5 key signs that indicate you’re going through menopause

Perimenopause is the period of time leading up to menopause – which itself is defined as a single day, 12 months after your last period – and it usually lasts between four and eight years. A period in which estrogen levels decline, it is accompanied by a number of different symptoms, which vary (in severity as well as type) from person to person.

“In women over 45, you don’t necessarily need a blood test, but you can focus on the symptoms instead,” says Dr Paula Briggs, President of the British Menopause Society and Sexual and Reproductive Health Consultant at Liverpool Women’s Hospital. “If the symptoms start to impact your quality of life, I would advise you speak to someone, whether it’s a pharmacist, GP or nurse practitioner.

When it comes to treatment, Dr Briggs says the important thing is that care is individualized – not everyone benefits from the same treatment. For some this may mean daily holistic lifestyle changes, such as exercise or cognitive behavioral therapy (CBT), or a more balanced diet, while for others hormone replacement therapy may be more effective. “The message that seems to be strongest right now is that all women should have HRT, but that’s not true,” says Dr Briggs. “Not all women want HRT, and not all are eligible.”

Knowledge is power, so understanding the symptoms that accompany perimenopause will not only help you find the right treatment, but also a semblance of peace if and when you experience them.

5 key signs and symptoms of menopause

1. Changes in the menstrual cycle

One of the first signs you may be going through perimenopause? “The gap between periods can get shorter or longer, and they often get heavier,” says Dr. Briggs. This is because the gradual reduction in estrogen impacts ovulation, which means the time between periods can fluctuate, as can the flow. According to the Mayo Clinic, a gap of 60 days or more between periods indicates that you are likely in late perimenopause.

2. Hot flashes

A common symptom of menopause, hot flashes (and their after-dark counterparts, night sweats) can be very uncomfortable. Defined by a sudden sensation of warmth, usually in the face, neck, and chest, hot flashes can also cause flushing of the skin and sweating, making it a physical and often emotionally impactful experience.

3. Difficulty sleeping

Whether it’s constantly waking up at night or not being able to fall asleep in the first place, another key sign is difficulty sleeping. “With disturbed sleep, there’s brain fog because if you’re not sleeping, you tend to have trouble thinking clearly,” says Dr. Briggs. You may also start noticing that you feel more tired, moody, or depressed during the day.

4. Mood swings

From anxiety to depression, many women spoke about the mental health issues that can accompany perimenopause. As Kathleen Baird-Murray wrote in a previous vogue story about the link between menopause and mental health, there is “an incredibly high suicide rate among women aged 45 to 54, which doctors say may be linked to biological changes associated with menopause.” But, given the lack of research in this area, it can be difficult to know whether mood swings are related to other factors or to menopause itself, says Dr. Briggs.

5. Vaginal dryness

“One of the virtually universal symptoms is vaginal dryness and vulvar itching, but nobody really talks about it – 80% of women have some element of these symptoms,” says Dr. Briggs. You may also experience more urinary tract infections or incontinence during this time due to tissue changes in the area.