Signs You’re in Perimenopause (Even If Your Period Is Regular)
Perimenopause Isn’t Always Obvious
Many women expect perimenopause to begin when their menstrual cycles become irregular, but the truth is, the transition often starts earlier, and can bring symptoms long before your period changes.
Hormonal shifts, especially declining progesterone and fluctuating estrogen, can begin in the late 30s to early 40s, and for some women, even sooner. Despite this, women in their early to mid-40s are often told they are “too young” to be in perimenopause, even though research confirms symptoms can begin years before measurable changes in menstrual patterns.
What Exactly Is Perimenopause?
Perimenopause is the transitional phase leading up to menopause, marked by changes in ovarian function and hormone production. Menopause is defined as 12 consecutive months without a menstrual period, but perimenopause can last 4–8 years and is characterized by:
Declining progesterone production due to fewer ovulatory cycles
Fluctuating (often spiking) estrogen levels that can vary dramatically from day to day
These hormonal changes can cause symptoms well before cycle irregularity begins.
Early Signs of Perimenopause (Even With Regular Periods)
You may be in perimenopause if you have regular periods and are experiencing three or more of the following symptoms:
New or Worsening PMS – Increased breast tenderness, bloating, mood swings, or headaches in the luteal phase may indicate progesterone decline and estrogen fluctuations.
Sleep Disturbances – Waking at night, especially between 2–4 AM, without trouble falling asleep initially can be linked to lower progesterone, increased nighttime cortisol, and thermoregulatory changes.
Night Sweats or Hot Flashes (Especially Premenstrually) – Vasomotor symptoms can appear years before menopause due to changes in how the brain regulates temperature.
Mood Changes – Irritability, anxiety, or low mood, often more pronounced in the premenstrual window, are common and related to shifts in both estrogen and progesterone.
Cognitive Changes (“Brain Fog”) – Difficulty with concentration, word recall, or memory lapses can be linked to fluctuating estrogen’s effect on neurotransmitters and brain blood flow.
Unexplained Weight Changes – Even without lifestyle changes, many women notice weight gain—particularly around the abdomen—due to hormonal changes, insulin resistance, and muscle mass decline.
Heavier or Longer Flow – Estrogen surges without adequate progesterone balance can increase endometrial growth, leading to heavier bleeding or clotting despite cycle regularity.
When to Seek Support
You don’t need to wait until menopause to address symptoms. In fact, early intervention can:
Reduce the severity of hot flashes, mood swings, and sleep disturbances
Support cardiovascular, bone, and brain health for the long term
Improve quality of life, energy levels, and emotional wellbeing
Perimenopause is a natural life stage, but it’s not something you need to simply “tough out.” Even with regular cycles, changes in sleep, mood, energy, weight, or cognitive function may signal your body is entering this transition.
Ready to make a change?
If you’re experiencing symptoms that could be related to perimenopause and you’d like to talk to someone about your options, I invite you to book a free 15-minute consult at The Clara Clinic in Toronto or virtually from anywhere in Ontario.
Be well,
Dr. Olivia Kulchyk, ND, MSCP – Menopause Society Certified Practitioner