How to Know If You’re Going Through Perimenopause 

by JJ Virgin on January 16, 2024

Most women think of menopause as the dreaded symptoms you’ve heard about from your mothers and grandmothers growing up. But those mood swings and hot flashes you think of are actually symptoms of perimenopause, which is the time leading up to your last period. 

Menopause is actually only one day: the one-year anniversary of your last period. This milestone marks the official transition into your next chapter. The perimenopause journey, however, can begin about four to six years before then.1 

There are over 30 symptoms of perimenopause that can impact you physically, mentally, and emotionally. With such wide-ranging signs, how are you supposed to know if you’re going through the change or if something else is going on? 

10 Common Perimenopausal Symptoms 

A decline in estrogen and progesterone is a central factor in the onset of many perimenopausal symptoms.2 These are the main hormones of your menstrual cycle, with estrogen dominating before ovulation and progesterone taking over afterward.  

Estrogen supports your bones, heart, skin, mood, cognitive function, and more.3 Progesterone is released in response to ovulation and helps to balance estrogen’s effects and prepare the uterus for potential pregnancy.4 When you are no longer ovulating, you’re also no longer producing as much progesterone. This imbalance, among other contributors, can lead to symptoms of perimenopause. 

The average age to reach menopause is 51, but symptoms can start as early as your 30s and can last for several years. Your experience depends on your genetics, diet, lifestyle, health status, and more.  

Recognizing and understanding the signs and symptoms is essential for effectively navigating this significant life stage. 

1. Irregular Menstrual Cycles 

Irregular menstrual cycles are one of the more obvious symptoms of perimenopause. Your period may become shorter or longer, and your flow may fluctuate in volume, too. You know what’s normal for you, so pay attention to your cycle length and how light or heavy your bleeding is each month.5  

These changes stem primarily from the declining levels of estrogen and progesterone. Estrogen stimulates the growth of the uterine lining, while progesterone helps stabilize it (preparing you for pregnancy). As their levels decrease, this can lead to irregular periods. 

Start logging the length of your cycle and your period, along with the volume of your flow. Use a cycle-tracking app like Clue or Natural Cycles, or find one that integrates with one of your favorite wearable devices to keep all your tracking in one place. 

2. Hot Flashes and Night Sweats 

Hot flashes and night sweats, marked by sudden and intense heat waves, can significantly disrupt daily life and overall well-being. You’ll know a hot flash when you feel it—it’s a sudden and overwhelming sense of heat across your face, neck, and chest. It may also come with a rapid increase in heart rate, causing a heightened sense of discomfort. Night sweats are essentially hot flashes while you sleep, and they can disrupt restorative rest.  

As you progress through perimenopause, decreasing estrogen can cause your hypothalamus (your internal thermostat) to become more sensitive. Even slight temperature changes can trigger a hot flash, which is your body’s attempt to make you sweat and cool down. 

Estrogen is already impacted by perimenopause, but spiking your blood sugar through a poorly balanced diet can exacerbate symptoms.6 Maintaining steady blood-sugar levels can help minimize the duration and severity of these symptoms. 

Eating by the plate with a protein-first approach is the best way to stay balanced. Optimal protein provides essential amino acids for building and regulating hormones.  

3. Vaginal Changes 

Perimenopause can create changes in your sexual health, including vaginal health. Declining levels of estrogen make the vaginal lining thinner, less elastic, and more susceptible to dryness and irritation. This can lead to pain, itching, and discomfort, particularly during sex.7 

The impact of these changes on your sexual well-being can be significant, affecting both your physical comfort and emotional satisfaction. Sex may become painful or less enjoyable—but you don’t have to suffer through it.  

To help relieve these symptoms, consider lubricants or moisturizers specifically designed to alleviate vaginal dryness. In some cases, you might consider hormone therapy to help restore estrogen levels and alleviate vaginal discomfort.  

4. Mood Swings 

Disruptions in estrogen and progesterone levels (which not only regulate your menstrual cycle but help regulate mood and emotional well-being, too) can lead to mood swings, irritability, anxiety, and mild depression (aka a non-stop emotional rollercoaster). 

