10 Surprising Signs You’re in Perimenopause (That No One Talks About)

If you’re in your late 30’s or 40’s and feeling “off”—emotionally, physically, hormonally—you’re not imagining things. You might be in perimenopause.

We tend to think of menopause as something that starts in our 50s, marked by hot flashes and the end of periods. But the truth is, many women begin experiencing perimenopause—the years leading up to menopause—much earlier than expected.

So What’s the Difference?

• Menopause is officially defined as having 12 consecutive months without a period.

• Perimenopause is the transition phase before menopause, when hormone levels (especially estrogen and progesterone) start to shift unpredictably.

This phase can start as early as your mid-to-late 30s, but most commonly begins in your early to mid-40s. And it’s not short—perimenopause can last anywhere from 4 to 10 years, depending on genetics, lifestyle, stress, and other factors.

Did you know??

Research shows that the average age for perimenopause onset is around 47, but some women start noticing changes in their late 30s to early 40s. Factors like ethnicity, genetics, and lifestyle all influence the timing and intensity of symptoms.

A major 2022 study from the SWAN (Study of Women’s Health Across the Nation) found that:

• Black and Latina women often experience perimenopause earlier and more intensely than white women

• Asian-American women tend to report different symptom profiles, such as more frequent somatic symptoms and less reported mood disturbance (Samarasinghe et al., 2022)

Menopause doesn’t follow one path—and neither should your care.

Here Are 10 Unexpected Signs You Might Be in Perimenopause

1. Your Periods Are Getting Weird

Lighter, heavier, longer, shorter—or totally unpredictable? One of the first signs of perimenopause is a shift in your cycle. This isn’t just “getting older”—it’s your hormones fluctuating in response to declining ovarian function.

2. You’re Tossing and Turning All Night

Hormonal shifts (especially decreasing progesterone) affect sleep cycles. Add in night sweats or racing thoughts, and suddenly insomnia becomes your new norm—even if you’ve always slept fine.

A 2020 review published in Menopause found that over 40% of women in early perimenopause report significant sleep disruption, even without full-blown hot flashes.

3. You Cry (or Rage) Over Random Things

Feeling more emotionally sensitive, reactive, or even numb? Estrogen and progesterone affect mood-regulating neurotransmitters like serotonin and GABA. You’re not crazy—your chemistry is shifting.

4. Your Pelvic Floor Feels “Different”

Leaking when you sneeze, more UTIs, a feeling of heaviness or pressure “down there,” or pain with intimacy can all show up years before your last period. Estrogen helps keep pelvic tissues elastic, and when it declines, things change.

Studies have shown that low estrogen levels contribute to both urinary incontinence and pelvic organ prolapse, especially when combined with muscle coordination issues or chronic tension. (Lowder et al., 2021)

5. You Ache in New Places

Your hips, knees, or back are stiff and achy—especially in the morning? Estrogen plays a role in joint lubrication and collagen synthesis, so it’s not unusual to feel more creaky or inflamed.

A 2021 study in Frontiers in Endocrinology linked estrogen deficiency to increased joint pain, inflammation, and early signs of osteoarthritis in menopausal women.

6. You’re Always Bloated

Bloating isn’t just about food—estrogen and progesterone shifts affect gut motility, fluid balance, and digestion. What used to be a “food baby” might now feel like a daily battle with your jeans. Check out our blog about Belly Bloat in Menopause!

7. Sex Feels Different (or Less Appealing)

Vaginal dryness, discomfort, or a decreased libido are all common—and rarely talked about. This isn’t about your relationship; it’s about tissue health, circulation, and hormonal balance. Click here to read about Sex After 40!

8. You Have Brain Fog

Struggling to remember names or losing your train of thought? You’re not alone. Cognitive changes during perimenopause are well-documented, and estrogen is neuroprotective—meaning it helps support memory, focus, and word retrieval.

9. Your Skin and Hair Are Changing

Dryness, acne, thinning hair, or even a sudden “aged” look can all be part of the hormonal puzzle. Androgens like testosterone can become more dominant as estrogen drops, affecting hair, oil glands, and vaginal dryness.

10. You Just Don’t Feel Like You

It’s the most common—and most frustrating—thing women say: “I don’t feel like myself anymore.” It’s subtle, often invisible to others, and easy to dismiss. But it matters.

So What Can You Do?

Here’s the good news: you don’t have to just deal with it. You deserve to feel supported and empowered in this season—and pelvic floor therapy can play a powerful role in that.

Here, at South Texas Pelvic Health, we take a full-body, holistic approach to perimenopause. Yes, we address leaking, pain, or pelvic pressure—but we also go deeper.

We help you:

• Understand how fluctuating estrogen impacts connective tissue, pelvic organ support, and muscle coordination (Research shows estrogen loss can weaken pelvic tissues, reduce neuromuscular control, and increase injury risk during midlife.)

• Rebuild balance between breath, core, and pelvic floor, so your body works with you—not against you

• Improve ribcage hip, and foot mobility, release stored tension, and restore movement flow

• Build strength, muscle mass, and confidence through targeted strength training (Check out our blog → Menopause & Strength to learn why this is essential for bone health, metabolism, and long-term vitality)

• Regulate your nervous system to calm anxiety, improve sleep, and reduce overstimulation

• Learn postural and pressure management strategies to reduce tension and prevent prolapse

You’re not broken. You’re not crazy. You’re not alone.

This is your body asking for a new kind of support—not punishment. Let’s give it the care and attention it deserves.

Let’s get you the care you deserve!

Whether you’re just starting to notice symptoms or knee-deep in the thick of perimenopause, we’re here to help. Our therapists specialize in pelvic health, nervous system regulation, and real-life movement support for women in every stage of life.

Local to Corpus Christi, Texas and the surrounding areas?
📅 Book a consultation and let’s talk. We also offer virtual care to meet you where you are!

You don’t have to figure it out alone—we’re here when you’re ready.