Understanding Perimenopause: 5 Key Signs and What You Can Do

Perimenopause — the transitional time between having periods and menopause — doesn't always announce itself. Instead, it appears as a series of unexpected changes that leave many women wondering what's happening.

Understanding the signs puts you back in control. As research and treatment options continue to expand, it's possible to move through this phase with confidence, not just coping, but actually thriving.

Perimenopause usually begins in a woman's early 40s, but women can experience symptoms in their 30s or 50s. Research shows that the earlier we identify and treat symptoms of perimenopause, the better we can address not only those symptoms but lower the risk of cardiovascular and neurologic disease in the future.

Here are five signs or symptoms that you might be in perimenopause.

1. Irregular or Changing Periods

Cycles may become shorter or longer, bleeding heavier or lighter, or periods may be missed altogether. Remember, ovulation becomes irregular as well, meaning you may not ovulate during a cycle, or you could ovulate twice. Pregnancy is possible, so use contraceptives as wanted or needed.

Tips:

Track your cycle. There are several apps you can use to help you identify patterns.

See your clinician for:

• Very heavy bleeding

• Bleeding between periods

• Periods closer than every 21 days

• Bleeding after sex

(These can signal conditions other than perimenopause.)

2. Hot Flashes and Night Sweats 

Brief waves of heat, flushing, sweating, or waking up drenched at night. Temperature dysregulation results from estrogen loss in the hypothalamus. As we continue to learn more about the long-term effects of hot flashes (mainly on the heart and brain), hormonal and non-hormonal treatments are available, and we know that treatment not only helps with immediate symptoms but also prevents long-term vascular changes in the heart and brain. 

Tips:

• Dress in layers, keep rooms cool, and avoid spicy foods and alcohol before bed 

• Deep, slow breathing can reduce severity 

• Medical treatment options vary based on your health history and may include hormone therapy, non-hormonal medications, or newer prescriptions specifically for hot flashes. Discuss these options with your clinician. 

3. Sleep Problems 

Having issues with falling asleep, staying asleep, or waking up too early is often made worse by night sweats. Sleep disruption is usually one of the earliest symptoms of perimenopause, secondary to irregular production of progesterone and declining estrogen levels. Women also have an increased risk of developing sleep apnea during perimenopause (due to decreased estrogen levels affect on your throat muscles). Sleep apnea in women can look very different, often without the loud snoring or gasping. Women frequently report feeling poorly rested, irritable, and more sleepy during the day. 

Tips:

• Keep a consistent bedtime and limit screens and caffeine late in the day 

• Mindfulness, cognitive behavioral therapy for insomnia, or short-term sleep aids may help 

• Consider a sleep screening or overnight pulse-oximetry to evaluate for sleep apnea 

4. Mood Changes 

As progesterone and estrogen begin to fluctuate more, mood symptoms can increase. Increased anxiety, irritability, mood swings, or feeling less emotionally resilient are common. Women with prior PMS or depression are especially susceptible. 

Tips:

• Exercise regularly 

• Prioritize social connection 

• Prioritize sleep 

• Menopause hormone therapy or other medications can help 

• If mood changes feel severe or frightening, seek care promptly 

5. Vaginal & Sexual Changes 

Vaginal dryness, discomfort with sex, and urinary urgency or infections may occur as estrogen declines. 

Tips:

• Use lubricants during sex and moisturizers regularly for ongoing comfort 

• Vaginal estrogen is highly effective and low risk (ask your clinician) 

• Pelvic floor physical therapy can help improve neuromuscular control 

Other Common Symptoms of Perimenopause  

You may also notice other changes or symptoms, including:  

• Breast tenderness 

• New or worsening migraines 

• Weight redistribution (especially to the abdomen) 

• Brain fog and trouble concentrating 

• Joint aches 

How Canyon Ranch Can Help  

Perimenopause can present in many ways and change over time. The good news is that we have effective treatments and therapies to not only smooth this period but also prevent long-term health consequences. Please don't suffer in silence. Talk to your provider, join us at an M/Power retreat, and learn how to thrive through this transition and beyond.