Perimenopause & Menopause: The Symptoms No One Warns You About (And What to Do Next)
If you’ve ever said, “I feel like I’m falling apart… but my labs are normal,” you’re not alone.
Starting in my 30s, I started having symptoms like night sweats, itchy skin, mood changes, and disrupted sleep and I assumed it was related to hypothyroidism (underactive thyroid). My doctor said I was too young for perimenopause so it had to be my thyroid, right? Wrong.
It was perimenopause. And here’s the part no one tells you: perimenopause can start in your 30s. If you’re feeling confused, overwhelmed, or like your body is suddenly unpredictable, this post will walk you through what perimenopause really is, what symptoms to look for (including the weird ones), and what options you can consider, without shame, fear, or controversy.
What Is Perimenopause?
Perimenopause is the phase before menopause, when your hormones begin to shift and fluctuate.
This transition can last years, and symptoms often begin subtly, then ramp up over time.
During perimenopause, your ovaries may still produce estrogen and progesterone, but the levels can swing dramatically, which is why you might feel “fine” one week and completely off the next.
Perimenopause can start in your:
- late 30s
- early 40s
- mid-to-late 40s
- and yes, sometimes even earlier
And the frustrating part? Many women are told they’re “too young” for it.
What Is Menopause (Really)?
Here’s one of the most misunderstood facts about menopause:
Menopause is technically one day.
Menopause is officially defined as the point when you’ve gone: 12 full months (365 days) without a period. That one day following the 12 months is menopause. After that, you are considered: Postmenopausal. That’s the stage you’re in once menopause has occurred. So when people say “I’ve been in menopause for 10 years,” what they usually mean is: they’ve been postmenopausal for 10 years.
How Long Does Perimenopause Last?
Perimenopause can last anywhere from:
- a few years
- to 8–10+ years for some women
Perimenopause & Menopause Symptoms (Normal + Weird Ones)
For many women, symptoms start in their late 30s or early 40s and continue into their 50s until menopause is reached. The timeline can feel long because it’s not a straight line, it’s more like a rollercoaster.
Let’s talk about symptoms, because this is where so many women feel blindsided.
Some symptoms are well-known, but others are so unexpected that women don’t connect them to hormones at all. Below are the most commonly reported.
The “Common” Symptoms Most People Know
These are the symptoms you usually hear about:
Hot flashes & night sweats
- hot flashes (sudden heat rush)
- night sweats (waking up drenched)
- waking up hot then freezing
Sleep issues
- trouble falling asleep
- waking up at 2–4am
- restless sleep
- insomnia even when exhausted
Period changes
- irregular cycles
- heavier or lighter bleeding
- spotting
- skipped periods
- shorter cycles or longer cycles
The “Weird” Symptoms No One Warns You About
These are the ones that make women think something is seriously wrong (and honestly, they can be scary).
Itchy skin & skin sensations
- itchy skin (sometimes intense)
- crawling sensations
- increased skin sensitivity
- dryness or irritation
Heart palpitations
- fluttering heart
- racing heart
- skipping beats
- anxiety-like adrenaline rushes
If you ever have chest pain, fainting, or severe palpitations, always get checked—just to be safe.
Want the full checklist?
The printable version includes the complete list, including symptoms many women are never warned about.
A simple, printable checklist to help you recognize hormone-related symptoms, including the ones no one warns you about.
✔ Covers common and unexpected symptoms
✔ Easy to print or save
✔ Helpful to bring to a doctor’s appointment
✔ Designed for clarity, not overwhelm
Why Perimenopause Symptoms Can Feel Random
One of the hardest parts is that symptoms don’t always show up in a neat pattern.
You might have:
- 2 months of feeling “normal”
- followed by a sudden wave of symptoms
- then a random good week again
That’s because hormones during perimenopause don’t gradually decline in a smooth way, they fluctuate.
How Estrogen & Progesterone Support Your Body (and What Can Shift Over Time)
Hormones don’t just affect periods. Estrogen and progesterone support many systems in the body, which is why changes during perimenopause can feel so widespread.
Estrogen Supports:
- Bone health — helps maintain bone density
- Heart & blood vessel health — supports healthy cholesterol balance and blood vessel flexibility
- Brain & nervous system function — influences mood, memory, focus, and temperature regulation
- Skin, joints & connective tissue — supports collagen, lubrication, and elasticity
- Vaginal & bladder health — helps maintain tissue strength and urinary comfort
As estrogen levels decline over time, some women may become more vulnerable to:
- bone loss (osteopenia or osteoporosis)
- cardiovascular changes later in life
- vaginal dryness or discomfort
- bladder symptoms or recurrent UTIs
- joint stiffness or aches
Progesterone Supports:
- Sleep quality
- Calming the nervous system
- Mood stability
- Balancing estrogen’s effects on the uterine lining
When progesterone fluctuates or declines (often early in perimenopause), some women notice:
- anxiety or feeling “wired but tired”
- trouble falling or staying asleep
- heavier or irregular periods
- increased sensitivity to stress
The Reassuring Part
These changes happen gradually, not overnight. They don’t mean something is “wrong,” and they don’t mean problems are inevitable. Think of midlife as a window of awareness, not a countdown clock.
