When Do Perimenopause Symptoms Begin?

First, What Is Perimenopause?

Perimenopause is the transitional period leading up to menopause—defined as going 12 consecutive months without a menstrual period. During perimenopause, your body gradually reduces hormone production. Testosterone declines at a slow and fairly steady pace while estrogen and progesterone fluctuate wildly with peaks and valleys, as it moves toward the end of reproductive years.

While menopause marks the official end of menstruation and fertility, perimenopause is the often unpredictable phase before it. And here’s the catch—it looks different for everyone.

So… When Does Perimenopause Start?

This is one of the most common (and trickiest) questions with no definitive answer. There is no set age or single sign that marks the beginning of perimenopause, which is why many women don’t recognize it until they’re well into the experience.

Typically, perimenopause begins in your late 30s to early 50s, though most women start to notice symptoms in their mid-to-late 40s. The entire transition can last anywhere from 2 to 10 years.

The earliest and most common signs include:

• Irregular periods (longer, shorter, heavier, or lighter than usual)
• Sleep disruptions
• Joint pain
• Mood swings or anxiety
• Hot flashes or night sweats
• Changes in libido
• Changes in body composition (such as increased belly fat)
• Difficulty concentrating or “brain fog”
• Vaginal dryness or discomfort during sex

For some, changes in menstruation are the first noticeable sign. For others, it's psychological or physical symptoms—like weight gain, joint pain, fatigue, or memory lapses—that raise the first red flag.

What’s Actually Happening In My Body?

Perimenopause is driven by fluctuating hormone levels—particularly estrogen and progesterone. These hormonal shifts impact multiple systems in the body and can lead to a wide range of physical and emotional symptoms.

Because these hormone levels don’t decline in a straight line—but instead rise and fall unpredictably—symptoms can appear suddenly, intensify, or change over time. This is why many women find perimenopause confusing or difficult to recognize at first.

Common experiences during this transition include unexplained weight gain (particularly around the middle), joint or muscle discomfort, mood changes such as increased sadness or irritability, irregular periods, sleep challenges, and shifts in social or emotional well-being. While the intensity and combination of symptoms vary for everyone, it’s completely normal to feel different in both body and mind during this phase.

And, while it may be “normal” to feel different, there is no need to suffer!

Common Signs And Symptoms Of Perimenopause

Here’s some more symptoms to be on the lookout for to indicate if you are in or entering perimenopause:

• Irregular or changing menstrual cycles
• Hot flashes and night sweats
• Mood swings or increased anxiety
• Trouble sleeping or staying asleep
• Brain fog or difficulty concentrating
• Vaginal dryness or discomfort
• Decreased libido
• Weight gain, especially around the abdomen
• Joint and muscle aches
• Headaches or new onset migraines
• Frequent urination
• PMS-like symptoms that feel more intense or unpredictable

Remember, not everyone will experience all of these symptoms—and that’s normal - but suffering is not!

How Will I Know If It’s Perimenopause?

There’s currently no single test to diagnose perimenopause. Hormone levels fluctuate so much that blood tests aren't always reliable, and neither are expensive saliva and urine tests. The best indicator is a combination of your symptoms, age, family, medical and menstrual history.

If you’re experiencing unusual symptoms that are interfering with your life, talk to a healthcare professional. They may perform labs to rule out other conditions like hypothyroidism, anemia, or autoimmune disorders, which can mimic perimenopausal symptoms.

Now What?

The good news? You are not powerless during this transition. Here are proactive steps you can take:

• Track your symptoms: Use a journal or app to note changes in mood, cycle, sleep, and energy.
• Stay informed: Educating yourself on the changes happening in your body empowers you to make decisions that support your health. The more you know, the better you can advocate for yourself and the care you deserve. HERE is a link to other articles I’ve written that may be helpful to you. And, be sure to download my Menopause Empowerment Guide!
• Prioritize self-care: Nutrition, movement (prioritizing resistance training), stress management, and rest are key. These are all tools that should be in your Menopause Toolkit.
• Connect with others: Talk to friends, family members, or support groups going through the same transition. Join our FREE ‘Pause Life Community to share experiences, ask questions, learn and feel supported.
• Seek professional support: Your healthcare professional can guide you through symptom management options, which may include lifestyle changes, supplements, or hormone therapy depending on your needs. If you’re in need of a clinician, check the Recommended Clinicians list on The ‘Pause Life website, the Menopause Society’s Certified Practitioner database, or use one of the telemedicine platforms I recommend: Alloy, Midi or Evernow.

You’re Not Alone—And This Is Nothing to Hide

Perimenopause isn’t a condition to be “fixed”—it’s a natural, expected phase of life that a woman will experience if she’s fortunate to live long enough. And the more we talk about it, the less mysterious and isolating it becomes.

Let’s normalize the conversation around perimenopause and menopause. There’s power in knowledge, and strength in community.

So take the Menopause Quiz, track your symptoms, ask questions, and approach this time of life with curiosity and compassion. You’ve navigated a lot in life already—and this is another chapter you can walk through with strength, support, and self-awareness.

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