When Fiona Byrne entered her 30s, her body started to change. Despite never experiencing acne as a teen, she suddenly had cystic pimples at 32. Then, a few years later, by her mid-30s, her nails became unusually brittle, she started getting dizzy on escalators, her skin itched, and her periods fell closer together. Around 40, she was waking up at 3 a.m. with night sweats, and her hair, which had always been silky, was inexplicably dry. At that point, she started doing some research to connect the dots of this growing constellation of symptoms, and when she finally met with a menopause expert, she got her answer: she was in perimenopause.
“It had been years and years of weird stuff before I had any clue that it was hormone-related. If I knew in my late 30s, I would have been on hormone replacement therapy (HRT) immediately,” says Byrne, now 49—and still in perimenopause.
Most women hit menopause around age 51 or 52, says Mariya Rozenfeld, DO, an ob-gyn and Menopause Society Certified Practitioner (MSCP)—the gold standard certification for physicians who treat patients with menopause—at NYU Langone. Once a woman hasn’t gotten her period for a year, and thus “runs out” of her egg stores, she is considered to be menopausal. Perimenopause isn’t as black and white: it’s the time before you hit menopause marked by fluctuations in hormone levels that cause an array of symptoms. And, they may appear a lot earlier than you’d expect.
Until recently, the median time women spend in perimenopause has been considered to be about four years, but newer studies suggest that the symptoms can last a lot longer and start as early as your thirties. One 2025 study published in NPJ Women's Health on 4,400 American women ages 30 and older found that roughly 55 percent of women 30 to 35 reported perimenopause symptoms that met the criteria for “moderate” or “severe” based on the Menopause Rating Scale. That number rose to just over 64 percent for women 36 to 40 years old. Despite this, most women didn’t seek treatment until they were 56 or older.
“If you think about when perimenopause symptoms really start and when they might start to wane, for most people, that probably takes about 10 years. It's not a short period of time, no matter what,” says Rajita Patil, MD, MSCP, an ob-gyn and director of the Comprehensive Menopause Program at UCLA. In other words, it’s way more common than you might think to be a perimenopause long-hauler.
In the past few years, the conversation around perimenopause and menopause has exploded, fueled, in part, by celebs like Naomi Watts, Penelope Cruz, and Halle Berry sharing their experiences. Social media, too, has allowed women to share resources, stories, and symptoms to better understand this life phase. “People are talking about it. Women are not silent anymore: the demand is there, and it will continue to make care better and make the doctors learn to give the care that these women deserve,” says Dr. Patil.
The age you hit menopause—and perimenopause—is both genetically predetermined by your egg storage, and by each person’s sensitivity to hormone fluctuations. So while some women might start feeling symptoms of perimenopause a few years before menopause in their late 40s, others, like Byrne, can feel it way earlier and more intensely. Here is what women dealing with long-haul perimenopause wish they knew before it started, and what doctors wish more women—and the public at large—knew about perimenopause.
Meet the experts: Mariya Rozenfeld, DO, is an ob-gyn and Menopause Society Certified Practitioner at NYU Langone. Rajita Patil, MD, is an ob-gyn, Menopause Society Certified Practitioner, and director of the Comprehensive Menopause Program at UCLA. Susan Loeb-Zeitlin, MD, is an ob-gyn and director of the Women’s Midlife Center at Weill Cornell Medicine.
Changes in mood, irritability, and sleep can be some of the first signs.
A big misconception about perimenopause is that it only starts after periods become irregular. While cycle changes in either direction (more or less frequent; heavier or lighter), are a hallmark sign of perimenopause, there are some more subtle symptoms that can go unnoticed. “In reality, women experience symptoms years before they notice major menstrual changes,” says Dr. Patil. Before anything happens to your cycle, you might notice that you’re not sleeping as well, struggling to cope with stressors, or experiencing more pronounced PMS—that could all be due to perimenopause, Dr. Patil says.
Looking back, Byrne remembers feeling an abnormal amount of rage and irritation at everyday stimuli beginning in her late thirties and early forties; a honking horn from a car on the street would drive her crazy. “It wasn't a normal, logical kind of rage,” she says. “It was just a boiling rage over nothing.” Emma Peterson, 39, noticed similar symptoms in her mid-30s: severe PMS, ovulation pain, trouble sleeping, and increased libido. “I felt like a 14 year old boy a lot of the time,” she says. “I felt so different and kind of feral.”
