Perimenopause: Awareness of Early Signs & Proactive Care

Perimenopause is a time of transition—one that can bring both physical and emotional shifts. For many, it arrives unexpectedly, disrupting familiar rhythms. Recognizing early signs, understanding what's happening, and taking supportive steps can help to make this phase less destabilizing.

What is Early Perimenopause? 

According to the STRAW criteria (Stages of Reproductive Aging Workshop), perimenopause begins when menstrual cycle patterns become inconsistent—defined as a cycle length variation of +/- 7 days. While many associate perimenopause with their mid-to-late 40s, research shows that by age 40, about 20% of women are already in the early stages.

Even before cycle become irregular, noticeable hormonal shifts can occur. This means symptoms may be earlier than expected, yet many people are told their symptoms are not hormone-related because they are still having regular periods. 

Recognizing the Early Signs

Perimenopause doesn’t follow a linear and predictable path. Some people experience mild, intermittent symptoms, while others find their routines disrupted. Because hormones fluctuate widely during this time, symptoms also fluctuate and are often transient—appearing one cycle and disappearing the next. Symptoms often appear in the late luteal phase (just before menstruation) and vary month to month.

Common signs include:

• Menstrual cycle changes – Periods may arrive earlier or later, with heavier or lighter flow. Heavy bleeding is especially common.
• Sleep disturbances – Difficulty falling or staying asleep, night waking, or reduced sleep quality.
• Vasomotor symptoms – Hot flashes, night sweats, and general temperature shifts.
• Mood fluctuations – Irritability, frustration, anxiety, or episodes of anger or rage.
• Brain fog – Difficulty concentrating, forgetfulness, or mental 'fog'.

Each person's experience wilI be unique in timing, intensity, and symptom patterns.

What you can do: Proactive Steps

While we can’t prevent perimenopause—it’s a natural part of aging—we can take steps to support you on multiple levels through the transition.

1. Track Your Cycles and Symptoms

Keeping a record of cycle changes and symptoms can help identify patterns and provide useful information for healthcare discussions.

2. Learn What to Expect

Understanding how symptoms fluctuate throughout perimenopause can make this phase feel less overwhelming. Knowledge helps you prepare for shifts, advocate for support and make informed decisions about your health.

3. Support Your Overall Health

Sleep: Aim for 7–9 hours per night. Establish consistent routine and limit screen exposure in the evening.

Nutrition: Focus on balanced meals with protein, healthy fats, and fibre to help stabilize blood sugar and energy levels. 

Support Your Nervous System: Hormonal shifts can heighten nervous system sensitivity. Mindfulness practices, movement, and time in nature can help.

4. Consider Bloodwork if Indicated

For people over 45, perimenopause is a clinical diagnosis, and lab testing is generally not indicated. However, if symptoms arise earlier, further evaluation may be appropriate.

If heavy bleeding is an issue, testing iron levels (including Ferritin) can help to rule out deficiency-related fatigue, brain fog or mood changes. Other potential assessments include: 

Vitamin D levels
Thyroid function (especially if fatigue and temperature dysregulation is present)
B12 and other key nutrients

5. Assess Your Broader Health Picture

This can be a good time to evaluate long-term health factors, including cardiovascular risk, metabolic health, and bone density, particularly if you have a family history of related conditions.

PERIMENOPAUSE IS A TRANSITION

Perimenopause is a natural phase of life, but that doesn't mean you have to navigate it alone. Your experience is valid. Understanding what's happening and taking small, intentional steps can help you feel more supported.