Could You Be in Perimenopause and Not Know It?
Heather Watters FNP FMACP • November 2, 2025

November 2, 2025

Is It Perimenopause? How to Spot the Signs


Many people assume that perimenopause only begins when periods stop or hot flashes arrive. But the truth is more subtle: you might already be in perimenopause, even if your periods are still pretty regular or your symptoms feel vague. Recognizing this transition early gives you a chance to respond proactively rather than react after things feel too chaotic.

Let’s walk through how perimenopause often hides in plain sight, which signs to watch for, and what steps you can take now.


What Is Perimenopause?

Perimenopause is the transitional phase leading up to menopause. It begins when the ovaries gradually reduce their production of hormones, especially estrogen and progesterone, but has not yet reached the point where you’ve gone 12 full months without a period.

Because hormone levels fluctuate wildly during this time (rather than steadily decline), symptoms can come and go. Some months feel “normal,” others bring surprises.

Perimenopause can last several years (often 4–8 years) before menopause truly begins.


Why It’s Easy to Miss It

●    Symptoms overlap with other life stressors. Fatigue, mood shifts, brain fog, changes in sleep, these are things many of us attribute to burnout, parenting, or aging rather than hormones.

●    Periods can continue. Many people in perimenopause still menstruate regularly (though sometimes with subtle changes in flow or timing).

●    Hormones are erratic. A single blood test may look “normal” because hormone levels fluctuate day to day, even hour to hour.

●    Cultural conditioning. We tend to reserve the idea of “menopause” for later years; earlier hormonal changes often go unnamed or invalidated.

Because the signs are often dismissed or misattributed, many people live in perimenopause for years without recognizing what’s really happening.


Common (and Less Common) Signs of Perimenopause

Here are red flags that may point toward perimenopause, even if you’ve not connected them to hormones yet:

Frequent or classic symptoms:

●    Changes in menstrual cycles (shorter cycles, heavier or lighter flow, spotting)

●    Hot flashes and night sweats (vasomotor symptoms)

●    Sleep disruptions (difficulty falling asleep, waking at night)

●    Mood swings, irritability, anxiety, low mood

●    Vaginal dryness, urinary symptoms, low libido

●    Cognitive changes: memory lapses, trouble focusing (“brain fog”)

“Low-key” or surprising symptoms:

●    New sensitivity to skin, changes in hair or nails

●    Digestive shifts (e.g., bloating, gas)

●    Weight gain (especially central or belly fat)

●    Joint aches, muscle tension

●    Fatigue that doesn’t improve with rest

●    Shifts in cholesterol, blood sugar, or metabolic markers

The key is this: if multiple symptoms appear together, especially across mood, cycles, sleep, and cognition, the odds increase that hormones are involved.


Functional Testing: What to Explore

Because hormone levels fluctuate in perimenopause, smart, dynamic testing is often more helpful than a single blood draw. Here are some tests your functional/integrative practitioner may order:

  1. Comprehensive Hormone Panels These may include saliva or dried urine (such as the DUTCH test) to capture metabolite fluctuations over time. Some providers may order serial serum hormone tests (measuring estradiol, progesterone, FSH, LH at different cycle days). A single test often isn’t enough.
  2. Metabolic & Lipid Panels Estrogen plays a role in fat distribution, lipid profiles, and insulin sensitivity. Checking glucose, HbA1c, lipids, and fasting insulin may give insight into shifts happening with hormonal transition.
  3. Thyroid & Adrenal Testing Hormonal transitions often overlap with thyroid or adrenal stress. A complete thyroid panel, including TSH, free T4, free T3, and reverse T3, plus cortisol rhythm tests, can provide valuable context.
  4. Micronutrient and Inflammation Markers Deficiencies in vitamin D, magnesium, and B vitamins, as well as elevated inflammation markers (such as CRP and cytokines), can worsen perimenopausal symptoms.
  5. Optional: Gut / Microbiome or Detox Panels Hormones are processed through detox and elimination pathways, so assessing gut health or detox burden may help fine-tune your care plan.
  6. Symptom Tracking Over Time Tools like the Menopause Rating Scale help track changes over months and can guide more targeted support.

Why Addressing It Early Matters

If left unchecked, perimenopause can:


●    Worsen sleep, mood, and energy

●    Contribute to bone loss or metabolic imbalance

●    Increase cardiovascular risk

●    Accelerate symptoms like vaginal dryness

●    Reduce quality of life and disrupt daily functioning

What You Can Do Right Now (Even Without Testing)

You don’t need to wait for labs to start supportive actions:


●    Track your symptoms: note cycles, sleep, mood, and energy changes.

●    Clean up your diet and support gut health with whole, anti-inflammatory foods.

●    Build consistency in sleep, stress management, and gentle movement.

