If you haven’t been sleeping well and your mood keeps shifting, it’s easy to blame stress.
But there could be another reason: perimenopause, the stage before menopause when hormone levels start to change.
“Perimenopause can start earlier than many women expect, even in their late 30s or 40s,” says Amy Marie Johnson, MD, an obstetrician and gynecologist with Hartford HealthCare Medical Group. “Hormones fluctuate, and many women may feel like something is off – but can’t quite put their finger on it.”
Here’s what to watch for.
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1. Changes in your period
You check your calendar…and then check it again.
“Your cycle is often the first place these hormonal changes show up,” says Dr. Johnson. “And it can become irregular long before periods stop altogether, which is usually around age 50.”
Your periods might change, too. They could become heavier or lighter, shorter or longer and may be unpredictable from month to month.
> Related: 4 Signs of Perimenopause (and How to Manage It)
2. Hot flashes and night sweats
Think hot flashes only happen during menopause? Think again.
Hot flashes can show up earlier than you expect. You might feel sudden heat, flushing or sweating, sometimes without any warning.
“For some women, this is occasional,” says Dr. Johnson. “For others, it can be frequent enough to really affect your sleep and daily comfort.”
> Related: Common Causes of Night Sweats (and When to Worry)
3. Weight shifts or body changes
Perimenopause can change more than your period. For many women, it also changes how their body looks and feels.
“Hormonal changes during perimenopause can affect how your body stores fat and uses energy,” says Dr. Johnson. “For many women, this leads to weight gain – especially around the abdomen.”
Weight gain be the result of a few different factors, including:
- Slower metabolism
- Changes in appetite and hunger cues
- Sleep disruption and stress
“If weight gain seems sudden or more than expected, let us know,” she adds. “We can help figure out what’s happening and discuss ways to manage it.”
> Related: Why Men Lose Weight Differently Than Women
4. Sleep problems
You’re exhausted all day. Then bedtime comes, and suddenly your brain is wide awake.
Sound familiar? Sleep issues are one of the most frustrating parts of perimenopause. And they can happen even if you’re not dealing with night sweats.
“Many women tell us they feel exhausted but still can’t fall asleep or stay asleep,” says Dr. Johnson. “This is very common (and frustrating) during this transition.”
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5. Mood and focus change
Do you feel different but aren’t sure why?
Maybe you’re more irritable than usual. Maybe small things feel overwhelming. Or maybe you walk into a room and forget why you went there in the first place.
“We hear this a lot,” says Dr. Johnson. “Hormonal shifts can really affect how you feel and think.”
You might notice:
- Mood swings
- Anxiety or irritability
- Trouble concentrating
- Memory lapses
> Related: 9 Foods That Can Actually Boost Your Mood
6. Vaginal dryness or discomfort
This topic isn’t always easy to talk about, but it’s common.
“Lower estrogen levels can lead to vaginal dryness or irritation,” says Dr. Johnson. “It can affect intimacy and daily comfort, and it’s something we can absolutely treat.”
Many women assume vaginal dryness is just something they have to live with. But there are options, from over-the-counter lubricants and moisturizers to prescription treatments.
> Related: 7 Everyday Habits That Can Improve Your Sex Life
7. Other symptoms you might not expect
Perimenopause doesn’t look the same for everyone.
Some women have hot flashes and irregular periods. Others notice headaches, joint aches or a drop in sex drive before they ever connect the dots. That’s part of what can make perimenopause so confusing.
Other symptoms can include:
- Brain fog
- Fatigue
- Joint pain
- Headaches
- Decreased sex drive
“If something feels new or out of the blue, it’s worth bringing up,” says Dr. Johnson.
> Related: 5 Natural Ways to Address Low Libido
When to see your doctor
Perimenopause is a normal transition, but you don’t have to feel uncomfortable or out of balance.
There are real options to help, whether that’s hormone replacement therapy (HRT) or changes in how you eat, move, sleep and manage stress. The right approach depends on your symptoms and your goals.
“A lot of women think they just have to push through it,” says Dr. Johnson. “But there are many ways we can help you feel better.”