In their 30s and 40s, most women are hitting their stride in their careers and personal lives—embodying what Dr. Patil calls their “superwoman phase.” So a lot of times, symptoms like fatigue, stress, or irritability are brushed off by women (and their doctors!), as simply being par for the course for this phase of life. But they’re not. When you’re in perimenopause, estrogen and progesterone are fluctuating pretty dramatically, and those fluctuations are what is causing that irritability, increased PMS, and extra fatigue.
Especially right before your period, your hormones’ monthly swan dive can feel way more intense. The PMS you’re used to can suddenly shapeshift into hot flashes, anxiety, fatigue, or even a feeling of “I don’t feel like myself anymore,” says Dr. Patil. “Those rapid hormonal shifts can oftentimes throw the neurotransmitters in the brain off that regulate mood. That's why some people who've never experienced mood symptoms before all of a sudden have mood symptoms.”
Dr. Patil suggests tracking your symptoms of moodiness, anxiety, or irritation and seeing how they fluctuate with your menstrual cycle to help you figure out if your symptoms are hormonal. Having data around your symptoms (like when they happen and how long they last) will also help you work with your doctor to pinpoint ways to alleviate them.
The symptoms can be pretty debilitating—so give yourself grace.
One of the reasons why it’s so hard to pinpoint whether or not you’re in perimenopause is because the symptoms can look so different for everyone. While in perimenopause from age 45 to 56, Laura Standard, now 60, says one of the biggest symptoms was migraines. They were so bad that she’d have to shut herself in a dark room and miss days of work. She had never gotten a migraine before perimenopause, and struggled with them for eight years in her 40s and 50s. (Once she hit menopause, they cleared right up.)
The fatigue of perimenopause was also just completely overwhelming for her: no matter how much sleep she got, it never felt like enough. “One of the worst things for me was bone-crushing fatigue: I felt like someone was pushing an anvil on my head as I was walking around,” says Standard. “I wish I had known it was going to last as long as it did.” In a study of 147,501 symptom logs tracked by women using the MenoLife app, the most common symptom logged for perimenopausal women was fatigue, followed by spotting, cramps, bloating, and headaches.
Perimenopause symptoms can affect so many different parts of your body: some patients may even notice a new onset of heart palpitations (caused by hot flashes), painful joint aches, and irritable bowel symptoms out of the blue, says Dr. Rozenfeld. One of the most frustrating for a lot of patients is brain fog, which comes with unusual forgetfulness, difficulty concentrating, and losing the right words to say mid-sentence.
Looking back, Standard wishes she had more grace for herself and what she was going through—especially because a lot of the time, she didn’t even realize that her symptoms were from perimenopause. When she was experiencing horrible fatigue, maybe it was less important to get everything done at work and at home than it was to listen to her body and take a break.
You might need to alter your lifestyle.
Upon hitting perimenopause, Byrne realized pretty quickly that alcohol wasn’t going to work for her anymore. A few drinks were all it took to throw a wrench in her sleep and mental health for days on end. She’s not alone: especially in women, alcohol can negatively impact sleep quality and increase feelings of sleepiness, per a 2025 study on alcohol use and menopause in the journal Women’s Health. So the idea that a glass of wine before bed helps you sleep? Not actually true.
Under the surface, the loss of estrogen in your body can impact bone health, muscle mass, the gut microbiome, metabolic health, and more. During the perimenopausal period, women are more prone to developing insulin resistance or weight gain—which can affect their risk profile for diabetes and cardiovascular diseases, says Susan Loeb-Zeitlin, MD, an ob-gyn and director of the Women’s Midlife Center at Weill Cornell Medicine. In this critical time, it becomes all the more important to maintain 150 minutes of exercise each week, avoid smoking and drinking alcohol, stay socially engaged with friends and community members, and ensure you’re keeping up with doctor’s appointments.
Especially since your sleep might be disrupted by night sweats, nailing your sleep hygiene and addressing any sleep disorders (like sleep apnea or insomnia) are going to be key in alleviating your symptoms. “The magic recipe to healthy aging is really in how we live our life: it’s what we eat, how we move, how we sleep, what we employ for stress reduction,” says Dr. Patil. This perimenopausal period of time is a great opportunity to set yourself up for healthy aging in the years to come, and to take a proactive approach in your risk of diseases. “It's a window of vulnerability, but it's also a window of opportunity,” she says.
Getting medication, like HRT, can make all the difference.
