By Allison Danish, MPH

Feeling not quite yourself lately? Tired, irritable, waking up throughout the night? Maybe it’s just stress, and maybe… it’s perimenopause.

That magical stage before menopause, “Perimenopause is a time of transition when reproductive hormone levels, like estrogen and progesterone, are volatile and it can last anywhere between 2-10+ years,” says Dr. Alyssa Dweck, MS, MD, FACOG, practicing OBGYN and Chief Medical Officer of Bonafide.

Because many of us assume menopause is a challenge for 50-something-year-old us to deal with, perimenopause may seem like a far-away billboard on the long road trip of life. But as Dr. Dweck says, “With the average age of menopause in the US being 51 years old, the average age of perimenopause can range widely from one’s early 40’s onward, with some experiencing symptoms as early as their late 30’s.”

Speaking of experiencing symptoms, what are some of the most common signs of perimenopause? What should you be on the lookout for so you’re not blind-sided?

Signs you may be in perimenopause

While signs and symptoms of perimenopause can run the gambit, from as common (and iconic) as hot flashes to as rare as tinnitus—here are 5 of the most common signs according to Dr. Dweck.

1.    Mood changes

It’s common for people going through perimenopause to experience mood swings, irritability, and even symptoms of anxiety and depression. Experts aren’t entirely sure why—but theories generally implicate a complex mish-mash of hormonal changes, stress, sleep disruption, hot flashes/night sweats, and (more recently) the amount of white matter in certain estrogen-sensitive parts of the brain.

But what we do know for sure is you’re not going crazy—this is a very real symptom of perimenopause and you are not alone. 4 in 10 people experience PMS-like symptoms during perimenopause; perimenopausal people are 40% more likely to develop depressive symptoms than premenopausal people; and up to 25% of perimenopausal people may develop anxiety. Keep an eye on these changes, and be sure to reach out to your doctor or a therapist for help managing these symptoms.

2.    Sleep disruption

56% of perimenopausal people reporting disrupted sleep—that’s over half! Often these sleep disturbances can be attributed to hot flashes and night sweats, but newer research suggests that the hallmark hormonal changes seen during perimenopause may also contribute to waking during the night. Scientists don’t know exactly how this works, but there’s evidence that estrogen affects your sleep!

3.    Hot flashes + night sweats

Up to 70% of perimenopausal people experience hot flashes + night sweats (also known as vasomotor symptoms). Caused by the decrease in estrogen, the part of the brain that’s responsible for temperature regulation is affected—that means its response to changes inside the body or in the environment are out-of-whack. This is what results in flushing, sweating, reddening of skin, or even sudden chills.

4.    Menstrual irregularities

Oftentimes the first symptom people notice, menstrual irregularities can be expected in pretty much everyone in perimenopause. As hormones begin to fluctuate on the perimenopause rollercoaster, so does ovulation—so you may skip periods, see the time between periods shorten or lengthen, or notice a lighter or heavier flow than usual.

5.    Vaginal dryness + pain during sex

Vaginal dryness and pain during sex (dyspareunia) are some of the symptoms associated with genitourinary syndrome of menopause (GSM)—which is also pretty common! Anywhere from 13-87% of perimenopausal/postmenopausal people experience GSM-like symptoms.

Dr. Dweck says this happens because, “Estrogen levels are variable and trend downward as menopause approaches. Lower estrogen results in less blood flow and natural lubrication in the vagina.  Because of this, vaginal tissue gradually becomes thinner and less elastic, which can contribute to less comfort during sex.”

Lubricants and moisture-providing vaginal suppositories are great over-the-counter tools to help combat dryness and discomfort. Bonafide’s Revaree is one suppository formulation our team personally loves—made with hyaluronic acid, a naturally-occurring substance in our bodies, it can provide hormone-free relief from dryness. You can also discuss local estrogen with your doctor, which has been shown to be effective for treating persistent symptoms of GSM.

You might also find Ohnut, a squishy buffer made to limit the depth of penetration, useful if deeper penetration hurts. If you’re experiencing entry pain, Kiwi may also be a helpful tool to bring in blood flow and relieve tension in the superficial pelvic floor muscles (which can become tight in response to repeated painful experiences during sex).

What to do if you suspect you’re in perimenopause

So, you’re around the right age and you’ve been noticing some symptoms of perimenopause—now what?

Dr. Dweck recommends starting with, “Education! Since genetics matter when it comes to age of onset of menopause and the severity of your experience, learn from your mom, sisters, grandmothers and aunts [and other relatives] about their experience with perimenopause (and menopause).”

Beyond education, you may find it helpful to start thinking more about your overall health. “Be proactive by optimizing your diet, exercise routine, sleep hygiene and stress reduction techniques,” Dr. Dweck advises. “Also keep a menstrual diary to help track your cycles.”

As we mentioned above, your cycle will very likely get wonky in perimenopause—it can be helpful to keep track of the frequency and quality of your periods!

Last, but not least, Dr. Dweck suggests, “consider[ing] the need for symptom management; with both hormone-free and hormonal options available, as there is certainly no need to suffer!” 68% of people report not treating their perimenopause symptoms—but there are healthcare professionals and tools out there who can make your menopause transition more comfortable.

How to prepare for perimenopause

Not quite in perimenopause, but want to prepare yourself for when the time comes? Look at you, so proactive! As Dr. Dweck says, “It’s never too early to adopt and optimize healthy lifestyle habits.” Here are a few of her suggestions that hold true before, during, and after perimenopause:

1.    Education

Perimenopause may not even be on your radar right now, but one of the best things you can do is learn about it! Dr. Dweck says, “Educating yourself on the symptoms and solutions available to you is also key, so you can feel more prepared for what may come during this transitional time.”

2.    Diet

Research shows that lifestyle factors, like nutrition, play a large role in the risk of developing cardiovascular disease, insulin resistance, and other negative health outcomes that are commonly associated with age and thus menopause and perimenopause. Dr. Dweck recommends the Mediterranean diet because it “is ideal as a heart healthy, low glycemic regimen for managing weight and mitigating certain medical issues that can be more common with lifestyle, aging and menopause.”

3.    Exercise

“A regular exercise regimen,” Dr. Dweck says, “which includes not only cardio (150mins/week), but also weight training for flexibility and strength is imperative, as we all lose muscle with age and face an increased risk of osteoporosis with menopause.”

This loss of muscle mass (sarcopenia) can start in your 30s and 40s, and you can begin losing bone density after 25. Check out these workout recommendations for perimenopause!

4.    Stress reduction

“Stress reduction through yoga or meditation is admittedly difficult, but imperative,” says Dr. Dweck. Research shows mindfulness-based stress reduction may be helpful for reducing depressive symptoms and other symptoms associated with perimenopause. Apps like Headspace can help guide you on your mindfulness journey. Optimizing sleep hygiene by following a regular sleep schedule, developing a sleep routine (reading a book, taking a bath, etc.), and avoiding stimulating activities or substances close to bedtime (drinking caffeine, watching TV, using your phone in bed) may also be helpful for combatting stress and sleep disturbances.

At the end of the day, aging is a privilege and perimenopause is just a normal part of it. Luckily, you have the power to learn about your body, make positive lifestyle changes, and pursue tools & treatment options to manage your symptoms so you can keep kicking booty.