Women's health
Perimenopause symptoms: early signs, testing and your options
By Natura Integrative Care Clinic · Updated · 4 min read
The short answer
Common perimenopause symptoms include irregular periods (shorter, longer, heavier or lighter), hot flashes and night sweats, poor sleep, mood changes, brain fog, vaginal dryness and lower libido. They usually begin in your mid-40s, sometimes in your late 30s, and often last four to eight years. Perimenopause is diagnosed from your symptoms and cycle history, not a blood test.
Perimenopause symptoms can creep in so gradually that it takes a while to connect the dots: a period that arrives early, a night of soaked sheets, a week where you can’t find the right word. Perimenopause is the phase when the ovaries gradually make less estrogen and ovulation becomes irregular. It ends at menopause, which is defined as 12 months in a row without a period.
During perimenopause, hormone levels don’t fall in a smooth line. Estrogen can dip low one month and spike higher than usual the next, which is why symptoms vary so much from person to person, and even month to month. More than 30 symptoms have been linked to perimenopause and menopause.
What are the first signs of perimenopause?
For many people, cycle changes come first. Periods may arrive earlier or later than usual, flow may get heavier or lighter, cycles may get shorter or longer, and you may notice spotting between periods or skip a month altogether.
Common perimenopause symptoms
| Area | What you might notice |
|---|---|
| Periods | Shorter or longer cycles, heavier or lighter flow, spotting, skipped periods |
| Temperature | Hot flashes and night sweats |
| Sleep and energy | Trouble falling or staying asleep, fatigue, lower energy |
| Mood and thinking | Mood swings, feeling anxious or irritable, brain fog, memory lapses, trouble concentrating |
| Body | Joint aches, muscle stiffness, headaches or migraines, breast tenderness |
| Sex and bladder | Vaginal dryness, discomfort during sex, lower libido, bladder control changes |
Not everyone gets all of these, and their intensity can change from month to month. Perimenopause usually lasts four to eight years, and menopausal symptoms last about seven years on average, though for up to a quarter of women they continue into their sixties or beyond.
It can be useful to track symptoms for two or three months before an appointment: the dates of each period and how heavy it was, hot flashes and night sweats, sleep, and mood. A notes app or a paper calendar is enough, and it gives your provider a clearer picture than memory alone.
Is there a perimenopause blood test?
Testing hormones can be helpful, but perimenopause is really a clinical diagnosis, as opposed to a laboratory diagnosis.
Testing still has a place. The Canadian Menopause Society says hormone tests may be needed if you’re under 45 and your periods have stopped, or under 40 with a possible early loss of ovarian function. Other tests can look for different causes of missed periods, such as a high prolactin level or pregnancy, when the picture isn’t clear.
Perimenopause options to discuss with your doctor
The Canadian Menopause Society describes menopausal hormone therapy (MHT) as the most effective treatment for hot flashes and night sweats. Its guidance says MHT can be started by people under 60, or within 10 years of menopause, who have no reason to avoid it; whether that applies to you is a conversation with your prescriber. The society also lists several non-hormonal prescription medications, and vaginal estrogen for vaginal dryness. All of these are prescribed by a family doctor, nurse practitioner or gynecologist.
