Top Signs of Perimenopause: What Every Woman Should Know (and a Few That Might Surprise You!)

“The changes are real. You’re not imagining things. And you’re definitely not alone.”

Welcome to the hormonal plot twist no one warned you about. If you're in your late 30s or 40s and feeling off, there’s a good chance you're in perimenopause—the often confusing, sometimes comical, and completely normal transition leading up to menopause.

While no two journeys are exactly alike, there are some telltale signs (and a few sneaky ones) that show up along the way. Let’s break down the most common and quirky symptoms so you can better understand what your body’s trying to tell you—and how to move through it with grace, grit, and maybe a cooling mist.

🔥 1. Irregular Periods (aka Your Cycle’s New Personality)

Your once-predictable period might now ghost you for months, then show up uninvited and overstay its welcome. From heavy to light, frequent to freakishly absent—this is often one of the first signs perimenopause is knocking.

Real talk? This part was brutal for me. My period turned into something straight out of a horror movie—“Carrie,” but on repeat. It was unpredictable, had a mind of its own, and when it arrived, it was heavy, intense, and relentless. I never knew if I was safe wearing light-colored pants or if I’d need to cancel plans… again. An IUD ended up being a total lifesaver, giving me back a sense of control when everything else felt chaotic.

Why it happens: Progesterone starts to dip first, and with estrogen going rogue, your cycles get thrown out of sync. That hormonal imbalance leads to periods that can be longer, heavier, or wildly irregular.

If your period has become a total nightmare, you are not alone. I share my own hormonal horror story in this blog: Heavy Bleeding in Perimenopause: My Story & How I Took Back Control.

💦 2. Hot Flashes & Night Sweats (Bring a Fan, Babe)

You’re sitting in a meeting and—bam!—a wave of fire rises from your chest to your cheeks. Sound familiar? Hot flashes and night sweats are classic signs that your internal thermostat is in rebellion.

I’ve been there. I used to wake up drenched—soaked sheets, soaked pajamas—the whole deal. It was like my body hit the “sweat” button and forgot to turn it off. Night after night. But once I started taking bioidentical progesterone, the night sweats completely stopped. It was a game-changer.

Why it happens: Your estrogen levels fluctuate wildly, impacting your hypothalamus (the part of your brain that regulates body temperature). Translation: you're not imagining it—your body is suddenly on fire.

If you're waking up drenched or burning up out of nowhere, you're not crazy—it’s hormonal. For deeper support, check out: Perimenopause Unfiltered: Sleep Struggles, Anxiety, and the Power of Empathy

😭 3. Mood Swings & Irritability (Snap One Minute, Cry the Next?)

Feel like your emotions have gone from Netflix drama to full-on soap opera? Thanks to hormone fluctuations, even minor stressors can feel massive.

This one’s a big one for me. I swear, some days I feel like a ticking time bomb of emotions. The tears, the rage, the overwhelm—it’s like my inner calm packed its bags and left without warning. One minute I’m fine, the next I’m crying because someone looked at me sideways. It’s not fun, but knowing it’s hormonal (and not a sudden personality shift) helps me show myself a little grace.

Real talk: You’re not losing it. You’re shifting, and your nervous system is working overtime to keep up. Support, connection, and tools like meditation, journaling, or hormone therapy can be game-changers.

This emotional rollercoaster is real, but there are ways to manage it naturally. Read: Perimenopause Mood Swings: How to Manage Emotional Ups and Downs Naturally.

🌙 4. Sleep Disturbances (Counting Sheep Not Working?)

Falling asleep like you used to? Not so much. Perimenopause brings with it restless nights, 3 a.m. wakeups, and racing thoughts—especially if you're prone to anxiety.

I’m still trying to figure this one out. Some nights I feel like I’m doing everything right, and I still wake up wired at 2 a.m. What I do know? Alcohol is a no-go—it totally wrecks my sleep. And when I need help winding down, I turn to Michelle’s Sanctuary on Insight Timer. Her meditations are like a soft hug for my nervous system and help me ease into rest.

Try this: Dial in your sleep hygiene, stay cool at night, and avoid late-day caffeine or sugar spikes. Progesterone and magnesium can help too.

If you’re up at 3 a.m. with racing thoughts, I get it. Here’s a deeper look at what helped me: Perimenopause Unfiltered: Sleep Struggles, Anxiety, and the Power of Empathy

🍑 5. Vaginal Dryness & Discomfort (Even if You’re Not in the Mood)

Let’s normalize talking about this! Vaginal tissue gets thinner and drier during perimenopause, leading to irritation, itching, or painful sex.

I experience this occasionally, and when it hits, it’s no joke. What’s helped me the most? Bioidentical vaginal estrogen. It’s been a total game-changer—restoring comfort, moisture, and making me feel like myself again down there.

Don’t suffer in silence: Vaginal estrogen, lubes, or moisturizers can restore comfort and confidence.

Want to dive deeper into this topic? Don’t miss: Dry, Achy & Over It: Reclaiming Your Vaginal Health in Perimenopause

🛑 6. Low Libido (And It’s Not Just “In Your Head”)

Maybe it’s hormones. Maybe it’s fatigue. Maybe it’s the fact that your brain is juggling 87 tabs. A drop in desire is incredibly common—but treatable.

