The First Signs of Perimenopause: What’s Normal and What’s Not?
As women, our bodies carry us through incredible seasons—pregnancy, postpartum, the busy years of raising families, and eventually the transition into midlife. Many of my patients, and even myself as a mom, notice subtle changes in their 30s and 40s: cycles that suddenly feel unpredictable, sleep that doesn’t come as easily, or a body that feels “different” in ways that are hard to explain. These are often the first signs of perimenopause.
Perimenopause is the natural, yet often misunderstood, bridge between our reproductive years and menopause. Shifts in hormones like estrogen and progesterone can impact everything from mood and memory to bladder health and intimacy. While these changes are normal, they don’t have to be endured silently.
In this post, I’ll walk you through the earliest signs of perimenopause—what’s expected, what’s not, and how you can feel supported and empowered during this stage of life.
What Is Perimenopause?
Perimenopause refers to the years leading up to menopause, when the ovaries gradually produce less estrogen and progesterone. For most women, this begins in the early to mid-40s, though some notice changes as early as their late 30s. This transition can last anywhere from four to ten years before menstruation stops completely.
It’s not a sudden shift, but rather a series of changes that unfold gradually. That’s why many women feel caught off guard—symptoms can come and go, leaving you wondering if it’s stress, age, or something more.
Common First Signs of Perimenopause (What’s Normal)
Every woman experiences perimenopause differently, but there are several hallmark symptoms that are considered normal:
Irregular periods: Cycles may shorten, lengthen, or occasionally skip altogether.
Hot flashes and night sweats: Sudden feelings of heat, flushing, or sweating are common.
Mood changes: Irritability, anxiety, or low mood may surface due to hormone fluctuations.
Sleep disturbances: Many women report waking in the middle of the night or struggling to fall asleep.
Brain fog: Difficulty concentrating or remembering details is frequently linked to hormone shifts.
Body changes: Breast tenderness, bloating, or weight gain around the midsection may appear.
These changes are normal, but they don’t have to be dismissed. Understanding what’s happening gives you the power to respond with healthy lifestyle shifts, supportive care, and professional guidance.
How Perimenopause Affects Pelvic Health
One area that doesn’t get talked about enough is how perimenopause impacts the pelvic floor and core. As estrogen levels decline, tissues in the vagina and bladder become more delicate. Many women experience:
Vaginal dryness or discomfort with intimacy
Increased urinary urgency or leakage when coughing, sneezing, or exercising
A sense of heaviness in the pelvis
Core weakness that makes daily activities more challenging
This is where pelvic floor physical therapy can play a life-changing role. By focusing on breathwork, mobility, muscle coordination, and tissue health, women can restore confidence in their bodies and reduce symptoms that often get brushed off as “just aging.”
When to Seek Help (What’s Not Normal)
While many symptoms are expected, there are times when medical support is necessary:
Very heavy bleeding (soaking through a pad or tampon in under 2 hours)
Periods lasting longer than 10 days
Severe mood swings, depression, or anxiety interfering with daily life
Painful intercourse that persists despite self-care
Sudden or drastic changes in your cycle or overall health
These signs should never be ignored. Partnering with your healthcare provider can rule out underlying conditions and give you peace of mind.
Navigating This Transition With Confidence
Perimenopause is a natural stage of life, but it doesn’t mean you have to “just live with it.” With the right tools—balanced nutrition, consistent exercise, stress management, and pelvic floor therapy—you can feel strong, vibrant, and connected to your body during this transition.
As a pelvic floor physical therapist and a mom, I’ve seen firsthand how much better women feel when they have education, support, and a personalized plan. Perimenopause is not the end of vitality—it’s the beginning of a new chapter in healthy aging.
Final Thoughts & Next Steps
If you’re noticing the first signs of perimenopause, know that you are not alone. These changes are common, but with the right guidance, you can move through this stage feeling informed and empowered. At FeminoCentric PT, we specialize in women’s health and pelvic floor therapy, helping women navigate perimenopause with strength, grace, and confidence.
Ready to feel supported through this transition? Schedule a consultation today and let’s create a plan that helps you embrace perimenopause as a season of growth, not limitation.
