KEY TAKEAWAYS:
• Perimenopause can start earlier than expected and may last for several years.
• Symptoms extend beyond hot flashes, affecting mood, sleep, memory and physical health.
• Experiences vary widely — no two women have the same symptoms or timeline.
• Feeling “off” or unlike yourself can be an early and important signal.
• Perimenopause symptoms are real, even when they’re subtle or hard to explain.
• Talking with a healthcare provider can help you understand symptoms and explore options.
• Support from others can make this stage feel less isolating and more manageable.
SUMMARY:
Perimenopause is a gradual transition that often begins before many women expect and brings a wide range of symptoms beyond the commonly understood ones. Because experiences vary, early signs are easy to overlook or dismiss. Recognizing what’s happening — and talking with a healthcare professional — can help you better understand your options and feel more in control. Most importantly, you don’t have to navigate this stage alone.
I sent my doctor a message through MyChart telling her I didn’t feel like myself. I wasn’t sick or in pain. But I felt discouraged in a way I couldn’t quite explain. I’d gained weight I couldn’t shake, even though my habits hadn’t changed. I also noticed I felt less motivated and more disconnected. Something was off. I just didn’t have a clear reason why.
That MyChart message led to an appointment.
Sitting across from my doctor, I shared my suspicions. “I think I’m in menopause. I’m not having hot flashes, but my periods are getting more and more irregular.” I’d even started a note in my phone — my “pause log” — when my periods stopped following the predictable schedule I’d known my whole adult life and started showing up whenever they felt like it.
She smiled and gently corrected me. Menopause, she explained, is a single milestone. It’s the moment you’ve gone a full year without a period. Everything leading up to it, sometimes for years, is perimenopause.
I immediately felt disappointed. I long believed that when menopause happens, it happens quick. Now my doctor was telling me this general unsettled feeling I had about myself could last years.
The hormonal shifts, seemingly unexplained symptoms and overwhelming sense that your body is operating by a different set of rules — that’s perimenopause.
And I had no idea I’d already been living in it.
Confronting my symptoms of perimenopause
I knew eventually hot flashes would come with perimenopause, but what else did the years ahead have in store? Looking back, I wish I could tell myself, “Hold on, sister — there’s so much more to this wild ride.”
The next shock of perimenopause came when my chin decided to resort back to its teenage self. I was suddenly dealing with awful cystic acne. This prompted yet another MyChart message, accompanied by a close-up photo of my clearly angry skin.
Hooray! The hormonal acne box got filled on my perimenopause bingo card.
Next up: chin hairs. Wonderful. Nothing prepares you for that moment when you touch your chin and feel something sharp poke your finger. Is that a… whisker? Tweezers, now! In those moments, it was hard to concentrate on much else.
And concentration became its own challenge. I started losing words mid-sentence or forgetting why I walked into a room. Brain fog is a very real perimenopause symptom that can make you feel like you’re losing your mind. It’s also a symptom that can be easily dismissed. You’re not alone.
Then the anxiety hit. My life was already in transition, as my oldest child was finishing his senior year of high school. The flood of college applications made me feel both proud and scared. I’d wake up in the middle of the night with a racing mind, thinking about how our family was changing and the unknowns that lay ahead. Many nights, I couldn’t relax and fall back asleep.
As promised, the hot flashes did eventually appear. No one can fully prepare you for the heat that builds in your core and rushes up your chest to your face. The sensation frequently made clothing feel unbearable. My husband couldn’t believe I’d abandoned my beloved blankets after years of running cold.
Finally, I had one of the most bizarre symptoms I’ve ever experienced: itchy ears. I remember rubbing my ears and feeling like they were on fire. The skin became so dry, I felt like I was constantly moisturizing to try to overcome it. I didn’t know that reduced estrogen causes skin to lose moisture.
Those were just my symptoms. Perimenopause has a notoriously long and surprising list of other things that can show up. In fact, researchers have identified up to 34 symptoms associated with perimenopause. No two women experience the same combination. Here are some worth knowing about.