I’ve struggled with this for years—honestly, ever since giving birth to my kids (who are now 18 and 20!). My poor husband—he’s been a trooper. But the truth is, fatigue plays a huge part in this. When you’re constantly exhausted, touched out, or overwhelmed, feeling sexy isn’t exactly top of the list.

You’re not broken. Hormonal shifts, low energy, and emotional burnout all affect your sex drive. Addressing the root causes—whether it's sleep, hormones, or stress—can help bring desire back in a way that feels right for you.

Low libido is common—and complex. Learn how testosterone, energy, and emotional wellness all play a role in this blog: Perimenopause and Testosterone: What Every Woman Over 40 Needs to Know for Energy, Mood, and Libido.

🧠 7. Brain Fog (Where Did I Put My... Wait, What Was I Saying?)

If words are hiding, and focus is elusive, welcome to the land of fog. This can be one of the most frustrating (and often under-discussed) symptoms.

This one has really hit me in the past year. Add that on top of my already overwhelmed and unorganized ADHD brain, and it’s a real challenge. Some days, just stringing a sentence together or remembering why I walked into a room feels like Olympic-level effort. It’s not just forgetfulness—it’s like my mental clarity packed a bag and left without a forwarding address.

Good news: Protein, omega-3s, sleep, and estrogen support may all help your brain bounce back.

😬 8. Electric Zaps, Itchy Skin & Tingling (Wait, What?!)

One of the lesser-known (and totally bizarre) symptoms of perimenopause? Random itching. Skin that suddenly feels dry, irritated, or just plain weird. Some women even report itchy ears or creepy-crawly sensations on their skin.

I get this too—and living in a dry climate makes it a total double whammy. Sometimes I feel like I’m scratching more than a cat on a bad day. It’s not just the weather—it’s hormonal shifts messing with collagen, hydration, and nerve endings.

Why it happens: Estrogen helps keep skin plump, hydrated, and smooth. When it drops, skin gets drier and more sensitive. And those random tingles or “zaps”? Nerves reacting to hormonal fluctuations.

What helps: Stay hydrated inside and out. Omega-3s, hyaluronic acid-rich skincare, gentle exfoliation, and moisturizing often can help keep the itch at bay.

😱 9. Increased Anxiety & Panic (Especially in the Middle of the Night)

Suddenly feeling anxious for no reason? Waking up with your heart racing or feeling like something terrible is about to happen? Yep—perimenopause anxiety is real, and it doesn’t always play fair.

This one’s been a huge pain for me—especially at night. I can lie awake catastrophizing about anything and everything. The smallest thought spirals into a full-blown worst-case scenario before I even realize it’s happening. It’s exhausting—and scary.

Why it happens: As progesterone drops (our naturally calming hormone), and estrogen fluctuates, your nervous system becomes more sensitive. Add in life stressors and midlife demands, and your body can slip into fight-or-flight mode without warning.

What helps: Deep breathing, nervous system support, magnesium, therapy, journaling, or sometimes hormone therapy. And remember: you're not "too sensitive"—your body is going through real shifts.

Want to hear my full story, from puberty to now? I open up in this post: Hormones, ADHD & Anxiety: Panic Attacks from Puberty to Perimenopause

💩 10. Digestive Drama (Bloating, Constipation, and Gas—Oh My)

Gut health and hormones are tightly linked. As estrogen and progesterone fluctuate, your digestion can suddenly feel... completely unrecognizable. Bloating, gas, constipation, diarrhea—sometimes all in the same week.

This one has been terrible for me. I can’t digest a lot of foods anymore, and it’s incredibly frustrating to watch my family enjoy things I love—but know would absolutely torment me. Am I a bit bitter about it? Yes. Yes, I am. When even your “safe” foods feel like a gamble, it’s hard not to feel defeated.

Why it happens: Hormones affect gut motility, enzyme production, and even your microbiome. So when they go haywire, your digestion often does too.

What helps: Eating slowly, managing stress, staying hydrated, cutting out known triggers (like gluten, dairy, or sugar for some), and supporting gut health with probiotics or digestive enzymes can help ease the chaos.

Your gut and your hormones are in constant conversation—especially during perimenopause. Get the full story here: Hormones, Gut Health, and Perimenopause: The Connection You Can’t Ignore.

Final Thoughts: You’re Not Broken—You’re in Transition

Perimenopause is messy, magical, and 100% real. If you’re experiencing a mash-up of these symptoms, know this: you’re not alone, and you’re not imagining things.

Advocate for yourself. Track your symptoms. Read the books. Find the doctor who listens. And lean on your girlfriends who get it.

Because this isn’t just the end of something. It’s the beginning of a new, powerful chapter.

Hormonally Yours,

Kimberlee Erin

Just a heads-up: I’m a Certified Menopause Coaching Specialist and Holistic Nutritionist, and while I love sharing what’s worked for me and my clients, this blog is for informational purposes only. It’s not a substitute for medical advice. Always check in with your healthcare provider before starting new supplements, hormones, or treatments—especially since every woman’s perimenopause journey is different. You deserve personalized care that truly fits you.