When she began perimenopause in her early forties, Wendy Wiseberg, 55, was suspicious of HRT. Like many others, she was under the impression that HRT had a large risk of causing breast cancer and heart attacks. (This risk was overstated in a 2002 trial and largely dispelled in a 2017 paper in the Canadian Medical Association Journal. While there is some risk of blood clots and cancers on HRT, it is much lower than previously thought, leading to the FDA’s removal of the black box warning on HRT last year.) Now, at 55, Wiseberg is taking HRT to manage her menopause symptoms. Had she known about HRT and its relative low risk of cancer, she says she might have been open to trying it, or other medications for her symptoms, sooner.
HRT, which usually refers to the use of bioidentical estrogen and/or progesterone, works to treat symptoms of perimenopause by replacing the hormones you’re gradually losing as you approach menopause. It’s FDA-approved to treat hot flashes, night sweats, urinary tract infections caused by low estrogen levels, and osteoporosis. A few studies have even found that HRT therapies help regulate mood and have antidepressant effects in perimenopausal women.
All that said, HRT isn’t for everyone, and it still does carry some risk—the severity of which varies person to person, Dr. Patil says. Luckily, though, HRT is just one of several methods in a toolbox to alleviate perimenopause symptoms. Doctors also use meds like neurokinin-3 receptor antagonists to treat hot flashes, vaginal estrogen for dryness and irritation, psychotropic medications to help with anxiety and depression, and cognitive-behavioral therapy to help with sleep and mood. While there is a lot of room for research and more medications to meet the demand of perimenopause care, talking about treatment options with your doctor might help save you a lot of pain and discomfort.
Find a doctor who listens to you.
While Peterson’s primary care provider told her she was in perimenopause, she says her ob-gyn is hesitant to treat her for it because she’s under 40. She feels “gaslit,” and worried about asking for the medication she needs, like cream to treat the vaginal discomfort she’d been dealing with. “I'm just bracing for pushback from professionals. Not getting the treatment that you need feels like a waste of time,” she says.
Menopause and perimenopause are still widely misunderstood in the medical community. One study found that 93 percent of graduating residents in internal medicine, family medicine, and obstetrics and gynecology didn’t feel comfortable managing patients with menopause. This leaves patients in the lurch, with the onus of recognizing perimenopause and finding care falling squarely on their shoulders.
“All of the doctors were saying that perimenopause started around 45, and I just knew that was wrong,” says Byrne. She researched doctors in her area who had experience treating perimenopause, and met with an ob-gyn who told her that perimenopause could very well start closer to 40. Byrne finally felt understood—and finally got her hands on HRT.
The Menopause Society, which is a national organization that trains health care professionals in menopause care, has a search tool you can use to find a specialist in your zip code, or to search for telehealth providers. “There's no one way that women go through this transition,” Dr. Loeb-Zeitlin says. “A trained menopause provider can give you the individualized approach to your own transition.”
You don’t have to go through it alone.
Despite the fact that half the population will go through perimenopause, it can feel extremely isolating in the moment—especially when your symptoms start earlier, or feel more intense, than the people around you. “Looking back, I wish I had talked to my female friends earlier about it—I didn't really know what was happening. We could have all supported each other from the beginning,” says Standard.
The biggest issue, she says, is just that people aren’t talking about it. Conversations about perimenopause aren’t happening in mainstream media, at the doctor’s office, in health classes, or even among mothers and their adult children. How do you know what to expect, or even recognize what you’re going through, if you don’t have an example?
After years of being fed up with the lack of information and representation of perimenopause, Byrne took to social media armed with her childhood dolls. She created the Peri Pals, where she acts out skits about perimenopause to spread awareness about the often frustrating symptoms. Since starting the account in April 2026—about six months ago—she’s racked up 132,000 followers and countless comments from women about how they can relate to scenarios about forgetting words in moments of brain fog, increased sensitivity to noises, and mood swings. “I didn't know that many people were feeling like that, too. It's validating,” says Byrne.
This period of life is challenging, and it’s important to let people help you navigate it. That could mean inviting a partner or family member to doctor’s appointments, spending time with friends who are also going through perimenopause, connecting with a practitioner who validates and understands what you’re going through, or even reading books in the ever-growing genre of perimenopause memoirs and guides, the women in this article say. “Building yourself that community with your family, friends, and workplace is the recipe to going through this in a positive way,” says Dr. Patil. “Nobody should just be suffering by themselves.”