Perimenopause Symptoms: 15 Signs You're in It (and What to Do Next)
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Hormones & Menopause

Perimenopause Symptoms: 15 Signs You're in It (and What to Do Next)

Dr. Emily RichardsonFeb 3, 202610 min read
Perimenopause isn't menopause—it's the chaotic lead-up, starting mid-30s to late 40s for most (average 47). Lasts 4-10 years. Estrogen/progesterone rollercoaster: 80% women affected, symptoms worse than menopause for 25% (SWAN study, Menopause 2021). Not "just aging"—hormonal. GP often misses (only 31% trained).
15 signs listed w/ science, severity, fixes. Track 3+ months? Test FSH >25 IU/L, estradiol swings. Lifestyle first; HRT if severe.
15 perimenopause symptoms checklist infographic
15 perimenopause symptoms checklist infographic

Perimenopause 101: The Hormone Chaos

Timeline: Begins 8-10 years pre-menopause. Irregular cycles first sign.
Stats: 91% vasomotor, 60% urogenital, 40-60% mood/cognitive (JAMA 2023).
Why now: Ovarian follicles dwindle; FSH surges drive estrogen spikes/dips.

The 15 Signs (Grouped)

Cycle Disruptions (Earliest)

  • Irregular Periods: Shorter/longer, heavier/lighter. Skip 60+ days? Flag.
    • Evidence: Obstet Gynecol 2019—cycle variability precedes by 2 years.
    Fix: Seed cycling (flax/pumpkin Day1-14; sesame/sunflower 15-28).
  • Heavy Clots/Flooding: Progesterone drop. Iron check.
    • Fix: Vit K2, tranexamic trial.

    Vasomotor (Hot Flashes/Night Sweats)

  • Hot Flashes: 75% women, 10+/day severe cases.
    • Evidence: Menopause 2022.
    Fix: Paced breathing, black cohosh 40mg (Phytomedicine 2020).
  • Night Sweats: Disrupt sleep 50%.
    • Fix: Cool room 65F, sage tea.

    Mood & Brain

  • Anxiety/Irritability: GABA drop; 50% prevalence.
    • Evidence: Psychoneuroendocrinology 2021.
    Fix: Magnesium 300mg, L-theanine.
  • Brain Fog: Recall/word-finding 46%.
    • Evidence: Neurology 2022.
    Fix: Omega-3 2g, aerobic 150min/week.
  • Depression: 2x risk.
    • Fix: SAMe 400mg or B6 50mg.

    Sleep & Energy

  • Insomnia: Cortisol mis-time.
    • Evidence: Sleep Med Rev 2020.
    Fix: Glycine 3g pre-bed.
  • Fatigue: Mitochondrial estrogen receptors down.
    • Fix: CoQ10 200mg + PQQ.

    Body Changes

  • Weight Gain: Belly shift, RMR -250cal.
    • See Articles 1-2.
  • Breast Tenderness: Estrogen surge.
    • Fix: Evening primrose 500mg.
  • Bloating/GI: Progesterone slows motility.
    • Fix: Digestive enzymes, probiotics.
  • Joint Pain: Estrogen anti-inflammatory loss.
    • Evidence: Arthritis Rheum 2021.
    Fix: Curcumin 1g + boswellia.
  • Libido Drop: Androgen/estrogen imbalance.
    • Fix: Maca 3g, test free T.
  • Hair/Skin Thinning: Collagen -30%/year.
    • See Vertical 3.
    Perimenopause symptom progression chart
    Perimenopause symptom progression chart

    Severity Triage

  • Mild (1-5 signs): Lifestyle 80% fix.
  • Moderate (6-10): Add supps.
  • Severe: Endos consult, DUTCH test.

    • 30-Day Symptom Tracker Plan

    Week 1: Log symptoms/app (Clue/Ovia).
    2: Sleep/protein/supp basics.
    3: Exercise/stress tools.
    4: Review trends, doc if >7 moderate.

    Labs to Request

    FSH, LH, E2, Prog, TSH, Free T3/T4, Cortisol, DHEA, HbA1c.

    HRT? Lifestyle First

    Non-hormonal 70% effective mild-moderate (Cochrane 2022).

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