If you're between 35 and 50 and something just feels “off” but your labs are normal and your doctor tells you “everything looks fine.” You might be in perimenopause. And no, you’re not imagining it.
If you're between 35 and 50 and something just feels “off” but your labs are normal and your doctor tells you “everything looks fine.”
As a physician, I’ve seen countless women told they’re “too young” or “just stressed” when they bring up sleep issues, mood swings, or unexplained weight gain. But the truth is, perimenopause can begin up to 10 years before your last period. That means symptoms can start as early as your mid-30s. And they’re often subtle, dismissed, or misattributed.
In this post, I’ll walk you through the 10 most common early signs of perimenopause; what to watch for, why they happen, and how we address them at Bespoke Medicine.
Perimenopause is the transitional period before menopause, marked by hormonal shifts (especially in estrogen and progesterone) that affect nearly every system in the body. It ends when you’ve gone 12 consecutive months without a period (menopause).
This isn’t a light switch. It’s a spectrum. Hormone levels fluctuate dramatically in perimenopause, creating symptoms that ebb, intensify, and change over time. Which is why static lab tests often miss it!
You fall asleep fine… but then you’re wide awake at 3 a.m., night after night.
This is one of the first and most common signs of perimenopause. Shifting progesterone (a calming hormone) and cortisol imbalances can throw off your circadian rhythm, even if you’ve never had sleep issues before.
If your brain turns on like a light switch in the middle of the night, it’s worth evaluating for perimenopausal patterns, even if your cycle is still regular
You’re suddenly more irritable. Things that never fazed you now send you into fight-or-flight mode.
Estrogen impacts serotonin and GABA, both key regulators of mood and calm. When estrogen fluctuates, anxiety often follows.
Tip: This isn’t “just stress.” If your anxiety feels hormonal, it probably is.
You walk into a room and forget why. You mix up names or lose track of your thoughts mid-sentence.
This can be one of the most frustrating—and scary—symptoms. But cognitive fog is extremely common as estrogen and progesterone affect how your brain processes and recalls information.
It’s not early-onset dementia. But it’s also not nothing. I listen closely to these reports; they’re real and worth addressing.
This one’s obvious, but the irregularities can be subtle at first. Shorter cycles. Heavier bleeding. Then skipped periods. Then 2 in a month.
Hormone fluctuations interfere with ovulation, which affects how (and whether) you menstruate.
Dates, flow, and any changes in PMS symptoms.
You haven’t changed your habits, but your jeans don’t fit like they used to.
Hormonal changes (especially lower estrogen and increased cortisol) promote fat storage around the abdomen. This is not about willpower. It’s biochemistry.
Tip: GLP-1 medications, when appropriate, can support metabolism shifts. But they work best in combination with tailored lifestyle strategies.
These are the hallmarks but many women don’t experience them right away. Or they misinterpret them as “just being warm.”
If you’re waking drenched in sweat or feel waves of heat out of nowhere, your thermoregulation may be changing due to estrogen instability.
New soreness, especially before your period, or a change in density or sensitivity can signal shifting progesterone and estrogen levels.
While usually benign, these changes should always be discussed and sometimes evaluated with imaging.
Your interest in sex has dropped or it’s less comfortable. This can stem from both physical and hormonal changes, including reduced estrogen and testosterone.
Tip: This is extremely common and absolutely treatable. Vaginal estrogen, moisturizers, and testosterone therapy can all help, depending on the situation.
Random soreness after mild activity? Achy in the mornings? Estrogen has anti-inflammatory properties and its decline can exacerbate pain and stiffness.
We rule out other causes, but perimenopause is often the missing piece in women who suddenly feel older than they are.
More intense mood swings, bloating, breast pain, and irritability before your period are classic signs of perimenopausal hormone shifts.
Why? Because ovulation becomes inconsistent, and hormone ratios are harder to predict. Your body’s normal rhythm is… not quite normal anymore.
If you see yourself in more than a few of these signs, you’re not alone and you’re not broken.
Most women I treat say the same thing: “I just want someone to take me seriously.”
At Bespoke Medicine, we take a data-informed, symptom-validated approach. That means: yes, we run labs. But we also listen. We track patterns over time. And we adjust care to fit you, not some outdated textbook.
At Bespoke Medicine, we support women in perimenopause and beyond with:
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If you're between 35 and 50 and something just feels “off” but your labs are normal and your doctor tells you “everything looks fine.” You might be in perimenopause. And no, you’re not imagining it.
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