If you're in your 40s and noticing changes in your menstrual cycle, sleep, mood, or energy, you might be wondering whether you've entered perimenopause.
It's a question I hear often in practice, particularly from women who aren't sure what changes to expect or whether hormone testing would help.
Perimenopause doesn't look the same for everyone. Some women notice changes in their periods first, while others begin experiencing symptoms when their cycles are still relatively regular.
What Are the Stages of Perimenopause?
Perimenopause is the transition leading up to menopause, when ovarian hormone levels fluctuate and menstrual cycles gradually become less predictable. There are two recognized stages of the menopause transition, primarily identified by changes in menstrual patterns.
Early menopause transition
During the early transition, menstrual cycles become more variable. One of the recognized signs is a persistent difference of seven days or more between consecutive cycles. For example, if your cycles were previously around 28 days, you might begin noticing cycles that are sometimes 21 days and sometimes 29 days.
You may also notice changes in menstrual flow, sleep, mood, or premenstrual symptoms.
It's important to recognize that some women experience symptoms before their menstrual cycles meet these formal staging criteria.
Late menopause transition
As women move closer to menopause, they may begin skipping periods or experiencing gaps of 60 days or longer between menstrual cycles. Hot flashes, night sweats, and sleep disturbances often become more noticeable during this stage, although symptoms vary considerably.
Menopause is reached after 12 consecutive months without a menstrual period, provided there isn't another explanation for the absence of bleeding.
The length of the transition varies from woman to woman, and these stages aren't always experienced in a predictable way.
Can You Be in Perimenopause if Your Periods Are Still Regular?
Yes, it's possible to experience symptoms associated with perimenopause before your menstrual cycles change noticeably. Sleep disruption, mood changes, hot flashes, and other symptoms may begin during the late reproductive years.
However, these symptoms can also have other explanations, so it's important not to assume that every change you're experiencing is related to reproductive hormones. I've written more about this in my article, Why So Many Women in Early Perimenopause Are Overlooked.
Do You Need Hormone Testing to Confirm Perimenopause?
This is another question I hear frequently.
For most otherwise healthy women over 45 who have typical menopausal symptoms and menstrual changes, hormone testing isn't routinely needed to identify perimenopause. Estrogen and follicle-stimulating hormone (FSH) levels can fluctuate significantly throughout the transition. A single blood test may therefore provide limited information and doesn't reliably tell us exactly where someone is in the process.
There are situations where hormone testing may be appropriate, particularly:
Women aged 40–45: FSH testing may be considered when menopausal symptoms and menstrual changes suggest early menopause.
Women under 40: Changes in menstrual cycles or suspected premature ovarian insufficiency require further investigation.
Women using hormonal contraception: Bleeding patterns may not reliably reflect ovarian function. Assessment depends on the type of contraception, age, symptoms, and the reason for testing.
Having a hormonal IUD, for example, doesn't automatically mean hormone testing is necessary.
It's also worth distinguishing hormone testing from other investigations. Depending on your symptoms and medical history, testing for concerns such as thyroid dysfunction, iron deficiency, or metabolic health may still be helpful.
What Should You Do if You Think You're in Perimenopause?
A good starting point is to pay attention to changes you're noticing over time.
Tracking your menstrual cycle, sleep, hot flashes, mood, and other symptoms can help you recognize patterns and provide useful information to discuss with your healthcare provider.
If changes in your weight or body composition are also a concern, you may find my article on why weight gain happens during perimenopause and menopause helpful.
It's also important to seek assessment for unusually heavy or prolonged bleeding, bleeding between periods, or bleeding after intercourse rather than assuming these changes are simply part of perimenopause. Any bleeding after menopause should be evaluated.
You don't need to wait until your periods stop to ask questions or explore options for managing symptoms.
Looking for Support Through Perimenopause?
As a Naturopathic Doctor and Menopause Society Certified Practitioner, I work with women navigating perimenopause and menopause.
My approach begins with understanding your symptoms, health history, and priorities so we can identify what's contributing to how you're feeling and develop an individualized plan.
If you're looking for guidance, you can book a complimentary 15-minute discovery call to learn more about my approach and whether working together may be a good fit.
Dr. Andrea Gri, ND, MSCP
Naturopathic Doctor | Menopause Society Certified Practitioner
References
1. Harlow SD, Gass M, Hall JE, et al. Executive summary of the Stages of Reproductive Aging Workshop +10: Addressing the unfinished agenda of staging reproductive aging. Fertility and Sterility. 2012;97(4):843–851. View article: https://pmc.ncbi.nlm.nih.gov/articles/PMC3340904/.
2. Crandall CJ, Mehta JM, Manson JE. Management of menopausal symptoms: A review. JAMA. 2023;329(5):405–420. [https://doi.org/10.1001/jama.2022.24140](https://doi.org/10.1001/jama.2022.24140).
3. Department of Veterans Affairs. Clinical Practice Guideline for Menopause. 2026. View guideline: https://www.healthquality.va.gov/HEALTHQUALITY/guidelines/WH/menopause/Menopause-CPG_2026-Guideline_v1_20260910.pdf
4. Ortmann O, Beckermann MJ, Inwald EC, et al. Peri- and postmenopause: Diagnosis and interventions. Interdisciplinary S3 guideline of the Association of the Scientific Medical Societies in Germany (AWMF 015/062): Short version. Archives of Gynecology and Obstetrics. 2020. [https://doi.org/10.1007/s00404-020-05682-4](https://doi.org/10.1007/s00404-020-05682-4).
5. Louie MY, Vegunta S. Abnormal uterine bleeding in perimenopausal women. Journal of Women's Health. 2022. [https://doi.org/10.1089/jwh.2022.0273](https://doi.org/10.1089/jwh.2022.0273).
Disclaimer: The information provided on this blog is for educational and informational purposes only and is not intended as medical advice. Always consult with a qualified healthcare professional before making any changes to your health regimen. The content shared here is based on the author’s research and personal experiences, and individual results may vary. The author and blog are not responsible for any adverse effects or consequences resulting from the use of any suggestions, preparations, or procedures discussed on this site.