Estrogen significantly impacts neurotransmitters, including the feel-good hormones serotonin and dopamine. When estrogen levels decline, this can disturb the delicate balance between these neurotransmitters, resulting in changes in emotional well-being.8 

Mindset determines everything. The right mindset helps you manage stress, sleep better, create a happier life, and move through menopause more powerfully. In Mindset Mastery: 20 Practices for Power and Purpose, you’ll learn how to incorporate mindset-shifting moments into your daily life. Get your FREE guide here. 

5. Low Libido 

Hormonal imbalances, particularly the declining levels of estrogen and progesterone, can have a profound impact on sexual desire and overall sexual well-being in several ways 

If you’re dealing with the vaginal changes mentioned above—not to mention low mood or hot flashes—the discomfort and potentially reduced sensitivity can contribute to a waning interest in sex.9 

There may also be reduced blood flow to the genital area, which can put a damper on your ability to get aroused. This can make it more difficult to have an orgasm, and the stress of it all can leave you with little interest in doing the deed. 

Plus, there are body changes happening at this time. The fluctuating levels of estrogen tend to shift where we hold fat in our bodies, and it can take some time to embrace a new shape and feel at home in our skin again. 

Addressing these changes in libido requires open and honest communication, both with your partner and healthcare provider.  

6. Sleep Disturbances 

During perimenopause, the decline in estrogen and progesterone levels can disturb your body’s usual sleep-wake cycle, or circadian rhythm.10 Night sweats can make it difficult to fall or stay asleep peacefully11 and mood disturbances like anxiety and depression can keep you up at night, too. Racing thoughts and increased stress levels can impede relaxation and the ability to fall asleep quickly.12 

All of these disturbances can disrupt the production of melatonin, the “sleepy” hormone that rises at night to help you feel tired and ready for bed.13 

Research shows that supplementing with melatonin can help menopausal women improve sleep quality and reduce the frequency of nighttime awakenings caused by night sweats and hot flashes.14 

No more compromising on great sleep! Sleep Candy™ combines 3 mg of melatonin with 5-hydroxytryptophan (5-HTP), a precursor to serotonin and melatonin. Inositol and L-theanine provide additional calming support, while vitamin B6 helps convert 5-HTP to melatonin. The end result? Your best night’s sleep, every single night.* 

7. Changes in Bone Health 

Estrogen plays a pivotal role in maintaining bone density and strength by boosting bone-building cells and supporting repair processes. 

As estrogen levels decrease, this delicate balance becomes disrupted, gradually reducing bone density. Over time, this can pave the way to osteoporosis, which increases the risk of fractures.15 

Talk with your healthcare provider about routine bone-density assessments, such as a DEXA scan, for maintaining good bone health. These tests provide valuable insights into your bone density and strength, helping to identify any potential issues early on. 

A protein-first meal approach is even more effective with strength training around perimenopause. Regularly lifting heavy can help stimulate bone remodeling, improving bone density and reducing the risk of osteoporosis. Resistance training provides other benefits, including maintaining (and even increasing) muscle mass, improving your mood, reducing stress, and enhancing overall mental well-being.16 

 My Resistance Training Cheat Sheet provides everything you need for your fitness journey, including home gym essentials, an 8-week workout plan, and a progress tracker to track your sets, reps, and weights with each workout. It’s FREE, so grab yours here

8. Changes in Skin and Hair 

Estrogen helps maintain skin elasticity and moisture. It’s one of the reasons people tend to glow around ovulation—that’s when estrogen is at its peak during the menstrual cycle. As levels decrease during perimenopause, your skin’s ability to produce collagen and retain moisture diminishes. The results include drier, less elastic skin, fine lines and wrinkles, and a general loss of skin radiance.17 

This can also influence hair texture and density. Hair thinning, decreased hair volume, and more brittle strands can become more common.  

The dysregulation of sex hormones during menopause can lead to an increase in hormones like testosterone, which may stimulate the growth of facial hair in some women (a condition called hirsutism).18  

A protein-first approach is helpful for hair and skin issues because of the amino acids protein provides, which support collagen production in your body. Collagen is a key protein for the health of your hair, skin, nails, and more. 

