The Change Before the Change: Signs Perimenopause is Here

What are the signs perimenopause is starting? This is a question I’ve heard time and again over my career — because frankly, we don’t talk about this enough! And as a result, lots of women don’t know if their missed period or their weight gain has to do with perimenopause…or something else. 

It’s time we have a chat about perimenopause, girlfriend. Because the signs perimenopause could be visiting you range from subtle to downright harsh. And they can start a lot earlier than you may think.

From cycle changes to vaginal atrophy, let’s talk about the signs of perimenopause and how you can make this time of transition more comfortable.

Perimenopause Definition

Perimenopause is defined as the time before menopause. The prefix “peri” means “about” or “around.” For some women, perimenopause starts as early as age 35. For other women, symptoms start later, between 4 to 10 years before menopause. 

Perimenopause is often when progesterone levels start to drop, as ovulation becomes more unpredictable. This decrease in progesterone (and other sex hormones including estrogen and testosterone) causes a whole host of frustrating symptoms, which we’ll discuss in depth in this article. 

Menopause Versus Perimenopause

Menopause is the official one-year anniversary of not getting your period for an entire year. The average age of menopause is 51. (1) But some women go through menopause early, and others hit menopause because they have a hysterectomy. 

So menopause is technically just one day of your life. But there are often many, many years that lead up to this event. And many different symptoms that manifest during this time. These years are known as perimenopause stages, or the stages of menopause

Because it’s not usually as if your body just shuts off your ovaries one day. It typically is a process that occurs over time.

What Age Does Perimenopause Start?

While we used to recognize that the age for perimenopause was just a few years before menopause, we now realize that some women begin to experience the symptoms of perimenopause much earlier than that.

The perimenopause age range is between anywhere from 35-51. Many women commonly report feeling many of the symptoms of perimenopause at 44.

What Are The First Signs Of Perimenopause?

For some women, the first signs of perimenopause may be subtle, as perimenopause estrogen levels begin to change. 

Other women get hit with horrible perimenopause symptoms from migraines to hot flashes. Because these symptoms are so wide-ranging, they are often dismissed by healthcare providers as “just PMS” or “just a part of aging.” 

The symptoms of perimenopause are so diverse, that it often looks different in every woman. 

In general, the first clues you may be experiencing perimenopause are often changes in your: 

  • Cycle (it could become shorter or longer)
  • Mood
  • Libido
  • Sleep
  • Vagina (it often becomes drier)

As you can see, many women in the beginning stages of perimenopause often experience symptoms that mimic other things. For example, you may feel depressed or anxious — and this could be due to perimenopause hormone levels. So it’s important to discuss this possibility with your doctor if you’re over the age of 35 and you start feeling “off.”

Periods In Perimenopause

Perimenopause period changes are one of the big signs of perimenopause. Perimenopause periods can be super unpredictable. But also, some women’s periods stay exactly the same and they notice other symptoms of perimenopause.

In perimenopause, you may notice:

  • More frequent periods
  • Less frequent periods
  • Heavy bleeding/heavy periods
  • Longer periods
  • Shorter periods
  • Cramps but no period

Perimenopause spotting is also a common symptom of perimenopause. However, spotting in between periods can also be a sign of something else, like fibroids, polycystic ovarian syndrome, or even cancer. So be sure to discuss this with your doctor if you experience spotting in perimenopause.

Also, if you’re in perimenopause and spotting when wiping, be sure to determine if you’re actually spotting (bleeding from your vagina) or bleeding because your vulva is dry and your toilet tissue is causing tiny tears and slight bleeding. 

Weight Gain With Perimenopause

Gaining weight in perimenopause seems like something almost every woman goes through. In fact, an analysis of international studies estimates that 39% of women going through the menopausal transition are either obese or overweight. (2)

And one study followed women in perimenopause and found they gained weight to the tune of 5-10 pounds over the course of their menopausal transition. (3)

So, if you’ve noticed that you’ve added a few pounds to the scale during this time, just know that weight gain with perimenopause is extremely common. You are definitely not alone. 

One more thing that feels important to note: this weight gain isn’t about how your looks are affected. I believe all women are beautiful at any weight and any size. From a doctor’s standpoint, however, most of the time this added weight comes with increased fasting insulin levels, higher blood pressure, and higher triglycerides. These are all symptoms that lead to unfavorable health outcomes like heart attack, stroke, and diabetes. This is why trying to keep the weight off in perimenopause is crucial. It’s got absolutely nothing to do with the size of your jeans.

Perimenopause weight gain is not a required part of your story. My Keto-Green™ way of life is the ultimate diet for perimenopause and beyond. It helps with not just weight loss, but also the brain fog and mood symptoms that often come with perimenopause, too. 

Perimenopause Vaginal Dryness

As your estrogen levels start to fall in perimenopause, you will probably start to notice changes to your vagina and vulva. The tissues of your vulva and vagina depend on estrogen to keep them hydrated and plump. So when estrogen levels change, you will often start to feel obvious differences in many ways down there. 