●    Prioritize nutrients like magnesium, omega-3 fats, B vitamins, and vitamin D.

●    Consider seeing a practitioner experienced in hormonal transitions and functional medicine.

Even if you’re not sure perimenopause is happening, these steps build hormonal resilience and can ease many midlife shifts.

Perimenopause isn’t a mysterious transition reserved for “older” women, it can begin earlier and manifest subtly. The more you understand your body’s patterns, symptoms, and shifts, the more power you have to navigate this change intentionally.

If in doubt, talk with a practitioner who specializes in hormones and functional testing to guide your plan. We can help!

References

  1. Santoro, N., et al. (2016). Perimenopause: From Research to Practice. PMC.
  2. Cunningham, A. C., et al. (2025). Perimenopause Symptoms, Severity, and Healthcare Implications. Nature Review.
  3. Crandall, C. J., Mehta, J., & Manson, J. E. (2023). Management of Menopausal Symptoms: A Review. JAMA.
  4. Metcalf, C. A., et al. (2023). Cognitive Problems in Perimenopause: A Review. PMC.
  5. Harvard Health Publishing. (n.d.). Perimenopause: Rocky Road to Menopause. Harvard Health.
  6. Rupa Health. (n.d.). A Functional Medicine Menopause Protocol: Comprehensive Testing, Nutrition, and Supplements. Rupa Health.


By Heather Watters FNP November 18, 2025
Science Finally Caught Up—Here’s What Women Should Know About Estrogen, Safety, and the WHI Debacle  For more than 20 years , women have been told to fear hormone replacement therapy—especially estrogen. And it all goes back to one study: the Women’s Health Initiative (WHI) . The problem? The WHI’s conclusions were misinterpreted , misreported , and applied to the wrong women for two decades… leaving millions afraid of a therapy that could have actually helped them. But now something huge has happened: 👉 The FDA has officially removed the Black Box warning for estrogen therapy. 👉 The North American Menopause Society (NAMS) has confirmed HRT is safe and beneficial for most healthy women under 60 or within 10 years of menopause. This is a monumental shift—and long overdue. Let’s break it all down in simple, real-woman language. What Went Wrong With the WHI? The WHI was launched in the 90s with one goal: understand risks of hormone therapy in menopausal women. But here’s the issue… ❌ 1. The average participant was 63 years old Most were 10+ years post-menopause , when cardiovascular and metabolic risk is already higher. ❌ 2. Many participants already had underlying health issues Obesity, smoking history, and cardiovascular disease were common—stacking the deck against hormone therapy. ❌ 3. They used synthetic hormones Not bioidentical hormones. Not personalized doses. Not transdermal or optimal delivery methods. ❌ 4. Media headlines caused unnecessary panic Instead of highlighting nuance, the headlines shouted: “Hormones cause cancer!” …even though the actual risk increase was statistically tiny, and estrogen alone showed no increased risk of breast cancer. This misinformation spread like wildfire—and it stuck. So What’s Changed Now? ✨ The FDA has removed the Black Box Warning on estrogen. This means the highest level of caution is no longer justified based on the evidence. ✨ Modern research shows… Estrogen reduces all-cause mortality in younger postmenopausal women Estrogen protects heart, brain, bones, and metabolism Starting HRT within 10 years of menopause is where the strongest benefits live Transdermal and bioidentical options offer excellent safety profiles ✨ The North American Menopause Society now states: For most healthy women under 60 or within 10 years of menopause, HRT’s benefits outweigh the risks. FINALLY. What This Means for YOU Women now have permission—backed by research—to reclaim their health without fear-based messaging. Estrogen therapy can help with: Hot flashes & night sweats Sleep struggles Anxiety & mood changes Weight gain (especially belly fat) Brain fog Vaginal dryness & painful intimacy Bone loss Skin and hair changes Cardiovascular protection This isn’t about vanity. This is about function, quality of life, longevity, and prevention . My Take as a Functional Medicine & Hormone Provider For years, I’ve seen women suffer because they were told: “Your labs are normal.” “It’s just aging.” “HRT is dangerous.” “You’ll just have to deal with it.” ❌ Women deserve better. ❌ Women deserve accuracy. ❌ Women deserve options. HRT isn’t for every woman—but it is a powerful, evidence-based therapy that can transform health when used appropriately. The WHI narrative kept women in fear for decades. Now, that chapter is finally closing. Ready to Explore Whether HRT Is Right for You? I offer free hormone consultations so we can: Review your symptoms Look at your health history Discuss safe, modern HRT options Explore lifestyle strategies to support hormones naturally Create a personalized plan that aligns with your goals ✨ BOOK YOUR FREE HORMONE CONSULT ($100 VALUE) Let’s bring clarity, safety, and confidence back to your hormone journey.
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