| Option | Who you’d talk to |
|---|---|
| Menopausal hormone therapy (MHT) | Family doctor, nurse practitioner, gynecologist |
| Non-hormonal prescription medications | Family doctor, nurse practitioner |
| Vaginal estrogen, lubricants and vaginal moisturizers | Family doctor, nurse practitioner, pharmacist |
| Cognitive behavioural therapy (CBT) or clinical hypnosis, both listed by The Menopause Society for hot flashes | Psychologists and other mental health professionals trained in these methods |
| Over-the-counter supplements | Review with your pharmacist, doctor or ND before starting |
Everyday habits the SOGC suggests during perimenopause include:
- Regular exercise: aerobic activity, strength training and stretching
- A consistent bedtime, a cool bedroom and less screen time at night
- Balanced meals with enough protein, calcium and vitamin D
- Limiting alcohol and caffeine, which can trigger hot flashes
- Dressing in layers and noticing your triggers, such as spicy food or hot drinks
- Stress-reduction practices and staying connected to people who support you
- Lubricants and vaginal moisturizers, used regularly, for dryness
To be straightforward: The Menopause Society’s 2023 position statement notes that lifestyle changes like these haven’t been shown in trials to reduce hot flashes on their own. It also does not recommend over-the-counter supplements or herbal remedies for hot flashes, including black cohosh and soy. Menopause supplements are heavily marketed, so if you’re taking or considering one, bring it to your pharmacist, doctor or ND so it can be checked against your other medications.
Seeing a naturopathic doctor for menopause: what does an ND do?
Your ND will listen carefully to your symptoms and help support you with natural therapies as you transition through menopause. If needed, your ND can refer you for hormone replacement therapy if that is something you want to explore.
Seeing a naturopathic doctor at Natura
Menopause and hormonal concerns are among the common reasons people book with a naturopathic doctor at Natura Integrative Care Clinic in Steinbach. Dr. Erin Esau, ND sees patients in person and by virtual visit, and Dr. Jayden Dobson, ND sees patients by virtual visit only. A first visit is 60 to 90 minutes; in person, it can be booked as an accelerated two-part visit, where a registered nurse first completes your intake for up to 60 minutes (health history and vital signs) and you then see the ND for 30 minutes.
Lab testing ordered by an ND isn’t covered by Manitoba Health, so you pay the lab directly. Prices vary widely depending on what’s tested, but generally start around $75. Natura doesn’t bill insurers directly; see fees and insurance for visit prices and how receipts work. Anything that needs a prescription goes through your family doctor, so keep them in the loop.
Other practitioners at Natura include Taryn Bloodworth, RNBN, who provides pelvic floor therapy and whose areas of focus include bladder leaks and painful intercourse, and clinical exercise physiologist Lindsay Porter, who designs structured exercise programs. See women’s health visits at Natura for more.
Common questions
What age does perimenopause usually start?
It typically begins in the mid-40s, though some people notice changes in their late 30s. It usually lasts four to eight years, but can be shorter or longer, and it ends once you’ve gone 12 months in a row without a period. If your periods stop before 40, see your doctor, as testing may be needed.
Can I get pregnant during perimenopause?
Yes. Ovulation becomes irregular in perimenopause, but it still happens, so pregnancy is less likely but possible until you’ve gone a full year without a period. If avoiding pregnancy matters to you, keep using contraception and talk with your provider about when it’s safe to stop.
Can a naturopathic doctor prescribe hormones for menopause in Manitoba?
No. Naturopathic doctors in Manitoba aren’t able to prescribe hormones, so menopausal hormone therapy is a discussion with your family doctor, nurse practitioner or gynecologist. A visit with an ND can include ordering testing, discussing food, activity and sleep, and reviewing any supplements you’re taking or considering, alongside your medical care.
How do I know if it’s perimenopause or something else?
Many perimenopause symptoms overlap with other health conditions. That’s why an assessment matters. Your provider will look at your age, cycle changes and symptoms, and may order tests to look for other causes, even though hormone levels themselves are not diagnostic of perimenopause.
Sources
- Perimenopause: frequently asked questions — SOGC (Menopause and U)
- Perimenopause: your early warning system — SOGC (Menopause and U)
- Diagnosis and management — Canadian Menopause Society
- Menopause symptoms — Menopause Foundation of Canada
- The 2023 nonhormone therapy position statement — The Menopause Society
- 9-8-8 Suicide Crisis Helpline
This article is general information, not medical advice for your situation. If you're unwell or worried, talk to your doctor or call Health Links – Info Santé, Manitoba’s free 24-hour nurse line, at 1-888-315-9257. In an emergency, call 911.
