Perimenopause: 10 signs you're already in it (perhaps without realising)

Perimenopause, or premenopause, is a natural hormonal transition phase that precedes the menopause. It can begin as early as the age of 35–40, or even earlier in some women — well before you might imagine being affected by these changes. Recent studies reveal that more than half of women aged 30 to 35 already experience moderate to severe symptoms of perimenopause. This gradual process generally spans 4 to 10 years, although this duration can vary considerably from one woman to another [1][2].

Unlike the menopause (which marks the permanent cessation of periods for 12 consecutive months), perimenopause refers to the period when your hormones begin to fluctuate erratically. Your cycles may become irregular, but you are still ovulating.

1. Irregular or unpredictable menstrual cycles

Your periods arrive early, late, skip a month, then return as if nothing happened. They may be heavier or, on the contrary, very light. This is often the first sign of perimenopause — and also the most common.

2. Disrupted sleep and insomnia

You have difficulty falling asleep, you wake up several times during the night, and your sleep is no longer as restorative as it once was. These disturbances may be directly linked to declining progesterone levels, which affect GABA receptors in the brain — the very ones that promote relaxation and deep sleep[3].

3. Irritability and mood swings

You swing from laughter to tears for no apparent reason, you regularly feel on edge, anxious over small things. Rest assured, it is not just "in your head": hormonal imbalance has a direct impact on your nervous system and your neurotransmitters.

4. Persistent fatigue and loss of energy

You feel exhausted even after a good night's sleep. This chronic fatigue comes with a general sense of low energy in everyday life. You no longer have the same energy as before.

5. Hot flushes

Sudden waves of heat wash over your face, neck or chest. They can occur during the day or at night, causing night sweats that disrupt your sleep even further. Even when mild, they are a telling sign of perimenopause.

6. Worsening premenstrual syndrome (PMS)

Your PMS becomes more intense than before: ultra-sensitive breasts, bloating, cramps and irritability are all amplified in the days leading up to your period. Anovulatory cycles also become more frequent, which further intensifies symptoms.

7. Difficulty concentrating and memory issues

You feel as though you are in a "mental fog". You search for words, lose your train of thought and struggle to concentrate, sometimes even for just a few minutes. These memory lapses and mental confusion are directly linked to hormonal fluctuations.

8. Reduced libido

Your sexual desire diminishes without any obvious explanation. You simply have "no desire" any more, or far less than usual. This drop in libido can sometimes be accompanied by vaginal dryness.

9. Weight gain

Even though your eating habits haven't changed, you are gaining weight, particularly around your abdomen and waist. Your metabolism is slowing down and the distribution of body fat is shifting. Weight comes on more easily and is harder to shift.

10. Joint pain

Your joints are causing you pain: shoulders, knees and hands. Less well known, these joint pains are nonetheless a relatively common symptom of perimenopause. Oestrogen plays a protective role in joint health, and fluctuations in its levels can be the source of this discomfort.

Progesterone is in freefall

Around the age of forty, progesterone is the first hormone to decline, due to an increase in anovulatory cycles (cycles without ovulation), which become the majority in late perimenopause[4]. 

To stay calm and sleep well, your brain relies on progesterone. This is converted into a soothing substance (allopregnanolone) that activates the receptors responsible for sleep and serenity. When progesterone declines, this protection disappears: your neurones become overexcited, triggering stress and insomnia[3].

Your periods may also become heavier due to anovulatory cycles, where the absence of progesterone allows excessive proliferation of the endometrium.

Oestrogen levels fluctuate significantly

Contrary to what one might expect, oestrogen does not decline in a linear fashion during perimenopause. On the contrary, it fluctuates unpredictably, sometimes reaching levels twice as high as those seen in the late follicular phase of a normal cycle, before dropping to levels lower than those during the reproductive years. 

These "hormonal rollercoasters" are driven by extreme fluctuations in FSH (follicle-stimulating hormone), which attempts to stimulate an ever-decreasing number of increasingly unresponsive ovarian follicles.

A Swiss longitudinal study of 127 perimenopausal women[5] has shown that there is no continuous decline in oestradiol over 12 months, but rather stable periods interspersed with significant fluctuations that vary considerably from one woman to another. These unpredictable variations explain why your symptoms appear and disappear without any apparent logic.