9. Memory and Cognitive Changes 

Estrogen has brain-protective effects and supports functions like learning and memory. Lower estrogen levels can impact these abilities. As a result, forgetfulness, difficulty concentrating, or mental fog become more common during perimenopause.19 

For most women, these cognitive changes are generally mild and temporary. At the same time, be proactive about brain health. Mental exercises, puzzles, and challenging activities like learning a new language can help keep your brain agile and counteract these subtle shifts.  

10. Weight Gain and Metabolic Changes 

Estrogen impacts how your body stores fat. Decreased levels of this hormone can significantly contribute to weight gain, especially an increase in visceral fat. This dangerous type of fat releases molecules that promote chronic inflammation, which can lead to other issues like heart disease and type 2 diabetes when left unchecked.  

Eating protein first is beneficial here, too. Protein-rich foods are satiating and aid in appetite control, which can assist in managing weight fluctuations that often occur during perimenopause.20 

A protein-first approach means you get 30-50 grams of protein at every meal. Don’t guess how much protein you’re getting. My Protein Cheat Sheet provides a list of foods containing 30-60 grams of protein to make it super easy,  and you can download it for free.  

Other metabolic changes that often occur during perimenopause include: 

  • Cholesterol Levels: One significant change is that “bad” LDL cholesterol tends to go up. This happens partly because estrogen levels decrease, and estrogen helps keep your cholesterol balanced by boosting “good” HDL cholesterol—so if estrogen is lower, HDL may be, too. Triglyceride levels may increase in some women during perimenopause as well. All of these factors can increase your risk of heart disease and other health conditions.21 
  • Insulin Resistance: Insulin sensitivity tends to decrease during perimenopause, leading to insulin resistance. This means your body’s cells can become less responsive to insulin, the hormone responsible for regulating blood-sugar levels. If you’re not prioritizing protein and eating by the plate, chronic blood-sugar dysregulation puts you at risk for developing type 2 diabetes.22 
  • Sarcopenia (Muscle Loss): Sarcopenia, the age-related loss of muscle mass and strength, can accelerate during perimenopause. Estrogen has a protective effect on muscle tissue, and as levels decrease, muscle loss may occur more rapidly, potentially leading to reduced metabolic rate and increased body fat percentage.23 

Work With Your Functional Medicine Doctor to Tailor Your Perimenopause Plan 

Although perimenopausal symptoms can share similarities, they can also vary significantly in terms of how severe they are and how long they last. Recognize that perimenopause is a unique experience for each person. Collaborating with a functional medicine practitioner and openly discussing any concerns during this transitional phase can be invaluable in effectively managing the challenges that come with it. 


