What are the first signs of perimenopause?
The first sign of perimenopause is usually a change in your periods: cycles getting shorter, longer or skipped, or bleeding becoming heavier or lighter. Many people also notice new or stronger mood swings, anxiety, worse PMS, poor sleep, night sweats or hot flashes. It usually starts in the mid-40s, though it can begin in the late 30s.
Early signs to watch for
| Sign | What it can look like |
|---|---|
| Cycle changes | Cycles a few days shorter, then later some long gaps or skipped periods |
| Different bleeding | Heavier periods with clots, or lighter ones; spotting |
| Mood changes | Irritability, anxiety, low mood or PMS that feels stronger than before |
| Sleep trouble | Waking at 3 am, lighter sleep, night sweats |
| Hot flashes | Sudden heat in the face, neck or chest, often around your period |
| Brain fog | Losing words, poorer concentration |
| Body changes | Breast tenderness, headaches, joint aches, lower sex drive, vaginal dryness |
Early on, cycles often get shorter before they get longer. That's because the follicular phase speeds up as egg reserves fall. Later, cycles without ovulation become more common and gaps between periods grow.
Why mood is often the first thing people notice
In perimenopause estrogen doesn't just fall, it swings: sometimes higher than before, sometimes much lower. For people sensitive to hormone changes, that can mean mood swings, anxiety or low mood that feel new, even before periods change much. Many describe it as PMS that has grown or spread. See perimenopause mood swings.
How to tell if it's perimenopause
There isn't one test. Hormone levels go up and down so much that a single blood test often isn't useful over 45. Doctors usually go by your age, your symptoms and how your cycles are changing. That's why a few months of notes on cycle length, bleeding, sleep and mood are so useful to bring to an appointment. Try our perimenopause self-check, and read what age perimenopause starts.
Lulu has a perimenopause mode that expects changing cycles and lets you track hot flashes, sleep and mood alongside your periods, so changes are easy to show a doctor.
When to see a doctor
See a doctor if symptoms affect your daily life, if periods become very heavy (changing protection every one to two hours) or last much longer than usual, if you bleed between periods or after sex, if cycles are closer than 21 days, or if you notice these changes before age 45. Treatments, including HRT, can help a lot. If low mood brings thoughts of self-harm, call your local emergency number, or in the US call or text 988.
Frequently asked questions
Can perimenopause start at 35?
It can begin in the late 30s for some people, though mid-40s is more typical. Symptoms before 40 should be checked, as they could be early menopause or something else.
Can you still get pregnant in perimenopause?
Yes. Fertility falls but you can still ovulate, so use contraception until a doctor says you no longer need it. See pregnant during perimenopause.
How long does perimenopause last?
On average about four years, but it can last up to eight or more. See how long does perimenopause last.
Is anxiety a sign of perimenopause?
It can be. New anxiety, especially if it comes with sleep changes or cycle changes in your 40s, is a common early symptom.
Sources
- Cleveland Clinic: Perimenopause
- NHS: Menopause and perimenopause symptoms
- ACOG: The Menopause Years
- National Institute on Aging: What is menopause?
This page is for information only and isn鈥檛 medical advice. If something worries you, please talk to a doctor.
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