Is It Perimenopause? How to Know What You're Really Dealing With
Did My Mother Know She Was in Perimenopause?
Probably not—and here's why.
About 20 years ago, our mothers were going through the menopause transition, but many had no idea what was happening to them. If they didn't experience the "classic" symptoms like hot flashes or night sweats, they likely didn't connect the dots. And their doctors? They surely didn't recognize anything other than dramatic menstrual changes or hot flashes as worthy of intervention!
Fast forward to today, and women are much more informed about perimenopause (the time leading up to and for one year after the final menstrual period). Many can list off at least some of the 45 recognized symptoms and understand that simply "not feeling like myself" is a validated symptom in itself.
But here's where it gets tricky.
The Perimenopause Puzzle
Many perimenopause symptoms can overlap with—or straight-up mimic—other physical or psychological conditions that are also common at midlife. We're talking about:
Thyroid disorders
Anxiety and depression
Anemia
Heart arrhythmias
Uterine cancer
This overlap can lead to a lot of second-guessing, especially when symptoms start at an earlier-than-expected age (like your late 30s). And while changes in your menstrual cycle can be an early sign, it's not always the first thing women experience in the menopause transition.
So how do you figure out what's actually going on?
Step 1: Look at Your Age
The age range for the Final Menstrual Period (FMP) is typically 45-55, with the average being around 51.
Between 40-45: An FMP in this range is considered early but not premature
Before 40: You really need a medical assessment to investigate whether something else is going on
The perimenopause window: Symptoms can start up to 10 years before your FMP
So if you're a 35-year-old woman experiencing changes in your sleep, mood, or period pattern, you're not off-base wondering, "Am I in perimenopause?" The answer might very well be yes.
Step 2: Rule Out Other Causes
This is the detective work part, and it's crucial. Let's walk through some common symptoms and what else they could be:
Suddenly Having Heavier Periods?
It's important to rule out structural causes that can be managed, like:
Fibroids
Uterine polyps
Uterine cancer
Other potential causes include:
Thyroid dysfunction
Bleeding disorders (like Von Willebrand disease)
Low platelet count
If all of these (plus many other potential causes) have been ruled out, then what you likely have is Functional Abnormal Uterine Bleeding. Translation: the gas and the brakes of your endocrine system (the part connecting your pituitary gland with your ovaries) are no longer coordinating well, and you're probably in perimenopause.
Important side note: Do NOT accept iron supplements as the full management plan. It's crucial to know WHY you're bleeding so that a solution can be found!
Experiencing Sleep Disruption?
Do you have trouble falling asleep, staying asleep, or both?
Many patients describe being so exhausted at bedtime that they fall asleep instantly—only to wake up at 2am, 3am, or so many times they lose count. This is called WASO (Wakefulness After Sleep Onset), and it's super common in perimenopause.
Trouble falling asleep isn't necessarily perimenopause—it could also be due to:
Stress
Anxiety or depression
Excess alcohol intake
Restless legs syndrome
Sleep apnea (snoring, waking up gasping, etc.)
But if you have WASO? That's more likely connected to the perimenopause transition because it's linked to fluctuating estrogen levels and their impact on wakefulness and anxiety.
Heart Palpitations?
Very common in perimenopause, but this is one symptom that always needs to be a diagnosis of exclusion. Some women do develop true heart arrhythmias in their 40s—you never know. A test like a Holter monitor should be done to rule out something more concerning before chalking it up to hormones.
Feeling More Anxious Than Usual?
Are you worrying about things that don't seem like a big deal in the light of day? Things you wouldn't have given a second thought to 10 years ago? Have you stopped driving on the highway or traveling because you can't shake the feeling that something terrible is going to happen?
These are very common experiences during the menopause transition.
Now, layer on:
Sleep deprivation
Work stress
Aging parents
Growing children
And you have plenty of reasons for feeling more anxious!
Here's the key: Many women have a long history of low mood or anxiety. However, if those symptoms worsen or start to affect your daily functioning during the menopause transition, they're likely connected to your changing hormones.
Migraines or Headaches Before Your Period?
These can occur at any point in a woman's reproductive life, but for some women, they become more pronounced or longer-lasting as they approach menopause.
That said, there are many other potential (and more concerning) reasons why migraines may become more frequent or severe. You should never chalk it up to perimenopause without asking your doctor to rule out any "red flag" warning symptoms.
The Bigger Picture
With 45 known symptoms of perimenopause, this is far from an exhaustive list. Think of this as a starting point for your own conversation with your doctor—not a replacement for individual medical assessment or care.
A Silver Lining
Perimenopause is not an easy phase of life to navigate. The symptoms can be confusing, frustrating, and sometimes downright scary when you don't know what's causing them.
But here's something to hold onto: We are so incredibly lucky to be going through this now, at a time when the symptoms are finally recognized and women are talking about them openly.
Our mothers navigated this transition in the dark. We don't have to.
Armed with information, community, and healthcare providers who actually understand what perimenopause looks like, you can advocate for yourself, get the right tests, and find the support you need.
You're not imagining things. You're not "too young." And you're definitely not alone.
Important Disclaimer: This blog post is for educational and informational purposes only and is not intended as individual medical advice. The symptoms described here can have multiple causes, some of which require immediate medical attention. This information is meant to help you have more informed conversations with your healthcare provider, not to self-diagnose or replace professional medical evaluation. Always consult with a qualified healthcare provider about your specific symptoms, health history, and concerns. If you're experiencing severe symptoms, chest pain, unusual bleeding, or any symptom that concerns you, seek medical attention promptly.