What Is Perimenopause? The Early Signs Most Women Miss
Most women have heard of menopause, but fewer know about the transitional stage leading up to it: Perimenopause. This stage can last 4–10 years, and it’s a time when the most disruptive symptoms begin — long before your periods actually stop altogether. If you’re in your late 30s to early 50s and feeling “off,” overwhelmed, or not quite like yourself, Perimenopause may be the reason.
This article covers what Perimenopause actually is, why it happens, and the early signs most women miss.
What Is Perimenopause?
Perimenopause is the transition phase leading up to menopause, when the ovaries begin producing lower outputs of estrogen, progesterone, testosterone — in less predictable patterns.
Think of perimenopause as your body’s hormonal dimmer switch:
Cycles become less predictable
Symptoms come and go in waves
These shifts can begin as early as age 35, though most women notice them often around age 40.
Early Signs of Perimenopause
While most people expect hot flashes or night sweats, those symptoms often come later. Early Perimenopause signs are much subtler — and frequently mistaken for stress, aging, or lifestyle changes.
Below are the symptoms women most commonly overlook.
1. Sudden Mood Changes
Mood swings, irritability, and emotional sensitivity may increase, even when nothing major has changed, and symptoms of PMDD (Premenstrual Dysphoric Disorder) worsen. Estrogen affects serotonin and other neurotransmitters, which can make emotional regulation more challenging.
Women often say:
“I don’t feel like myself lately.”
“Small things make me snap.”
2. New or Increased Anxiety
Many women begin experiencing anxiety or nighttime panic for the first time in their lives. This often happens because fluctuating estrogen affects the body’s stress response.
This is one of the most misdiagnosed perimenopause symptoms.
3. Sleep Disruptions
One of the earliest signs is waking between 2–4 AM, even if you fall asleep easily.
Hormonal fluctuations can affect your ability to stay asleep, leading to:
Night wakings
Restless sleep
Trouble falling back asleep
4. Brain Fog & Word-Finding Difficulty
If you're suddenly forgetting names, losing your train of thought, or struggling to focus, hormonal changes (deficiency) may be the cause. Patients often worry that they may be getting early dementia — but for women 35–55, Perimenopause Brain Fog is almost always the culprit.
5. Heavier or Longer Periods
Before periods stop altogether, they typically become:
Heavier
Longer
More irregular
More painful
This is due to a variety of irregularities in the ovaries’ production of estrogen and progesterone, which cause the uterine lining to grow thicker than usual.
6. Worsening PMS Symptoms
PMS often worsens in your 40s.
For example, worsening:
Breast tenderness
Mood dips
Irritability
Cravings (chocolate, sugar, salt)
PMDD
Anxiety
Acne
Abdominal Bloating
7. Hot Flashes & Night Sweats
These may show up earlier than expected but aren’t typically the first symptom.
But for women in perimenopause, they are extremely common — at least 90% of women experience some hot flashes and night sweats.
When to See a Perimenopause Specialist
You should seek evaluation if you are experiencing:
Heavy or disruptive periods — often leading to anemia and fatigue
Sleep changes, also associated with fatigue
New or worsening anxiety
Brain Fog affecting daily life, such as coming up with a word you are familiar with
Hot flashes or night sweats
Significant PMDD changes
Fatigue
Low Libido, frequently associated with decreased ovarian output of testosterone
You don’t have to live with symptoms that interfere with your quality of life.
Perimenopause Treatment Options
Every woman’s experience is unique, so treatment is personalized. Options may include:
Hormone therapy (HRT)
Non-hormonal medications
Sleep and mood support
Lifestyle and nutrition strategies
Supplements
Treatment for heavy bleeding
Endometrial Ablation can stop periods altogether
Endometrial Ablation typically stops headaches and PMDD around the time of periods
Telehealth Perimenopause care
At The Ashford Center, we specialize in creating tailored treatment plans that help women feel like themselves again.
You’re Not Alone — And You Don’t Have to Guess
Surveys show that 80-90% of women are dissatisfied with Perimenopause advice and care given to them by healthcare providers.
Most women are never taught how to recognize perimenopause — or that symptoms often begin long before periods stop. Understanding what’s happening in your body is the first step toward relief.
The Ashford Center specializes in answering the questions and concerns discussed above.
