What Is Perimenopause

The Basics

Perimenopause is the transitional phase before menopause—the months or years when your body begins the shift out of its reproductive years. It starts when the ovaries begin to run out of eggs, and hormone production starts to fluctuate as the body adjusts to this new reality.

This isn’t a disease or disorder. It’s a natural transition that every woman who reaches midlife will experience. But that doesn’t mean it’s easy, and it certainly doesn’t mean you should face it without information or support.

When It Begins

Perimenopause typically starts in a woman’s 40s, though it can begin as early as the mid-30s or as late as the early 50s. It can last anywhere from 4 to 10 years.

The transition is official when you’ve gone 12 consecutive months without a menstrual period—that marks menopause itself. Everything before that is perimenopause.

Many women don’t realize they’ve entered perimenopause until they’re well into it. Early symptoms like sleep disruption, mood changes, or weight shifts are often attributed to stress, life circumstances, or simply getting older—when in fact, hormones may be the primary driver.

The 34 Symptoms

Yes, there are 34 documented symptoms of perimenopause. Women have estrogen receptors throughout the body, which means every organ system can be affected by these hormonal shifts.

Most commonly recognized:

• Irregular periods (often the first sign)
• Hot flashes and night sweats
• Sleep disturbances
• Mood swings
• Weight changes, especially around the belly

Often overlooked:

• Brain fog and memory changes
• Anxiety or depression (even without prior history)
• Joint pain and stiffness
• Fatigue that doesn’t resolve with rest
• Heart palpitations
• Headaches or migraines
• Digestive changes
• Thinning hair or hair loss
• Dry skin and changes in skin texture
• Vaginal dryness and changes in intimate tissue

Rarely discussed:

• Changed body odor
• Tingling or “crawling” sensations on skin
• Electric shock sensations
• Burning tongue
• Allergies that appear or worsen
• Brittle nails
• Dizziness
• Changes in taste

Not every woman experiences all symptoms, and intensity varies widely. Some sail through with minimal disruption; others find daily life significantly affected.

What’s Happening in Your Body

As the egg supply dwindles, the need for reproductive hormones decreases. This leads to unpredictable fluctuations in estrogen, progesterone, and testosterone.

It’s not a steady decline—that would be easier. Instead, hormone levels spike and drop unpredictably, sometimes within the same day. This is why symptoms can feel so chaotic. One week you feel like yourself; the next week, you don’t recognize your own moods.

The fluctuation eventually settles into a new baseline once you’ve fully transitioned into post-menopause. But the years of fluctuation can be genuinely destabilizing.

The Emotional Landscape

Perimenopause brings a complex mix of emotions. For some women, the realization that natural conception is becoming unlikely brings relief. For others, it brings grief—even if they didn’t want (more) children, even if they thought they’d made peace with it.

Research on how Western women experience this stage reveals:

• Relief: Freedom from periods, pregnancy concerns, or birth control
• Grief: Mourning the end of fertility, youth, or a certain version of themselves
• Anxiety: About aging, changing bodies, unknown symptoms
• Invisibility: The cultural sense of mattering less as a woman ages
• Liberation: Finally having space to focus on oneself

All of these can exist simultaneously. Your emotional experience is not one thing.

Your Nervous System

Estrogen does far more than regulate reproduction. It supports brain function, mood stability, memory, and temperature regulation. As levels fluctuate and decline, the nervous system is directly affected.

According to Harvard Medical School, estrogen plays a crucial role in how our brains utilize energy, process memory, and regulate emotions. Without stable estrogen, these systems require additional support.

This is why perimenopause can feel like nervous system dysregulation:

• Anxiety that appears out of nowhere
• A startle response that feels heightened
• Difficulty calming down once activated
• Emotional reactions that feel disproportionate

These changes are not imagined. They are a direct result of shifts in brain chemistry. Understanding this can bring relief—and point toward solutions that support the nervous system directly.

Intimate Changes

The vulva and vagina are highly sensitive to estrogen. As levels fluctuate, many women notice:

• Less natural lubrication
• Tissues that feel drier, thinner, or more sensitive
• Discomfort during sex that wasn’t there before
• More frequent UTIs or yeast infections
• Changes in libido—sometimes lower, sometimes higher

These changes are common, but they’re not inevitable or untreatable. Topical support, systemic hormone therapy, and simple practices can maintain intimate health through the transition.

The physical changes can also affect how you feel about sexuality and intimacy. Desire that once felt spontaneous may become more responsive—requiring more warm-up, more context, more intention.

Finding Support

Too many women suffer in silence with symptoms that are dismissed by healthcare providers or attributed to stress. The medical system has historically under-researched and under-treated menopause; perimenopause even more so.

What helps:

• Finding a healthcare provider who takes perimenopause seriously (menopause specialists, some OB/GYNs, functional medicine practitioners)
• Tracking symptoms to identify patterns and communicate clearly
• Connecting with other women going through the same transition
• Accessing accurate information (like this)

You are not broken. You are not imagining this. You are going through a significant biological transition that deserves real support.

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Go Deeper

These are the original writings this entry draws from:

• The 34 Symptoms of Perimenopause

• Caring for Your Intimate Skin in Perimenopause

• How Hormones Affect Libido in Perimenopause

• Regulating Your Nervous System Through Perimenopause