Written by
Louise W Lu, PhD, MPH, BMLS
Reviewed by
Michelle Ordner, Registered Nurse
"My period is still here, but I’ve been sleeping poorly, gaining belly fat, and losing my temper more than usual. Is something wrong with me?"
This might not be just stress or aging — it could very well be the start of perimenopause.
Perimenopause is the transitional phase before menopause, when hormones become unstable and the body begins shifting. This period can last 4–10 years and affects far more than just your period. It impacts sleep, mood, weight, memory, libido, and even your immune system.
The problem? You might still be menstruating. Your labs might look normal. So it gets overlooked — by doctors, by society, and even by you.
Now’s a good time to grab a pen and paper and take a personal check-in.
Below are 10 common signs of perimenopause. Which ones have you noticed? How often do they occur? This might help you decode what your body’s trying to tell you.
Jump to Section:
- Irregular Periods
- Poor Sleep
- Mood Swings & Irritability
- Brain Fog & Memory Issues
- Night Sweats & Temperature Fluctuations
- Changes in Libido
- Weight Gain (Especially Around the Belly)
- Joint Pain & Muscle Stiffness
- Urinary Frequency, Infections, or Leakage
- Breast Tenderness or Swelling
1. Irregular Periods
When your cycle becomes unpredictable — shorter, longer, skipped altogether — this is often the very first sign of perimenopause.
What’s happening?
Your brain sends signals to your ovaries to trigger ovulation, but the ovaries start to respond more slowly. Hormones get patchy — sometimes too high, sometimes barely there — and your period becomes irregular, like a misfiring internal calendar.
| Stage of Perimenopause | Presentation | Frequency |
|---|---|---|
| Early Stage | Shorter cycles, periods arriving earlier than expected | Almost monthly |
| Middle Stage | Skipped months, heavier or lighter bleeding | Every 1–2 months |
| Late Stage | Periods occur every 3–6 months, eventually stop | Leading to menopause |
Could it be something else?
If your bleeding is very heavy, lasts more than 10 days, includes clots, or happens after sex, check with your doctor to rule out fibroids, polyps, or endometrial issues.
2. Poor Sleep
You feel exhausted but can’t fall asleep — or you wake up like clockwork around 2 or 3 AM with your mind racing and no hope of falling back asleep.
What’s happening?
Progesterone, which normally rises after ovulation, has calming effects that help you fall and stay asleep. But in perimenopause, ovulation becomes less regular, and so does progesterone. Meanwhile, fluctuating estrogen disrupts your internal thermostat and melatonin production, making your “sleep switch” glitchy.
| Stage of Perimenopause | Sleep Disruptions | Frequency |
|---|---|---|
| Early Stage | Trouble falling asleep, light sleep | 1–2 nights/week |
| Middle Stage | Waking up hot, multiple awakenings during the night | 3–5 nights/week |
| Late Stage | Fragmented sleep, early waking, vivid dreams | Almost nightly |
Could it be something else?
If you also have palpitations, weight loss, or tremors, it’s worth checking for thyroid dysfunction. Persistent low mood and disrupted sleep could also signal depression or anxiety.
3. Mood Swings & Irritability
You feel more easily triggered, cry unexpectedly, or snap at people over things that wouldn’t have bothered you before — and you don’t recognize yourself.
What’s happening?
Estrogen plays a key role in regulating serotonin (your feel-good chemical) and GABA (your calming chemical). When estrogen starts fluctuating unpredictably, your brain’s emotional balance gets disrupted, like a seesaw without an anchor.
| Stage of Perimenopause | Mood Changes | Frequency |
|---|---|---|
| Early Stage | Increased irritability, emotional sensitivity | 1–2 times/week |
| Middle Stage | Anger outbursts, tearfulness, mood cycling | 3–4 times/week |
| Late Stage | Low mood becomes more constant, anxiety or fatigue builds | Almost daily |
Could it be something else?
If low mood persists for over two weeks, especially with changes in appetite, sleep, or interest in activities, speak to a mental health provider to assess for clinical depression.
4. Brain Fog & Memory Issues
You forget words mid-sentence, lose your train of thought, or walk into a room and can’t remember why. You feel like your brain’s not firing the way it used to.
What’s happening?
Estrogen helps your brain produce acetylcholine — a neurotransmitter essential for memory, learning, and clear thinking. When estrogen drops or surges unexpectedly, those brain connections can feel like they’re buffering — like a weak Wi-Fi signal trying to load too much at once.
| Stage of Perimenopause | Symptoms | Frequency |
|---|---|---|
| Early Stage | Occasional forgetfulness, trouble focusing | 1–2 times/week |
| Middle Stage | Word-finding problems, reduced productivity | 3–5 times/week |
| Late Stage | Consistent slow thinking, frequent memory lapses | Almost daily |
Could it be something else?
Brain fog from perimenopause is frustrating but temporary. If you’re getting lost on familiar routes or forgetting how to do daily tasks, get checked for early cognitive decline or neurological conditions.
5. Night Sweats & Temperature Fluctuations
You wake up drenched in sweat, throw off the covers, then feel chilled a moment later. Sometimes you even have to change your pajamas or sheets.
What’s happening?
Estrogen helps regulate your hypothalamus — the part of your brain that controls body temperature. When estrogen drops suddenly, the brain mistakenly thinks you're overheating and activates a full-body “cool-down” response: sweating, flushing, and sometimes a racing heart.
| Stage of Perimenopause | Symptoms | Frequency |
|---|---|---|
| Early Stage | Occasional warmth or sweating at night | 1 time/week or less |
| Middle Stage | Frequent hot flashes or sweats disrupting sleep | 2–4 times/week |
| Late Stage | Nearly every night, often with irritability or heart palpitations | Daily |
Could it be something else?
