There are a plethora of symptoms that come along with perimenopause

 and menopause. These may include symptoms of brain fog, mood changes, hair and skin changes, sleep disturbances, weight changes, and more. These symptoms can also be attributed to other issues, like thyroid imbalance, poor nutrition, or stress. This often leads to one of the most common questions I hear from women in their 40s: "Am I in perimenopause?"


What is perimenopause?


Perimenopause is the years leading up to menopause, including the first year of menopause. Menopause is defined as 1 full year without a menstrual period.


How long does perimenopause last?

This can vary from person to person - but studies show that it can last up to 10 years for some people.


How do I know if I’m in perimenopause?


We use your symptoms to guide us on where you are in your reproductive journey. There are some pretty classic symptoms that inform us if you’re in perimenopause.


Early perimenopause is defined as a change in your menstrual cycle by 7 days. This means your period may be shorter by 7 days, or longer by 7 days. For example, instead of a 28-day cycle, you’re having a period every 21 days (or 3 weeks), or you’re having a longer period.


In reality, this often looks like an erratic bleeding pattern that can sometimes be light, and sometimes be heavy.


Late perimenopause is defined as a change in your menstrual cycle by 60 or more days. This means you may skip a period altogether (or skip several). Keep in mind, once you’ve missed a period for 1 full year, that is considered menopause. 


In both early and late perimenopause, we can have other symptoms present but those are unique to the individual and may not happen for everyone. These may include: 

  • Hot flashes and night sweats - also known as “vasomotor symptoms”
  • Sleep disturbance
  • Mood changes or irritability
  • Brain fog
  • Joint pain
  • Vaginal changes
  • Low sex drive
  • Urinary changes



However, these symptoms on their own are not enough to determine if you are or aren’t in the menopause transition. Your menstrual symptoms are the primary guiding factor.


Do I need to test my hormones to know if I’m in perimenopause?


No. Hormone testing specifically to inform if you are or aren’t in the menopause transition is not useful. This is because it is normal to see big fluctuations in hormone levels throughout this period. 


Therefore it is not recommended to use testing (such as estrogen or FSH as a primary guide)/


Note, that exceptions may include:

  • If a person does not have a uterus and we cannot use menstrual patterns as a guide
  • if a person is suspected to have premature ovarian insufficiency/early menopause testing may help guide the diagnosis. 
  • If there are other underlying conditions or factors where testing can support the diagnosis.


Testing may be helpful for the workup of other conditions that can look like perimenopause and help guide or tailor the treatment plan. For example, thyroid testing or blood sugar testing. This would be dependent on your symptoms and your naturopathic physician’s or healthcare provider’s assessment.


Take home - unless there are underlying factors, the guidelines do not recommend routine hormone testing to determine if you’re in perimenopause, because it’s not helpful.


Have more questions?

I get it, the menopause transition can be confusing. Schedule a discovery call to learn more about how I can help and my step-by-step perimenopause/menopause plan for you.



In Health,

Dr. Ashley Damm, ND, MSCP

Women’s Health and Fertility Naturopathic Physician & Menopause Society Certifed Practitioner

Vancouver, BC