FSH and LH go into overdrive

When your ovaries begin to tire, they send fewer signals, in particular via a substance called inhibin B. Your brain notices this slowdown and, in an attempt to "wake the system up", begins to produce large quantities of two controlling hormones: FSH (follicle-stimulating hormone) and LH (luteinising hormone).

Result: FSH levels can rise well above normal:

• Between 10 and 25 IU/L: You are probably entering perimenopause.
• Above 25 to 30 IU/L: You are close to the menopause.

Please note: as the ovaries still have occasional bursts of activity, these levels can be irregular from one month to the next[6][7].

Cortisol levels rise

When stress becomes chronic, it strongly activates the HPA axis (the body's alert response system). This activation releases specific hormones, such as CRH, which act directly on the brain to suppress the production of GnRH (the hormone that controls the ovaries). As a result, oestrogen and progesterone production decreases. Biologically, your body chooses to mobilise its resources for the stress response rather than for reproductive functions[8].

This disruption creates a chain reaction:

• Hormonal fluctuations cause physical symptoms, such as fatigue or irritability.
• These symptoms are interpreted by the body as additional stress, which drives cortisol levels higher.
• Elevated cortisol in turn worsens the initial symptoms, particularly sleep.

This phenomenon is particularly pronounced at night: fragmented sleep disrupts the HPA axis and can cause cortisol levels to spike by 27% at bedtime. Instead of calming down for the night, the body remains on high alert, which sustains fatigue and insomnia over the long term[9].

Listen to your body

If several of these symptoms are present and affecting your daily life, it is time to talk about them. You do not have to suffer in silence or "just get on with it".

Hormonal testing is not routine

Contrary to popular belief, hormonal testing is not always necessary to diagnose perimenopause. Hormone levels fluctuate enormously from one day to the next during this phase, which in any case makes interpretation complex.

When should you seek advice?

Make an appointment with your GP or gynaecologist if your symptoms are debilitating or if you have any concerns. The healthcare professional will be able to assess your overall situation and suggest suitable solutions.

Possible investigations

If necessary, your doctor may request a blood test for FSH (a level between 10 and 25 IU/L suggests perimenopause) and oestradiol. However, the diagnosis is based first and foremost on listening to your symptoms.

Adaptez votre hygiène de vie

Privilégiez un sommeil régulier, même si c'est difficile. Pratiquez une activité physique régulière (marche, yoga, natation) afin de réguler votre stress et maintenir votre métabolisme. Adoptez une alimentation équilibrée, riche en protéines (ou orientez vous vers un complément protéine ménopause si besoin), en oméga-3, en fibres et en légumes variés. Limitez les excitants (café, alcool) qui ont tendance à amplifier les bouffées de chaleur et les troubles du sommeil.

Appuyez-vous sur une solution naturelle avec Péri Essentials

Conçu par Jolly Mama, Péri Essentials est un complément alimentaire spécialement formulé pour accompagner les femmes en périménopause. Sa formule 100 % vegan réunit 17 nutriments essentiels, dont les vitamines B2, B3, B5, B6, B9, B12 et C qui contribuent à réduire la fatigue et soutenir le métabolisme énergétique.

Péri Essentials contient également du Bacopa Bacognize®, un extrait breveté dont l’objectif est de soutenir les fonctions cognitives, la concentration et la mémoire, particulièrement utile contre le « brouillard mental ».

La vitamine B6 aide quant à elle à réguler l'activité hormonale, tandis que la biotine contribue au maintien de la peau et des cheveux. Seulement 2 gélules par jour suffisent pour faire toute la différence au quotidien !

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Faites-vous accompagner par un professionnel

Dans tous les cas, ne restez pas seule avec vos symptômes. Parlez-en à votre médecin, votre gynécologue, à d'autres femmes qui vivent la même chose ou rejoignez des groupes de parole. La périménopause n'est pas une maladie, c'est une transition naturelle qui concerne toutes les femmes. Quels que soient les signes que vous rencontrez, vous méritez d'être entendue, comprise et accompagnée !