Is It Perimenopause or Something Else?
If you're in your 40s and starting to feel "off"—whether it's hot flashes, sudden mood shifts, or relentless fatigue—you might wonder: Is this perimenopause? Or is something else going on?
It's a fair question; many women don't feel equipped to answer it. That's because perimenopause is notoriously tricky to diagnose. There's no gold-standard blood test or clear starting point. Instead, it's often a mix of frustrating symptoms and guesswork.
But here's the empowering truth: understanding what's normal during this phase of life—and what might need a second look—can help you feel informed, grounded, and in control of your health.
What Is Perimenopause?
Perimenopause is the transitional phase before menopause (the point when your periods stop completely for 12 months). It often starts in your 40s—but can begin earlier or later—and typically lasts four to eight years.
During this time, your estrogen levels begin to fluctuate unpredictably, which can trigger a host of symptoms like:
Irregular periods
Hot flashes and night sweats
Mood swings or increased anxiety
Sleep disturbances
Vaginal dryness
Brain fog
Fatigue
Changes in sex drive
It's a hormonal rollercoaster—and no two rides are the same. Some women breeze through with minor symptoms. Others feel like their body and mind have turned against them.
Why It's Hard to Know for Sure
One of the most confusing things about perimenopause is that there's no simple test to confirm it. Hormone levels can fluctuate wildly—even within the same day—so lab results often don't give a clear picture. You could feel completely off, yet your bloodwork may still fall within "normal" ranges.
To make matters more complicated, many perimenopause symptoms overlap with other health conditions. Fatigue, weight gain, mood swings, and brain fog might sound like classic hormonal changes—but they can also be signs of thyroid dysfunction, autoimmune issues, or even early neurological disorders like multiple sclerosis (MS).
Because these symptoms often appear gradually, it's easy to dismiss them or assume they're just part of getting older—or worse, to have a healthcare provider dismiss them.
Perimenopause isn't the only thing that can cause a missed period, anxiety, or sleep problems. But it is a common and under-discussed reason. That's why knowing your baseline, tracking your symptoms, and staying curious about what your body is trying to tell you can help you and your provider connect the dots more effectively.
The truth? It's not all in your head. And you're not overreacting. You're simply navigating a long overdue transition for better understanding and support.
Signs You're Likely in Perimenopause
While there's no perfect test, there are patterns to watch for:
Your period is changing. Maybe it's coming early, late, heavier, or lighter—or skipping altogether. Changes in cycle length are often one of the first signs that hormones are shifting.
You're noticing clusters of symptoms. Hot flashes, sleep issues, and mood changes often show up together in perimenopause.
Symptoms are creeping in gradually. Unlike some illnesses that come on suddenly, perimenopause tends to unfold slowly over time.
If this sounds like you, it's worth bringing up with your provider—even if your periods haven't stopped yet.
When It Might Be Something Else
Some perimenopause-like symptoms could signal another issue, especially if:
They appear suddenly or severely
They occur outside the typical age window (before 40 or after 55)
They don't respond at all to hormone-supportive strategies like HRT or lifestyle changes
Know When to Seek Professional Help
Here are a few examples of what else could be at play:
Symptom: Hot flashes, hair thinning, irritability Could Also Be: Overactive thyroid(hyperthyroidism)
Symptom: Weight gain, fatigue, depression Could Also Be: Underactive thyroid (hypothyroidism)
Symptom: Irregular bleeding Could Also Be: Fibroids, polyps, cancer, or pregnancy
Symptom: Sleep disturbances Could Also Be: Sleep apnea or anxiety disorder
Symptom: Mood changes Could Also Be: Clinical depression or other mental health conditions
Symptom: Numbness or tingling Could Also Be: Neurological issues, such as MS
Symptom: Pain during sex or urinary symptoms Could Also Be: Infections, pelvic floor dysfunction, or GSM (Genitourinary Syndrome of Menopause)
Remember: one symptom doesn't necessarily mean something serious—but it's worth investigating if your gut says something feels off.
The Case for Advocacy
Too often, women's concerns during midlife are dismissed with a shrug and a "That's just menopause." While perimenopause is a valid explanation for many symptoms, it shouldn't be the automatic catch-all—especially if your symptoms are severe, unrelenting, or don't quite fit the typical profile.
If your provider isn't listening? Find one who will. You deserve answers, not brush-offs.
What You Can Do
You don't have to be a hormone expert to take charge of this transition. Start with these steps:
Track your symptoms – Use a symptom journal or app to spot patterns over time.
Bring it to your provider – Share your menstrual history, lifestyle changes, and any new or worsening symptoms.
Ask questions – Don't be afraid to say, "Could this be something else?"
Support your body—Nourish yourself with hormone-friendly habits, such as sleep, protein-rich meals, stress reduction, and movement.
Yes, perimenopause is a significant transition—but knowledge is power. By staying informed, paying attention to your body, and working with a provider who takes you seriously, you'll be better equipped to manage this chapter and catch anything that might not be "just hormones."
You don't have to guess your way through perimenopause. Once you understand it—you're in control of your health.
