Perimenopause and Menopause Symptoms to Watch For

Navigating perimenopause and menopause — and even the years leading up to them — can feel like stepping into unfamiliar territory. Your body starts to change in ways you don’t recognize, sending signals that range from mildly frustrating to completely overwhelming.

Brushing off these symptoms as “just stress” or “getting older” can leave you feeling isolated and uncomfortable. However, paying close attention to what your body is trying to tell you is the crucial first step toward taking control of your well-being.

“Perimenopause includes the 10 years leading up to menopause,” says Karen Kaufman, MD, medical director for MIORA at Life Time in Colorado. “Signs and symptoms can start as early as age 35, and it can be difficult to tell if those symptoms are from normal aging or if there’s something else going on. It opens the door to taking a deeper look at your hormones.”

Here, Kaufman outlines key signals your body may be sending to indicate a hormone imbalance, as well as how to differentiate them from what you can typically expect leading up to and during perimenopause and menopause. She also offers suggestions for seeking treatment.

5 Common Symptoms to Monitor

Changes during perimenopause and menopause are common, but if you’re noticing symptoms that seem unusual or extreme — think mood or sleep issues, heavier periods, changes in skin or hair — it can be a reason to seek an expert’s care, according to Kaufman.

“Women’s experience during this time can differ widely,” she says. “Some may experience joint pain, hot flashes, night sweats, changes in body composition, or changes in the menstrual cycle. These are the signs that, as a patient, I would be thinking, ‘Huh, maybe there’s something going on with my hormone balance.’”

It’s important to know that there is typically no single cause of a symptom — there can be many factors in the body contributing. “All of our body systems talk to each other,” Kaufman explains. “Our body is a system of systems, and they all communicate with each other. These symptoms may appear as a sign that one or more systems may not be functioning properly.”

1. Irregular periods or abnormal periods.

Period changes are a common sign that a deeper issue might need to be addressed.

“Let’s say you used to be very regular, which in the medical world is anywhere from 24 to 31 days, and now suddenly you’re not,” says Kaufman. “Or your periods are suddenly seven days and heavy. That’s something to bring up as a concern and a reason to do further testing.”

2. Insomnia

Women’s hormones influence many functions in the body, including sleep. If you’re having trouble falling asleep or find yourself waking up frequently, it’s worth taking a closer look.

“As hormones become imbalanced, sleep can become more broken,” says Kaufman. “This is commonly due to a change in hormones, specifically progesterone and estrogen. Sleep is so critical for our brain, not just to restore our bodies and help them recover, but also to release growth hormone, which helps us age more gracefully.”

The waste clearance network in our brains is also hard at work while we’re sleeping, working to clear out the byproducts produced from all its done throughout the day. “Without deep sleep, we can’t do this well,” she adds.

3. Hot flashes and night sweats

Hot flashes and night sweats are the symptoms that most often drive women to their provider looking for answers, according to Kaufman.

“Hot flashes and nights sweats are a clue that estrogen is fluctuating wildly or is possibly deficient,” she says. “Estrogen is key in regulating our body temperature. When the temperature system in our brain is dysregulated, our body can react as if it’s overheating.”

Estrogen has over 400 functions in the body, and it needs to be stable to protect our bones, heart, and brain. “Hot flashes and night sweats can indicate hormone instability, which is why they’re not something to ignore.”

4. Mood changes

While mood swings before your period can be common, they can become more prevalent at other times of the month as you enter the perimenopausal phase.

“It’s not just three days before your period like it might have been in your 20s,” says Kaufman. “If you’re experiencing this, it’s something to look into.”

5. Brain fog

Brain fog can be a challenging symptom to recognize and discern from what you might think is a sign of normal aging.

“Brain fog can feel like you’re pushing your thoughts through mud,” Kaufman explains. “It’s not really related to memory. Additionally, in perimenopause, attention deficit disorder symptoms can flare. I’ve heard people say, ‘I can’t tell if it’s my mood or if it’s brain fog, but I’m having trouble focusing.’ Those feelings are very real for people, and they’re all based in hormonal changes.”

How to Differentiate Between What’s Normal and Abnormal

With a changing body and so many signs to look out for, it can be difficult to know the difference between normal shifts and something more concerning.

“It’s normal to have some erratic things surface,” says Kaufman. “In your 30s, you may notice things are not quite as smooth as they used to be. But if you’re suddenly noticing things you’ve never experienced before, and it starts to become a pattern, those are important clues.

“I think it can be surprising for people to learn that age 35 is when you might start noticing changes,” she adds. “And some of the early signs are worth paying attention to so you can prevent issues down the road.”

What to Do If You’re Experiencing Symptoms

If you’re experiencing some of these symptoms, the first thing Kaufman recommends is to document them over time.

“One of the things that’s really helpful to present to a provider of any kind is a diary or journal,” she says. “For example, you might keep track of your periods and know they are ‘X’ number of days apart. Then maybe you notice in the middle of the month you’re completely exhausted and at the end of the month, you notice you’re irritable with painful, enlarged breasts. It’s those details you want to bring to your doctor.”

Ideally, that healthcare provider is one who is both informed on and has experience addressing the topic. “I urge anyone to find an integrative functional provider because, unfortunately, these concerns are often written off as ‘normal’ in traditional medical settings,” says Kaufman. “To that, I say, yes, it may be common, but it’s not always normal. And when we pay attention to what’s going on, we can find the root causes. Sometimes this requires being your own advocate to find a provider who will pay attention to your diary and help you access some deeper testing.”

Getting to the root cause through testing goes beyond simply testing hormone levels.

“A lot of people go to their gynecologist and ask to get their hormones checked, only to be told, ‘check, check, check,’ everything looks normal,” says Kaufman. “Just because they’re within this wide range we call ‘normal’ doesn’t mean they fall in a range for optimal health.” (Learn more: “Normal vs. Optimal Lab Ranges: Why the Difference Matters.”)

Comprehensive bloodwork, like the blood lab analysis offered by MIORA, is key to finding answers about what may be influencing your hormone health. (Learn more: “What Is MIORA at Life Time?”)

“At MIORA, we take each system within the body and connect all the dots,” Kaufman explains. “For example, your cortisol levels are connected to how your thyroid functions, how your blood sugar functions, and even how your sex hormones function. We show you the bigger picture, so we can begin to pinpoint and optimize instead of simply talking about symptoms and treating them in isolation.”

Finally, Kaufman encourages seeking help as soon as you start noticing symptoms or changes rather than waiting for things to get worse.

“I often tell patients, ‘Don’t let it get so bad before asking for help’,” she says. “We’re not meant to take a deep dive into unwellness before we get back to healthy again. There’s so much opportunity even early on in perimenopause to set yourself up for optimal health.”

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