We’re talking about symptoms like:

  • Feeling very dry
  • Painful sex
  • Itching
  • More urinary tract infections

One of the most important tools in your perimenopause medicine cabinet, if you’re experiencing vaginal dryness, is Julva®, my patented rejuvenating cream for your vulva

Julva® helps deliver much-needed juiciness to your vulvovaginal tissues. But it’s so much more than that. It also contains dehydroepiandrosterone (DHEA), which is a naturally occurring hormone that your body turns into estrogen and testosterone. So Julva® really gets to the root of the problem and helps support your hormone levels. 

Learn more about Julva® and its’ restorative powers here.

Perimenopause Symptoms

In addition to changing periods, weight gain, and vaginal dryness, some of the other symptoms for perimenopause include (4):

  • Depression
  • Anxiety
  • Mood swings
  • Bloating
  • Fatigue
  • Nausea
  • Acne
  • Cramps
  • Hair Loss
  • Hot flashes
  • Breast tenderness
  • Breast pain
  • Heart palpitations
  • Insomnia
  • Brain fog
  • Difficulty concentrating
  • Clumsiness
  • Joint pain
  • Constipation
  • Diarrhea 
  • Back pain/lower back pain
  • Body odor
  • Body aches
  • High blood pressure
  • High cholesterol
  • Headaches
  • Migraines
  • Night sweats
  • Low libido
  • Painful sex

How Long Does Perimenopause Last?

There’s not a one-size-fits-all perimenopause experience. But for most women, perimenopause lasts somewhere between 4-15 years. One of the signs perimenopause is ending and you’re transitioning into menopause is longer stretches in between your periods. Eventually, your periods will stop coming and you’ll reach menopause.

Can You Get Pregnant During Perimenopause?

Yes, girlfriend, you can get pregnant during perimenopause. Perimenopause pregnancy is harder to achieve because you are ovulating less predictably, but it is possible. Remember that you still need to use some sort of pregnancy-preventing measure if you do not want to get pregnant during this phase of your life.

And if you do want to get pregnant during perimenopause, you may have to put in extra effort…but it is certainly not impossible.

Perimenopause Supplements

For the most part, perimenopause relief can be hard to find. Beyond hormonal contraceptives (which may or may not be the right choice for you) traditional medicine doesn’t always have a lot to offer in terms of options for perimenopausal women…and I say that as a triple board-certified gynecologist of over 30 years! 

This is why we often look to vitamins and supplements as perimenopause treatments. While we can’t stop perimenopause or menopause from happening, you don’t have to suffer through two decades of your life with mood symptoms and vaginal dryness.

Here are some of my best supplements for perimenopause.

Mighty Maca® Plus

Mighty Maca® Plus is my go-to perimenopause supplement. Why? Because in perimenopause, you have to prioritize adrenal support. Your adrenals can serve as an important backup source of sex hormones for your body when your ovaries start to produce less. 

Mighty Maca® Plus gives your adrenals a massive boost of support, thanks to the generous serving of adaptogenic maca in it. Adaptogens are natural herbs that help your adrenals chill out and feel less stressed — so they can get on with their job of producing sex hormones instead of cortisol. Mighty Maca® Plus is also loaded with great-for-you ingredients and makes nutrition easy…because I know how busy perimenopausal women are. Learn more about Mighty Maca® Plus here.


In perimenopause, progesterone levels can become less-than-ideal. Which is why supplementing with progesterone is so popular with perimenopausal women. 

Problem is, most “progesterone supplements” actually contain progestin, a synthetic version of progesterone, which is the hormone your body naturally produces. 

With my Balance Cream, I’ve fixed that problem — only including natural, bio-identical progesterone plus pregnenolone in my formula. These two hormones coupled with the other clean, natural ingredients in it make it a perfect cream for your face and neck, too. Check out Balance here.


I already mentioned Julva® earlier, but I thought I’d include it here too, since it really is one of my most popular supplements for perimenopause.

Julva® turns back the clock and helps your vaginal tissues remember their former glory. Plus, it also helps with a waning sex drive too. Learn more about Julva® and its’ vulva-restoring powers here. 

Perimenopause Can Be Beautiful

Perimenopause can be a beautiful time of transition. One where you find your confidence as a woman and really evolve. Don’t be afraid of the perimenopause signs - with a little bit of support and a whole lot of oxytocin, you really can make this transitional time in your life a lovely one. 



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Dr. Anna Cabeca

Dr. Anna Cabeca

Certified OB/GYN, Anti-Aging and Integrative Medicine expert and founder of The Girlfriend Doctor. During Dr. Anna’s health journey, she turned to research to create products to help thousands of women through menopause, hormones, and sexual health. She is the author of best-selling The Hormone Fix, and Keto-Green 16 and MenuPause.

Learn more about my scientific advisory board.