Perimenopause symptoms most people expect
- Hot flashes
- Irregular periods
- Night sweats
Perimenopause symptoms that can surprise you
- Bloating
- Facial hair
- Hair thinning or loss
- Headaches
- Heart palpitations
- Hormonal acne
- Itchy or dry skin
- Joint aches and stiffness
- Weight gain, especially around the mid-section
Perimenopause symptoms that can disrupt daily life
- Anxiety, especially at night
- Brain fog and word-finding difficulty
- Depression or low mood
- Difficulty concentrating
- Fatigue
- Irritability
- Loss of motivation
- Memory lapses
- Mood swings
- Sleep disruption
Perimenopause symptoms that don’t get discussed enough
- Body odor changes
- Breast tenderness
- Changes in libido
- Digestive changes
- Dizziness
- Dry eyes
- Electric shock sensations
- Gum and mouth changes
- Painful sex
- Tingling in hands and feet
- Tinnitus (ringing in the ears)
- Urinary urgency or leaking
- Vaginal dryness
Perimenopause symptoms can start as early as the late 30s, though most women first notice symptoms in their mid-40s with the average age being 47. The lack of a single timeline is exactly what makes perimenopause so easy to dismiss.
If you’re reading this list and it’s setting off alarm bells, know that it’s not all in your head. Trust your instincts and consider a conversation with your doctor.
How I took control of perimenopause
While my perimenopause symptoms were filling up that bingo card, I never felt alone. My doctor and friends were a source of empowerment, surrounding me with support I was grateful to accept.
When I started talking with my doctor about treatments to manage my perimenopause symptoms, I expressed concern about hormone replacement therapy (HRT). A close friend of mine chose not to take it because of her mother’s breast cancer. Like many women, I’d heard concerns about HRT and breast cancer risk. It’s also important to know that my father experienced a massive stroke at age 50. That life-altering event shaped how I approached my own health — and ultimately led me to make different choices about hormonal birth control.
My doctor was patient and informed. She helped me understand that today’s HRT isn’t the same as our mothers’ hormone therapy. She also explained that HRT isn’t usually the first step – timing matters, and whether it’s even the right option depends on where you are in the perimenopause transition and your individual health picture. Together, we weighed the risks and my family history with the benefits to make an informed decision for me.
She also recommended I get a bone density scan to understand my bone health at the start of perimenopause. After years of lifting weights, I was surprised to learn that I had signs of osteopenia, a condition where bone density is lower than normal. I learned that continuing to lift weights would be crucial to keeping my bones from further degenerating.
It wasn’t just conversations with my doctor that helped. I was leaning on the women in my life as well. We shared notes on our unique symptoms. We related with each other about this weird, disruptive stage of life. It was through such close connection that we found some form of relief. From hand-held fans to doctor-recommended supplements and infinite online articles, we validated our experiences.
Don’t discount sharing your struggles with your partner, either. My husband couldn’t fully understand what I was going through, but I shared it all with him. He was understanding, supportive and often just as surprised as I was with the symptoms.
You don’t have to figure perimenopause out alone
If you’re reading this and nodding along, I want you to know something: you are not being dramatic. You are not falling apart. You could very well be experiencing perimenopause, and there’s a difference.
Talk to your doctor — not because you must, but because you deserve a partner in this chapter of your life. Ask about bloodwork. Ask whether a bone density scan makes sense for you. My doctor brought it up unprompted, and it opened a conversation I’m glad we had.
Ask all the questions you’ve been thinking about at 2 AM. Every woman’s perimenopause looks different – no two timelines, no two symptom combinations, no single right answer. What matters is knowing your own body well enough to start the conversation.
You don’t have to figure this out alone. I promise you have more company than you think.
Find support from OhioHealth here.
About the author
Missy Gleason is the Advisor of Brand Journalism and Social Media at OhioHealth. A veteran healthcare storyteller with more than 25 years of experience, including a background as a television news producer, she’s passionate about translating clinical expertise into content that helps women feel informed and empowered.