Understanding how hormones affect your body gives you the opportunity to:
- support long-term health
- reduce symptom intensity
- and make informed choices with a provider you trust
What Helps? Support Options (Without the Pressure)
There isn’t one “right” way to handle perimenopause and menopause.
The best plan is the one that:
- improves your quality of life
- fits your health history
- feels right for your comfort level
- is guided by a professional you trust
Here are a few common support options.
Lifestyle Support (The Unsexy but Powerful Basics)
These aren’t trendy, but they matter.
Helpful habits include:
- keeping your bedroom cool at night
- limiting alcohol (it can worsen hot flashes)
- reducing caffeine if anxiety/sleep issues are worse
- prioritizing protein + fiber (blood sugar support)
- strength training (supports metabolism + bone health)
- daily walks (stress + sleep support)
- stress regulation (breathing, stretching, nervous system resets)
Even small changes can reduce symptom intensity.
Hormone Replacement Therapy
Hormone replacement therapy (HRT) is one of the most debated topics in the menopause world.
Some women feel it gave them their life back. Others prefer not to use it at all. Both choices are valid.
Why people are cautious about HRT
Many women grew up hearing that hormone therapy causes breast cancer.
That fear largely traces back to a large study from decades ago that shaped public perception for years, even though research and recommendations have evolved since then.
What’s different now
Today, many providers use modern options such as:
- lower doses
- different delivery methods (like patches)
- and sometimes bioidentical hormones
Bioidentical hormones are designed to be structurally similar to hormones your body naturally produces.
Important note: “bioidentical” doesn’t automatically mean risk-free, and hormone therapy is not one-size-fits-all. It’s something to discuss with a qualified medical provider.
If you’re curious about HRT, it may be worth having a conversation with a menopause-informed doctor who can explain options based on your health history.
Here is a link to a podcast I found very helpful with Gary Brecka, a human biologist. The podcast is called The Ultimate Human Podcast and he shares his wife’s journey to menopause on this episode. You can watch it HERE.
Supplements That May Help (Symptom-Based)
Supplements can be helpful for some women, but results vary.
Always check with your doctor, especially if you:
- take medications
- have thyroid issues
- have high blood pressure
- have a history of hormone-sensitive conditions
Here are a few that are commonly discussed:
Hot flashes + night sweats
- Black cohosh (short-term use and not for everyone, discuss with your provider)
- Evening primrose oil (mixed results, but some women like it)
- Magnesium glycinate (helps sleep + calming)
Sleep support
- Magnesium glycinate
- Melatonin (short-term support for some)
- L-theanine (calming, can support sleep)
Mood + anxiety support
- Ashwagandha (stress support for some)
- B-complex (energy + mood support, depending on your needs)
- Omega-3s (brain + inflammation support)
Joint aches + inflammation
- Omega-3
- Turmeric/curcumin
- Vitamin D (if low)
Brain fog + energy support
- B12 (especially if low – have your doctor test your levels)
- Electrolytes + hydration (simple but helpful)
- Have your doctor check your iron levels
Vaginal + urinary support
- Vaginal moisturizers (non-hormonal options exist)
- D-mannose (often used for urinary support)
- Probiotics (some women find helpful)
Supplements can be supportive, but they aren’t a replacement for medical care if symptoms are severe.
When to Talk to a Doctor (Even If You Think It’s “Just Hormones”)
Perimenopause can explain a lot, but it’s still important to rule out other issues. Consider seeing a provider if you have:
- very heavy bleeding or bleeding after sex
- bleeding after menopause (after 12 months without a period)
- severe depression or anxiety
- chest pain or fainting
- extreme fatigue that doesn’t improve
- sudden unexplained weight loss
You deserve to feel taken seriously.
Final Thoughts: You’re Not Crazy—You’re Not Alone
If perimenopause started for you early, you may have spent years feeling confused, dismissed, or frustrated. I know I did.
But once you understand what’s happening, everything starts to make more sense:
- your symptoms are real
- your experience is valid
- and there are options to help you feel like yourself again
Perimenopause and menopause aren’t just “hot flashes.” They can affect your sleep, skin, mood, brain, weight, confidence, and quality of life. And the more we talk about it openly, the more women stop suffering in silence.
Key Takeaways on Perimenopause & Menopause
- Perimenopause can begin in your 30s or 40s
- Symptoms are often inconsistent and unpredictable
- Hormone levels fluctuate, not decline smoothly
- Symptoms go far beyond hot flashes
- Labs can appear “normal” even when symptoms are real
- Support options exist for lifestyle, medical, or both
- You are not imagining this, and you are not alon
Frequently Asked Questions
Can perimenopause start in your 30s?
Yes. Many women begin noticing symptoms in their 30s, especially subtle ones like sleep disruption, anxiety, itchy skin, or cycle changes.
What is menopause exactly?
Menopause is officially reached after 365 days without a period. That day is menopause, after that, you’re postmenopausal.
Is hormone therapy safe?
It depends on your personal health history. Many women choose it and do well, others don’t. It’s best discussed with a menopause-informed provider.
Related Posts:
- Understanding Insulin Resistance in Midlife
- The Realistic 12-Week Workout Plan for Women Over 50 (No Gym Required)
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