Content medically reviewed by Caitlin Pandolfo, MD

Not feeling like yourself, and not sure why? Have irregular periods caught you by surprise? Are night sweats interrupting your sleep? If you're in your 30s or 40s and answered yes, you may be experiencing perimenopause symptoms.

Stuck in the Middle With Yourself

The word "menopause" is often misused to represent the entire menopausal transition, but it's only one part of the process. Perimenopause, when your body begins the transition to menopause and you begin to experience menopause symptoms, comes first. When you've gone 12 months without a period, that’s the definition of menopause. After menopause comes postmenopause and life without ovulation and menstruation.

The average age a woman experiences menopause is at 51 or 52. However, it can take five to seven years for periods to stop completely. This means perimenopause generally starts in your 40s. Some women, however, may notice changes in their mid-30s.

Perimenopause begins when the body starts producing less estrogen, a hormone needed for reproduction. During perimenopause, estrogen production slows, leading to periods stopping and a range of symptoms.

"Most people don't realize it's not just your period going away," said Dr. Caitlin Pandolfo, OB/GYN at Essentia Health. "You either start missing periods, or they come more frequently. They're heavier or lighter. Everything gets weird. That encompasses the perimenopause transition."

In the first stage of perimenopause, more frequent periods are common. Some women may see their regular 28-day cycle shrink to fewer than 21 days. Then, menstrual cycles usually lengthen. By the final stage of perimenopause, cycles—from the first day of one period to the first day of the next period—may last more than 36 days before eventually stopping.

Expected & Unexpected Perimenopause Symptoms

As hormone levels fluctuate, irregular periods are often the first noticeable signs of perimenopause. However, they aren’t the only signs to look out for.

"Perimenopausal mood swings are often a bit of a surprise for people," Dr. Pandolfo said. "You can be more irritable. You can feel not quite like yourself, and a lot of it can tie into sleep because sleep becomes significantly disrupted."

Other perimenopause symptoms includ:

• Anxiety.
• Changes in sex drive.
• Difficulty concentrating.
• Hot flashes and night sweats.
• Increased forgetfulness.
• Slowing metabolism, often leading to weight gain.
• Thinning hair.
• Vaginal dryness.

Responding to Perimenopause Symptoms

While perimenopause doesn't last forever, it might feel that way for a while. Still, you don't need to suffer through it. Lifestyle changes can help you improve your overall well-being and better tolerate symptoms. Regular exercise, a diet rich in fruits, vegetables, and whole grains, and stress management can help. You can also wear breathable fabrics, such as cotton, and use a fan to keep cool. To sleep more comfortably, lower the room temperature and place an ice pack under your pillow.

Medications can also help manage symptoms. Hormone-replacement therapy, for example, can help ease perimenopause symptoms by regulating hormones.

"If you're suffering, we can fix a lot of symptoms nonhormonally and with hormones," Dr. Pandolfo said. "I encourage people to be open to all of the options for medication management to make the whole transition a lot more comfortable."

Could It Be Anything Else?

Some cancer treatments can trigger menopausal symptoms. Other conditions that may cause similar symptoms include pregnancy and thyroid conditions. No matter the cause of symptoms, it's always good to check in with your primary care provider or gynecologist, who can order blood tests to check hormone levels and look for other possible conditions.

"If you're younger than 40 and you're experiencing menstrual irregularities, come see us," Dr. Pandolfo said. "It's worth talking to someone to see if there's something else that needs to be addressed."

Take Action for Long-Term Health

In addition to noticeable symptoms, the menopausal transition brings changes you can't see, such as bone density loss and higher cholesterol levels.

During perimenopause and after you've reached menopause, being proactive about your health can lower your risks of developing many health issues and improve your quality of life. If you aren't already practicing healthy habits, perimenopause is a great time to start.

• Adding a calcium and vitamin D supplement.
• Eating a balanced diet.
• Managing stress.
• Participating in strength training along with aerobic activity.
• Sticking with a consistent sleep routine.
• Talking with your provider about bothersome or concerning symptoms.

"A lot of my patients come in and say, 'I was done having babies, so I stopped coming to the gynecologist,' and it's now 20 years later," Dr. Pandolfo said. "They're coming back with a list of complaints that we could have addressed sooner. Just mentioning it to us is important. We can make sure the seasons of perimenopause, menopause' and later life are all comfortable."