Perimenopause: The Transition That Often Starts Earlier Than You Think

Perimenopause is the hormonal transition leading up to menopause — and for many people, it begins in the late 30s or early 40s, sometimes earlier.

This phase is often misunderstood because labs may still look “normal,” yet symptoms can feel very real.

Perimenopause is not a sudden switch. It’s a gradual shift.

Common Symptoms

• Irregular cycles

• Shorter or longer periods

• Increased anxiety or mood changes

• Sleep disturbances

• Night sweats

• Fatigue

• Brain fog

• Heavier bleeding

• Increased PMS symptoms

What’s Happening Hormone-Wise

Ovulation becomes less predictable.

Progesterone is often the first hormone to decline, while estrogen may fluctuate — sometimes high, sometimes low — creating the rollercoaster many people feel.

Why Symptoms Can Feel Intense

Hormone fluctuations

Rapid shifts in estrogen can affect mood, sleep, and temperature regulation.

Lower progesterone

Reduced progesterone can lead to anxiety, insomnia, and increased stress sensitivity.

Nervous system changes

The stress response often becomes more reactive during this phase.

Metabolic shifts

Changes in insulin sensitivity can affect energy and weight distribution.

A Supportive Approach

Perimenopause is not just about replacing hormones — it’s about supporting the body through a transition.

Care may focus on:

• Supporting sleep and nervous system regulation

• Stabilizing blood sugar

• Supporting progesterone balance

• Reducing inflammation

• Optimizing stress resilience

• Supporting metabolic health

FAQ

How long does perimenopause last?

Typically 4–10 years, though it varies.

Can you still get pregnant during perimenopause?

Yes — ovulation can still occur unpredictably.

Are labs helpful during perimenopause?

They can provide context, but symptoms often guide care more than single lab values.

What age does perimenopause usually start?

Perimenopause commonly begins in the early to mid-40s, but hormonal shifts can start in the late 30s for some individuals. The timing varies widely and is influenced by genetics, stress, and overall health.

Can perimenopause cause anxiety or panic symptoms?

Yes. Fluctuating estrogen and lower progesterone can affect neurotransmitters like serotonin and GABA, which regulate mood and stress response. Many people notice new or worsening anxiety during this transition.

Why are my periods heavier during perimenopause?

When ovulation becomes inconsistent, progesterone may be lower, allowing estrogen to stimulate the uterine lining more strongly. This can lead to heavier or longer bleeding.

Can perimenopause cause heart palpitations?

Yes — hormone fluctuations can influence the autonomic nervous system and cardiovascular sensitivity, which may feel like skipped beats or fluttering sensations. Persistent symptoms should always be evaluated medically.

Why is my sleep suddenly worse?

Lower progesterone, which normally has calming effects, combined with estrogen fluctuations can disrupt sleep cycles and temperature regulation, leading to insomnia or nighttime waking.

Can perimenopause cause weight gain?

Hormonal shifts can change insulin sensitivity and fat distribution, often leading to increased abdominal weight even without major lifestyle changes.

Is brain fog normal in perimenopause?

Many people experience changes in memory, focus, or mental clarity due to estrogen’s role in cognitive function and neurotransmitter regulation.

Do symptoms happen even if labs look normal?

Yes — hormone levels fluctuate throughout the cycle and from month to month, so a single lab snapshot may not reflect the full picture. Symptoms often provide the most useful information.

Can lifestyle changes really make a difference during perimenopause?

Absolutely. Sleep quality, stress regulation, nutrition, and metabolic health significantly influence how intense symptoms feel.

How is perimenopause different from menopause?

Perimenopause is the transition phase where hormones fluctuate and cycles become irregular. Menopause is defined as 12 consecutive months without a period.

Should I be concerned about irregular cycles?

Irregular cycles are common in perimenopause, but very heavy bleeding, bleeding between periods, or cycles that are consistently very short or very long should be evaluated.

Can perimenopause affect libido?

Yes — hormonal fluctuations, sleep disruption, stress, and vaginal tissue changes can all influence sexual desire and comfort.

Does stress make perimenopause symptoms worse?

Chronic stress can amplify hormone fluctuations and increase nervous system sensitivity, often intensifying symptoms like insomnia, anxiety, and fatigue.

Is it possible to feel better during perimenopause?

Yes. With the right support, many people feel more stable, energized, and resilient during this transition.

Perimenopause is not a decline — it’s a transition that deserves support and understanding.

Dr. Kseniya Zvereva (ND) is a licensed naturopathic doctor in Washington, California, and Minnesota and founder of Xenia Integrative. She specializes in hormone imbalance, fatigue, gut dysfunction, pain, and stress-related conditions using personalized, evidence-informed naturopathic medicine.

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