How do I know if I am in Perimenopause?

Perimenopause is a natural transition in every woman’s life, but for many, it doesn't feel that way. Instead, it can be confusing, overwhelming, and at times even isolating. Common symptoms include brain fog, insomnia, anxiety, and mood swings. The fact that these symptoms are often brushed off as stress, aging, or something else entirely can delay a proper diagnosis.

As a result, women may spend months or even years dealing with symptoms, without fully understanding what is happening in their bodies. Recognizing perimenopause is crucial, as it allows women to make informed decisions about their health and well-being during this transitional period. Understanding what to expect can empower you to navigate this time with a lot more ease and confidence.

What is Perimenopause?

Perimenopause refers to the years leading up to menopause, when your reproductive hormones begin to shift and your body starts preparing for its next chapter. For most women, this begins in their 40s, but some may notice changes as early as their mid-30s.

During this time, our ovaries begin to produce less hormones, which can often happen in an irregular and unpredictable pattern. This will lead to hormonal fluctuations that will contribute to the symptoms mentioned before.

While the perimenopausal phase is temporary, it can last anywhere from a few months to ten years. The good news? With the right support, this season can become a time of renewal, empowerment, and deeper connection to your body.

Why It May Be Tricky to Diagnose

Diagnosing perimenopause can be challenging as there is no universal consensus in the medical community, and different doctors may use varying methods that may or may not include hormonal testing. There’s no single lab test that definitively confirms perimenopause. Hormones fluctuate not just monthly, but daily, so lab work may not always reflect what you’re actually feeling.

According to Dr. Aviva Romm, renowned MD, midwife and herbalist, in her book Botanical Medicine for Women's Health, hormonal markers for perimenopause include a luteinizing hormone (LH) level greater than 50 mIU/L and an estradiol level less than 50 pg/mL. However, she also emphasizes that a diagnosis may not be clear-cut, and that practitioners need to rely on a combination of test results, symptoms and medical history.

According to ND Lara Briden, an expert in women’s hormonal health, perimenopause cannot be diagnosed solely based on lab tests. Instead, she typically diagnoses it based on age and symptoms.

Many practitioners rely on the guidelines created by Canadian endocrinology professor Dr. Jerilynn C. Prior. According to these guidelines, a midlife woman with regular cycles is likely in perimenopause if she experiences at least three of the following nine changes:

• New or heavier menstrual bleeding

• Shorter menstrual cycles (<26 days)

• Sore or swollen breasts

• Mid-sleep waking

• More intense menstrual cramps

• Premenstrual night sweats

• New or worsened migraines

• Stronger PMS mood shifts

• Weight gain without diet/lifestyle changes

If this sounds familiar, you’re not alone—and you’re not imagining it.

If you're over 37 and experience at least three of these symptoms, it's likely you are entering perimenopause, provided other conditions have been ruled out.

What is my Approach?

When it comes to understanding the changes of perimenopause, I primarily focus on symptoms, as they are often the best indicator of what’s happening in your body. However, I believe hormonal testing can be a very helpful tool to guide treatment and ensure a comprehensive approach.

In addition, I also turn to functional tools like Hair Tissue Mineral Analysis (HTMA) to gain deeper insight into your body’s internal landscape. This simple, non-invasive test helps assess mineral imbalances and patterns of stress, giving us valuable information about how your body is functioning at a cellular level. By understanding your unique terrain, we can create a personalized plan that supports not just symptom relief, but true healing and long-term vitality ✨.