You’re exhausted but can’t sleep. Your PMS feels like it leveled up. One day you’re weepy over a dog food commercial, the next you’re raging at your teens for leaving crumbs on the counter. And somewhere between juggling carpools and deadlines, you wonder: Wait … is this perimenopause?
If you remember the days when the internet wasn’t a thing and you actually listened to the radio, chances are no one prepared you for this stage of life. We heard about hot flashes and menopause coming eventually, but no one warned us that perimenopause — the hormonal roller coaster leading up to it — can start in your 30s or early 40s and bring a grab bag of weird, confusing symptoms that can easily be mistaken for stress, burnout, or just “getting older.”
We’re breaking down 10 surprising signs of perimenopause that often fly under the radar. Whether you’re starting to suspect something’s up with your body or just want to know what’s coming, we’ve got you covered — with zero judgment and plenty of real talk.
What Is Perimenopause?
Krysmaru Araujo Torres, MD, Head of Medical Affairs, the Nature’s Bounty brand, explains that perimenopause refers to the time during which the ovaries begin declining in function and the body makes the natural transition to menopause, marking the end of the reproductive years. Women start perimenopause at different ages, usually during their 40s, but it can start as early as their mid-30s.
“There are different signs of perimenopause, including menstrual irregularity. Once a woman has gone through 12 consecutive months without a menstrual period, they have officially reached menopause, and the perimenopause period is over,” says Dr. Torres.
Surprising Perimenopause Signs You Probably Don't Know About
While irregular periods, hot flashes, and night sweats are the more obvious signs of perimenopause, they’re just the tip of the hormonal iceberg. Dr. Torres shares that women experience a slew of symptoms that signal they could be in perimenopause. Some of these symptoms are subtle and difficult to identify, while others are not so mild.
“What women may find surprising is just how vast the number of symptoms can be and for how long they experience them,” Dr. Torres tells CafeMom. Here’s a breakdown of some of the more common (but still confusing!) signs of perimenopause that many women aren’t fully prepared for:
Sleep Problems
Falling asleep can feel impossible, or you may wake up at 3 a.m. like clockwork, mind racing. Even when you do sleep, it may feel less restful. Shifting estrogen and progesterone levels can interfere with your circadian rhythm and your ability to stay asleep.
Weight Gain
Many women notice weight creeping on — especially around the midsection — even if their eating or exercise habits haven’t changed. Hormonal changes affect metabolism and fat distribution, making it harder to maintain the weight you’re used to.
Decrease in Muscle Mass
Dr. Torres says a decline in bone density and muscle mass can be difficult to identify. Lower estrogen levels contribute to a gradual loss of muscle, which can also slow your metabolism further.
Decrease in Bone Mass
Estrogen plays a crucial role in maintaining bone density. As levels drop, bone loss can accelerate — sometimes without any symptoms — making this a silent but serious concern.
Bladder Problems
You may experience more frequent urges to pee or accidental leaks when you sneeze or laugh. Declining estrogen can weaken the tissues around the bladder and urethra, making infections or incontinence more common.
Painful Intercourse (Vaginal Dryness)
Thinning vaginal walls and reduced natural lubrication can lead to discomfort or pain during sex. It’s common, but not often talked about, and very treatable once identified.
Low Libido
Many women experience a drop in sex drive. This lowered libido can be due to hormonal changes, vaginal dryness, fatigue, or just feeling emotionally overwhelmed. It’s a complex symptom, but very real.
Cholesterol Changes
Estrogen helps keep cholesterol in check. During perimenopause, LDL (“bad”) cholesterol can rise while HDL (“good”) cholesterol may drop. This can increase the risk of heart disease over time.
Mood Changes
Sudden mood swings, tearfulness, or feeling emotionally fragile can hit out of nowhere. These aren’t just “bad days” — they’re often linked to estrogen’s impact on brain chemistry.
Irritability
You might find yourself snapping more easily, feeling overstimulated, or losing patience, especially during the luteal phase of your cycle. Hormonal fluctuations can lower your stress tolerance and increase reactivity. Cue the mom rage.
“What women may find surprising is just how vast the number of symptoms can be and for how long they experience them,” Dr. Torres tells CafeMom.
Tips for Going Through Perimenopause
Dr. Torres says that a lot more research is needed to better understand perimenopause and menopause, as well as to correctly attribute symptoms during these decades to hormonal changes or other underlying medical conditions.
“It’s so important to recognize that all organs and systems in a woman’s body are impacted by perimenopause and menopause,” explains Dr. Torres.
Learn About Your Body
Dr. Torres advises women going through perimenopause to listen to their bodies, seek information to make informed decisions about their health when talking to their health care providers. It’s also important women advocate for their health needs and treatment options. This could include hormone replacement therapy, symptom management strategies, as well as focusing on better nutrition and incorporating more physical activity into their lifestyle.
Eat a Balanced Diet
Dr. Torres shares that strong muscles and bones are vital to helping perimenopausal women thrive. Women can support their bone and muscle health by following a nutritious diet that secures necessary protein, fiber, and nutrients like calcium and vitamin D.
Get Physically Active
Dr. Torres advises that regular physical activity, such as resistance training and aerobics, is incredibly important to build and maintain stronger bones and muscles, and improve agility and balance.
If any of these symptoms sound familiar, you’re not imagining things — and you’re definitely not alone. Perimenopause can be a confusing, unpredictable phase, but understanding what’s happening in your body is the first step toward feeling better.
If you’re experiencing changes that impact your daily life, don’t hesitate to talk to your doctor or a menopause-informed health care provider. You deserve support, clear answers, and options that help you navigate this transition with confidence and care.
*Disclaimer: The advice on CafeMom.com is not a substitute for consultation with a medical professional or treatment for a specific condition. You should not use this information to diagnose or treat a health problem without consulting a qualified professional. Please contact your health-care provider with questions and concerns.