  1. Gava G, Orsili I, Alvisi S, Mancini I, Seracchioli R, Meriggiola MC. Cognition, Mood and Sleep in Menopausal Transition: The Role of Menopause Hormone Therapy. Medicina (Kaunas). 2019 Oct 1;55(10):668. doi: 10.3390/medicina55100668. PMID: 31581598; PMCID: PMC6843314.  
  1. Cleveland Clinic: Perimenopause: Age, Stages, Signs, Symptoms & Treatment  
  1. Cleveland Clinic: Estrogen: Hormone, Function, Levels & Imbalances  
  1. Cleveland Clinic: Progesterone: Natural Function, Levels & Side Effects  
  1. Merck Manuals: Menstrual Cycle – Women’s Health Issues  
  1. Stella: Sugar and Menopause – What You Need to Know  
  1. Harvard Health: Perimenopause: Rocky road to menopause  
  1. Wharton W, Gleason CE, Olson SR, Carlsson CM, Asthana S. Neurobiological Underpinnings of the Estrogen – Mood Relationship. Curr Psychiatry Rev. 2012 Aug 1;8(3):247-256. doi: 10.2174/157340012800792957. PMID: 23990808; PMCID: PMC3753111.  
  1. Scavello I, Maseroli E, Di Stasi V, Vignozzi L. Sexual Health in Menopause. Medicina (Kaunas). 2019 Sep 2;55(9):559. doi: 10.3390/medicina55090559. PMID: 31480774; PMCID: PMC6780739.  
  1. Baker FC, de Zambotti M, Colrain IM, Bei B. Sleep problems during the menopausal transition: prevalence, impact, and management challenges. Nat Sci Sleep. 2018 Feb 9;10:73-95. doi: 10.2147/NSS.S125807. PMID: 29445307; PMCID: PMC5810528.  
  1. Medical News Today: Coping with menopausal hot flashes and night sweats  
  1. American Congress of Obstetricians and Gynecologists: Mood Changes During Perimenopause Are Real. Here’s What to Know  
  1. Jehan S, Jean-Louis G, Zizi F, Auguste E, Pandi-Perumal SR, Gupta R, Attarian H, McFarlane SI, Hardeland R, Brzezinski A. Sleep, Melatonin, and the Menopausal Transition: What Are the Links? Sleep Sci. 2017 Jan-Mar;10(1):11-18. doi: 10.5935/1984-0063.20170003. PMID: 28966733; PMCID: PMC5611767.   
  1. Zhang J, Jiang B. Influence of Melatonin Treatment on Emotion, Sleep, and Life Quality in Perimenopausal Women: A Clinical Study. J Healthc Eng. 2023 Oct 10;2023:2198804. doi: 10.1155/2023/2198804. PMID: 37854169; PMCID: PMC10581846.  
  1. Seifert-Klauss V, Fillenberg S, Schneider H, Luppa P, Mueller D, Kiechle M. Bone loss in premenopausal, perimenopausal and postmenopausal women: results of a prospective observational study over 9 years. Climacteric. 2012 Oct;15(5):433-40. doi: 10.3109/13697137.2012.658110. Epub 2012 Mar 23. PMID: 22443333.  
  1. Mishra N, Mishra VN, Devanshi. Exercise beyond menopause: Dos and Don’ts. J Midlife Health. 2011 Jul;2(2):51-6. doi: 10.4103/0976-7800.92524. PMID: 22408332; PMCID: PMC3296386.   
  1. Stevenson S, Thornton J. Effect of estrogens on skin aging and the potential role of SERMs. Clin Interv Aging. 2007;2(3):283-97. doi: 10.2147/cia.s798. PMID: 18044179; PMCID: PMC2685269.   
  1. Goluch-Koniuszy ZS. Nutrition of women with hair loss problem during the period of menopause. Prz Menopauzalny. 2016 Mar;15(1):56-61. doi: 10.5114/pm.2016.58776. Epub 2016 Mar 29. PMID: 27095961; PMCID: PMC4828511.  
  1. Hara Y, Waters EM, McEwen BS, Morrison JH. Estrogen Effects on Cognitive and Synaptic Health Over the Lifecourse. Physiol Rev. 2015 Jul;95(3):785-807. doi: 10.1152/physrev.00036.2014. PMID: 26109339; PMCID: PMC4491541.  
  1. Pataky MW, Young WF, Nair KS. Hormonal and Metabolic Changes of Aging and the Influence of Lifestyle Modifications. Mayo Clin Proc. 2021 Mar;96(3):788-814. doi: 10.1016/j.mayocp.2020.07.033. PMID: 33673927; PMCID: PMC8020896.   
  1. Time Magazine: How Menopause Affects Cholesterol—And How to Manage It  
  1. Women’s Health Network: How to Avoid Insulin Resistance – Women’s Health Network  
  1. Buckinx F, Aubertin-Leheudre M. Sarcopenia in Menopausal Women: Current Perspectives. Int J Womens Health. 2022 Jun 23;14:805-819. doi: 10.2147/IJWH.S340537. PMID: 35769543; PMCID: PMC9235827. 

The views in this blog by JJ Virgin should never be used as a substitute for professional medical advice. Please work with a healthcare practitioner concerning any medical problem or concern. The information here is not intended to diagnose, treat, or prevent any disease or condition. Statements contained here have not been evaluated by the Food and Drug Administration.  

*These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.