One of the conversations I frequently have with women in their 40s is about changes they're noticing in how they feel and how their bodies are changing, even though their menstrual cycles are still relatively regular.
Maybe they're not sleeping as well as they used to, they're feeling more irritable or anxious, their energy isn't quite the same, or they're noticing changes in their weight and body composition.
Often, they're wondering whether these changes could be related to perimenopause, and it's a reasonable question. While changes in menstrual cycles are an important part of identifying the menopause transition, symptoms can begin before those changes become obvious.
What Is Perimenopause?
Perimenopause is the transition leading up to menopause, when ovarian hormone levels begin to fluctuate and menstrual cycles eventually become less predictable.
It typically begins in a woman's 40s, although the timing varies considerably. The transition can last several years, and menopause is reached after 12 consecutive months without a menstrual period, provided there isn't another explanation.
One of the challenges with recognizing early perimenopause is that we often associate it with irregular periods. However, many women begin experiencing symptoms before they notice significant changes in their cycles. For a closer look at how menstrual patterns change throughout the transition, you can also read my article, Am I in Perimenopause?
What Are the Early Signs of Perimenopause?
Hot flashes and night sweats are among the more recognizable symptoms of the menopause transition, but they're not the only changes women may experience.
Other concerns I commonly discuss with patients include:
Changes in sleep, including difficulty staying asleep
Mood changes, increased irritability, or anxiety
Difficulty concentrating or feeling mentally foggy
Changes in menstrual flow or cycle length
Vaginal dryness or discomfort with intercourse
Changes in sexual desire
Joint or muscle discomfort
Some women also notice changes in their weight or body composition, particularly around the abdomen, although these changes are influenced by several factors beyond reproductive hormones. If this is something you've noticed, I've written more about why weight gain happens during perimenopause and menopause and what can help.
Not every woman will experience these symptoms, and their severity can vary considerably.
It's also important to recognize that these symptoms aren't specific to perimenopause. Having one or more doesn't necessarily mean you're in the menopause transition.
Why a Thorough Assessment Matters
When a woman comes to see me because she's feeling different in her body, I don't automatically assume hormones are responsible for everything. Perimenopause may be part of the picture, but sleep disruption, fatigue, mood changes, and weight concerns can have several contributing factors.
Depending on her symptoms and health history, we may need to consider thyroid function, iron status, blood sugar regulation, sleep quality, stress, medications, and other health concerns. We also review menstrual patterns, changes in symptoms over time, and how these changes are affecting her daily life.
For most otherwise healthy women over 45 with typical symptoms of perimenopause, hormone testing isn't routinely needed to make a clinical diagnosis or guide symptom management. Hormone levels fluctuate considerably during this stage, so a single blood test often doesn't tell us very much. The goal is to understand what's contributing to how you're feeling so we can focus on the areas that are most likely to make a meaningful difference.
You Don't Have to Wait Until Your Periods Become Irregular to Ask for Help
This is something I wish more women knew.
If you're noticing changes in your sleep, mood, energy, or overall well-being, you don't need to wait until your periods become irregular before discussing them with your healthcare provider.
That doesn't mean every symptom is caused by perimenopause. It means those changes deserve attention, whether they're related to reproductive hormones, another health concern, or a combination of factors.
There are effective options for managing menopausal symptoms, including lifestyle strategies, menopausal hormone therapy when appropriate, and nonhormonal treatments. The right approach depends on your symptoms, health history, preferences, and goals.
Looking for Support Through Perimenopause?
If you're in your 40s and noticing changes in how you feel, I'd be happy to help you better understand what's happening.
As a Naturopathic Doctor and Menopause Society Certified Practitioner, I work with women navigating perimenopause and menopause, and the hormonal and metabolic changes that can accompany midlife.
My approach begins with a thorough assessment so we can identify your priorities and develop a plan that fits your needs and goals.
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. 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).
2. Duralde ER, Sobel TH, Manson JE. Management of perimenopausal and menopausal symptoms. BMJ. 2023;382:e072612. [https://doi.org/10.1136/bmj-2022-072612](https://doi.org/10.1136/bmj-2022-072612).
3. Monteleone P, Mascagni G, Giannini A, Genazzani AR, Simoncini T. Symptoms of menopause: Global prevalence, physiology and implications. Nature Reviews Endocrinology. 2018;14:199–215. [https://doi.org/10.1038/nrendo.2017.180](https://doi.org/10.1038/nrendo.2017.180).
4. Maki PM, Inan Eroglu E, Janssenswillen C, et al. Associations between vasomotor symptoms, sleep disturbances, and frequent mood changes individually and within symptom groups across the menopausal transition and early postmenopause: Observations from the Study of Women's Health Across the Nation. Menopause. 2026. [View on PubMed](https://pubmed.ncbi.nlm.nih.gov/41529146/).
5. Nichols AR, Chavarro JE, Oken E. Reproductive risk factors across the female lifecourse and later metabolic health. Cell Metabolism. 2024. [View article](https://pmc.ncbi.nlm.nih.gov/articles/PMC10871592/).
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.