5 Surprising Signs You’re in Perimenopause (That Have Nothing to Do with Hot Flashes)

When most people think of menopause, they picture one thing: hot flashes. But for many women, the signs of perimenopause are much more subtle (and surprising).

You may find yourself lying awake at 3 am, snapping at your partner for no reason, or staring at your fridge wondering what you were looking for. And guess what? It might not just be stress or aging…

It could be perimenopause.

Perimenopause is the early years leading up to menopause. Let’s break the silence and shine a light on 5 lesser-known signs that your body might be entering this powerful new phase of life, well before your period stops for good.

1. Sleep Is Suddenly a Struggle

Trouble falling asleep. Waking up drenched in sweat. Tossing and turning at 3 am with your mind racing.

Sound familiar?
Sleep disruption is one of the earliest and most common symptoms of perimenopause, often due to fluctuating estrogen and progesterone levels, which affect your body’s ability to regulate temperature and calm the nervous system (Freeman et al., 2015).

What to do: Try calming nighttime rituals like magnesium baths, herbal teas, or guided meditations (my Guided Meditation for Menopause book has a few great ones!). Keep your bedroom cool and dark, and reduce blue light before bed. Yes, no scrolling before bed, can consider reading a book instead.

2. Your Mood Feels All Over the Place

One moment you’re fine, and the next you’re weepy, irritable, or anxious for no clear reason. Sound like PMS… but worse?

You’re not imagining it. Shifting hormone levels can make your emotions feel unpredictable, and if you’ve had anxiety or depression in the past, perimenopause can intensify those symptoms (Schmidt et al., 2004).

What to do: Be gentle with yourself. Journaling, talking to a trusted friend, or working with a therapist can help you navigate the emotional waves.

3. Anxiety Is Creeping In

This is a big one that doesn’t get talked about enough. Many women in their 40s suddenly experience panic attacks, health anxiety, or unexplained worry, even if they’ve never struggled with anxiety before.

The drop in progesterone (a calming hormone) and increase in cortisol sensitivity can leave your nervous system feeling like it’s in overdrive.

What to do: Incorporate calming practices like breathwork, yoga, or nature walks. Adaptogens like ashwagandha or rhodiola (check with your provider first) can also support your stress response.

4. Weird New Aches and Pains

Are your joints a little creakier? Is your back sore in ways it didn’t used to be?

Estrogen plays a key role in joint and muscle health. When it starts to decline, many women feel achier or stiffer than usual, especially in the morning.

What to do: Gentle movements, such as stretching, Pilates, or strength training, can help. An anti-inflammatory diet is also a game-changer. Check out those good foods for digestion I outline in The Ultimate Guide to Menopause Gut Health.

5. Your Brain Feels… Foggy

You’re not losing your mind—your hormones are just throwing your brain a curveball.
Forgetfulness, trouble concentrating, and “word-search moments” are all classic signs of perimenopause.\

What to do: Stay hydrated, get enough healthy fats, and build in mental breaks throughout your day. Omega-3s and sleep quality also play a huge role in cognitive clarity.

Listen to Your Body—She’s Talking to You

Perimenopause is a natural life stage and not something to fear. Just learn to understand as these early symptoms are your body’s way of saying:

“Pay attention, beautiful. Change is coming.”

And with the right tools, support, and mindset, this change can be one of the most powerful chapters of your life.

Want to go deeper?

Explore The Ultimate Guide to Menopause and the full Menopause Wellness Series for practical tools, holistic tips, and honest support for every stage of the journey.

References

Freeman, E. W., Sammel, M. D., Lin, H., & Nelson, D. B. (2015). Associations of hormones and menopausal status with depressed mood in women with no history of depression. Archives of General Psychiatry, 63(4), 375–382.
Schmidt, P. J., et al. (2004). Estrogen replacement in perimenopause-related depression. American Journal of Obstetrics and Gynecology, 190(3), 639–646.

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