What are the first signs of perimenopause?
Written and medically reviewed by Stacy Silverman, MSN, APRN, FNP-BC · Published · Last reviewed
For many women the first signs of perimenopause are changes in the menstrual cycle, new sleep problems, and mood changes such as anxiety or irritability, often beginning in the early to mid-40s and sometimes earlier. Hot flashes frequently come later.
Cycle changes are often first
Early perimenopause is commonly defined by a persistent change of seven days or more in the length of your cycle. Periods may come closer together, become heavier, or start to skip. Very heavy bleeding, bleeding between periods or bleeding after sex should always be evaluated.
Other early symptoms
Fluctuating estrogen and falling progesterone can show up in ways women do not expect:
- Waking at 2 to 4 a.m. and struggling to fall back asleep
- Anxiety, irritability or low mood that feels out of character
- Worsening premenstrual symptoms
- Brain fog and trouble finding words
- Breast tenderness, headaches or migraines around the cycle
- Night sweats, sometimes before daytime hot flashes appear
Can a blood test confirm it?
Usually not on its own. Hormone levels change from day to day in perimenopause, so a 'normal' result does not rule it out. Diagnosis is generally clinical, based on age, cycle pattern and symptoms, with labs used to exclude other causes such as thyroid problems or anemia.
When to talk with a provider
If symptoms are affecting your sleep, work, relationships or sense of yourself, it is reasonable to seek care now rather than waiting until periods stop. Effective treatments exist for perimenopausal symptoms.
Learn how we approach this in Perimenopause Care.
Sources
- ACOG, The Menopause Years (patient FAQ)
- Harlow SD et al., STRAW+10 staging of reproductive aging, Menopause 2012
- The Menopause Society, Perimenopause
This article is for education only and is not a substitute for individual medical advice.