenopause, defined as the shift between years your body can reproduce and those it can’t, starts around the late 30s to mid-40s and signs of perimenopause can last as long as a decade or more. (Yes, really!) So what’s causing this?

“The first signs of perimenopause are typically due to declining progesterone," Arianna Sholes-Douglas, M.D., F.A.C.O.G., founder and owner of Tula Wellness and Aesthetics Center in Tucson, Arizona and the author of The Menopause Myth, tells Woman's Day. "It's suggested that hot flashes are due to decreasing estrogen but there are several other factors at play including diet, thyroid, testosterone, progesterone, and adrenal glands,”

We asked Sholes-Douglas and Alyssa Dweck M.D., a gynecologist in New York, an assistant clinical professor at the Mount Sinai School of Medicine in New York City and a medical advisor to ChromaDex, to talk us through the most common signs of perimenopause so you can prepare and know what’s normal — and what’s not.

Unpredictable Periods

You’ll know you’re done with menopause when your menstrual cycle is missing in action for one full year, with no spotting or cycle interrupting the 365 days. So it stands to reason that your period starts to shift during perimenopause. This sign of perimenopause is related to less regular ovulation timing. Expect minor shifts in length, heaviness, and duration of flow in the late 30s or early 40s.

When each period is more than 60 days from the last, you’re officially in “late perimenopause,” according to the Mayo Clinic.

Decreased Fertility

As your hormones are adjusting, the body is releasing eggs less regularly. That means you will likely have more challenges if you’re trying to get pregnant soon before or during perimenopause.

Signs of perimenopause, like lower fertility, can occur a few years prior to your last period. If you’re having trouble conceiving and are around perimenopausal age, talk to your OB-GYN about whether it might be worthwhile to test the hormone levels in your blood to determine if this is the reason for your conception issues.

Hot Flashes and Night Sweats

One of the most common signs of perimenopause, one-third to one-half of American women experience hot flashes according to Harvard health experts. Expect feelings of warmth that start near the head and neck, and work their way down the body for about 10 minutes.

“Less estrogen in the body causes internal thermostat to go awry, causing hot flashes and night sweats,” Dweck says.

The Journal of the American Medical Association recommends dressing in layers, steering clear of spicy foods, and integrating regular exercise to keep your cool if you experience hot flashes.

Weight Gain

Your internal temperature isn’t the only thing that can climb during this transition—the number on the scale often does as well.

“Weight gain in part is due to less muscle mass and lower metabolism that typically occurs with age," Dweck says. "Stress also causes constant cortisol release and can lead to fat around the middle."

Although perimenopause hasn’t been proven as the cause for weight gain, it’s associated with this time of life and can increase risk for type 2 diabetes, according to a study in the journal Climacteric. Estrogen or estrogen-progestin therapy might help the body balance out this sign of perimenopause, although more research is needed to confirm. Talk to your OB-GYN if you notice weight gain or waist circumference, and you can discuss activity, diet, and possibly hormonal action steps.

Mental Fogginess, Headaches, and Other Cognitive Challenges

From feeling fuzzy to feeling down, your brain is also impacted by perimenopause. And symptoms of depression are more common in perimenopausal women than the general population, per a study in the Journal of Women’s Health.

“Night sweats and poor-quality sleep lead to mental fogginess,” Dweck says, and headaches and mood are dramatically impacted by hormonal shifts. If you’re forgetting things more frequently, experiencing an unusually painful headache, have trouble concentrating on tasks you used to ace, or are feeling more depressed than usual for two weeks or more, talk to your doctor.