If night sweats come with unexplained weight loss, fever, or persistent fatigue, talk to your doctor to rule out infections, autoimmune conditions, or lymphoma.
6. Changes in Libido
Your sex drive feels unpredictable — sometimes low, sometimes nonexistent — and you’re not sure why. It’s not about your partner, it’s your body.
What’s happening?
Estrogen and testosterone both influence desire and arousal. As these hormones decline or fluctuate, your physical and emotional interest in sex may drop. Vaginal dryness and sensitivity changes can also make sex feel uncomfortable, which naturally reduces your desire even more.
| Stage of Perimenopause | Symptoms | Frequency |
|---|---|---|
| Early Stage | Inconsistent libido | 1–2 times/week |
| Middle Stage | Noticeable drop in desire, vaginal dryness | 3–4 times/week |
| Late Stage | Low libido most days, little response to stimulation | Nearly daily |
Could it be something else?
If your low libido comes with chronic fatigue, depression, or other hormonal symptoms, talk to your provider to rule out thyroid issues, adrenal fatigue, or clinical depression.
7. Weight Gain (Especially Around the Belly)
You’re eating the same, exercising regularly, but your jeans feel tighter — especially around your midsection.
What’s happening?
Estrogen helps determine where your body stores fat. As estrogen levels decline, fat storage shifts from hips and thighs to the belly. At the same time, metabolism slows and insulin sensitivity decreases, making it easier to gain weight and harder to lose it — even without lifestyle changes.
| Stage of Perimenopause | Presentation | Frequency |
|---|---|---|
| Early Stage | Stable weight but increase in waist size | 0.5–1 kg/month |
| Middle Stage | Fat accumulates around abdomen, clothes feel tighter | Notable weekly changes |
| Late Stage | Harder to lose weight, muscle mass declines | Ongoing, persistent |
Could it be something else?
If your weight gain is rapid, includes puffiness or swelling, or comes with fatigue, ask your doctor to check your thyroid, adrenal function, and insulin resistance.
8. Joint Pain & Muscle Stiffness
You wake up feeling stiff, like your knees or fingers don’t want to bend, or your shoulders ache without any injury.
What’s happening?
Estrogen has natural anti-inflammatory effects and supports joint lubrication. As estrogen declines, inflammation can increase and the fluid that cushions your joints may decrease, leading to stiffness, soreness, or aches — even without overuse or injury.
| Stage of Perimenopause | Symptoms | Frequency |
|---|---|---|
| Early Stage | Morning stiffness, improves with movement | 1–2 times/week |
| Middle Stage | Joint aches after sitting, soreness during exercise | 3–4 times/week |
| Late Stage | Persistent stiffness, muscle tightness becomes daily | Nearly every day |
Could it be something else?
If joint pain is accompanied by swelling, redness, or occurs symmetrically (both sides of the body), check for autoimmune conditions like rheumatoid arthritis or gout.
9. Urinary Frequency, Infections, or Leakage
You notice you’re needing to pee more often, waking up at night to go, or experiencing occasional leaks when laughing, sneezing, or exercising.
What’s happening?
Estrogen supports the health and flexibility of the urethra and vaginal tissues. When estrogen levels drop, those tissues become thinner and less elastic, making them more sensitive, less protective, and more prone to irritation, infections, or incontinence.
| Stage of Perimenopause | Symptoms | Frequency |
|---|---|---|
| Early Stage | Daytime urinary frequency | 1–2 times/week |
| Middle Stage | Nighttime urination, light leakage, burning sensation | 3–4 times/week |
| Late Stage | Recurrent infections, dryness, discomfort during sex | Nearly daily |
Could it be something else?
If symptoms include fever, blood in urine, or severe pain, consult your doctor immediately to rule out urinary tract infections or other underlying conditions.
10. Breast Tenderness or Swelling
Your breasts feel sore, puffy, or unusually sensitive — and it’s not just before your period. Even putting on a bra can feel uncomfortable.
What’s happening?
During perimenopause, estrogen levels can spike unpredictably. When this happens without enough progesterone to balance it out, it can overstimulate breast tissue, leading to swelling and tenderness at irregular times in your cycle.
| Stage of Perimenopause | Symptoms | Frequency |
|---|---|---|
| Early Stage | Mild swelling and tenderness before period | Once a month |
| Middle Stage | Unpredictable soreness, not always linked to cycle | 2–3 times/week |
| Late Stage | Lingering discomfort, sensitivity or pain in one or both breasts | Nearly daily |
Could it be something else?
If you notice a lump, nipple discharge, or visible changes in breast shape or skin, seek medical evaluation immediately to rule out more serious conditions.
Closing Thoughts: You're Not "Losing It" — You're Evolving
Perimenopause is not a disease or a sign of failure. It’s a phase your body enters to prepare for the next chapter. Learning about it is an act of self-care, a gesture of compassion toward the changing body you live in.
Coming Up Next | Blog 3
So, what can I do?
In the next post, we’ll explore specific strategies to support your body during perimenopause — from nutrition, sleep rhythms, supplementation, to emotional balance. Because you deserve to feel good again.
Stay tuned for: “What Can I Do? A Practical Guide to Supporting Yourself Through Perimenopause”
Authors:
Michelle Ordner
Registered Nurse (RN)
Michelle's expertise spans healthcare, nutrition infusion, and menopausal care. She began her nursing career in New Zealand in 1991 and has since served 17 years in critical care across the USA. After returning to NZ, she trained in cosmetic medicine and stem cell therapy, and holds a UK certification in intravenous nutrition. Her work focuses on integrative care for menopausal health and wellness.
