A checklist
Is this perimenopause?
Certainly it's too early for perimenopause. I'm only in my 30's!
Two symptoms: hot flashes, and periods stopping. For some of us, those are the only signs we've heard of to signal The 'Pause. The real symptom list can be much longer, and is strange enough that you may never link it to your hormones. That's okay, we're all just doing our best with the knowledge we have. We have a few facts to share with you, and a checklist you can take to your doctor.
Perimenopause can begin as early as the mid-30s and can last up to ten years. Menstrual cycles often stay regular well into perimenopause, which is one of the reasons so many women never think to connect it. Instead of one explanation, they collect several: the dermatologist for the itching, the orthopedist for the shoulder, someone else for the sleep, someone else for the anxiety.
There are about 114 symptoms on this list, and most of them are the random ones nobody mentions unless they're just complaining about this stage in life in general. We are tired, busy, feeling overwhelmed and overstimulated, and figuring it's just work and family stuff and "getting older." Review the list and check whatever sounds like you. Print it, save it to your phone, or email it to yourself, then bring it with you on your next appointment. We're not doctors and this isn't a diagnostic tool. We're just handing you the words (brain fog much?), a few facts we went and checked (and experienced ourselves), and some questions to ask, so you don't have to start from scratch in a fifteen minute appointment.
Most of this is new information
For a long time, the whole subject was handled quietly. Periods were something you managed without mentioning, tampons traveled up a sleeve on the way to the bathroom, and plenty of households had a code word for the whole business.
Advertising followed the same convention, and the results were wonderfully odd. For decades, pad commercials poured a tidy blue liquid onto a white pad. A product made for one specific fluid, sold using a fluid that does not exist. That was simply the standard, and it went unremarked for years.
Menopause got one phrase to carry all of it. The change. Two words covering the sleep, the joints, the mood, the memory, and the skin, which is a lot of ground for two words. So the working definition stayed small for generations, and it stayed small for everyone, including the people you would expect to know more.
Medical training is still catching up to it. A 2023 survey of US OB/GYN residency program directors found that fewer than a third had a menopause curriculum in their program, and almost all of them said residents should.
Put those together and you get the situation we are in. A subject that stayed quiet for cultural reasons, and a field of research that started late. Neither of which is anybody's fault, and both of which are changing quickly.
It also explains something worth knowing: most of what women understand about perimenopause right now came from other women. Group chats, comment sections, and friends who said the quiet part out loud. That is an unusual way for knowledge to travel, and it has moved fast. Worth remembering when you walk into an appointment. You are not behind. You are early.
Earlier and longer than we thought
Perimenopause can begin in the mid-30s and can last up to ten years. During that stretch, estrogen does not decline in a straight line. Estrogen rises, drops, and rises again, which is why symptoms come in waves and why a good month is not evidence that perimenopause has passed.
And your hormones don't stop moving when your periods do. The decline is gradual rather than a switch getting flipped. The biggest shifts usually come in the first couple of years after your last period, and plenty of us notice hot flashes or hormonal migraines ten years out or more. That's documented, not unusual. So if you thought crossing the finish line meant it was over, that's why it doesn't feel over.
The symptoms that can be understood
Estrogen has a job almost everywhere. Your brain, your joints, your skin, your gut, your bladder, your inner ear, even your gums. So when estrogen starts swinging, all of those places notice. That's why the list is so long and so scattered, and why hardly any of it gets traced back to hormones.
Anxiety out of nowhere. Panic at 3am. A sore shoulder that seemed like getting older. Tiredness that seemed like being busy. Taken one at a time, each has a perfectly sensible explanation, which is exactly why the pattern is easy to miss.
Check what you're experiencing
This checklist is free and it's yours. Nothing here is stored or sent anywhere. When you're done, hit print and choose "Save as PDF" to keep it on your phone, or email it to yourself.
Part of this list comes from clinical sources. Part of it comes from women describing their own experience in their own words, which is where a lot of this knowledge lives. Both belong here. Neither one is a diagnosis.
PART ONE · Physical
The ones you've heard of
Here so your list is complete when you hand it over.
Sleep + Energy
Progesterone is the one that helps you drop off and stay under, and it's the first to go.
Temperature and sweating
Joints, muscles, and strength
Estrogen keeps your joints cushioned and your inflammation in check. With less estrogen, joints ache, shoulders catch, and mornings start stiff.
Ears, hearing, and balance
Your ears are full of estrogen receptors, and the same inner ear runs your balance. When hearing and balance go at once, it can get mistaken for something else entirely.
Eyes
Mouth, teeth, and throat
Estrogen receptors sit in the lining of your mouth, your salivary glands, and the nerve that carries pain from your face. Oral discomfort runs about 43% in perimenopause and after, against 6% before.
Smell and taste
Estrogen and progesterone receptors sit in the tissue that does your smelling, so this can go in any direction: sharper, phantom, distorted, or fading.
Skin, itching, and nerve sensations
Up to 55% of us get itchy skin through this. Estrogen keeps skin plump and holding onto water, and it also has a hand in how nerves fire, so the itch and the crawling feeling come from the same place.
Hair, body, and odor
Heart and circulation
Histamine and allergies
Estrogen tells mast cells to release histamine and slows the enzyme that clears it, and falling progesterone takes away the brake. Which is why these tend to arrive together.
Digestion and appetite
Estrogen helps set the pace of your gut, so things slow down and queasiness follows.
Bladder and vulvar
This tissue depends on estrogen to stay thick and springy. It's also the part almost nobody brings up.
Breasts and cycle
Sex and intimacy
PART TWO · Mental and emotional
Words and memory
Here's the good news buried in the research. SWAN followed thousands of us for 20 years and found that in perimenopause, scores on memory tests didn't drop. They just stopped improving with practice the way they normally do at this age. And for most women it recovered afterward.
Focus and getting things done
Rage and irritability
Mood and anxiety
Feeling unlike yourself
People, noise, and needing space
Done ticking? Here's why so much of this is new to us.
The odd symptoms usually show up alongside the familiar ones instead of replacing them. If you have boxes ticked in five different groups, that spread is what to show someone. The pattern tells the story. No single line on this list can.
A few of these need a doctor, not a checkbox
Here is the risk with a list this long. Once you have an explanation that fits, everything starts getting filed under it. The symptoms below can absolutely happen during these years too, but a few of them need someone to look at you today rather than at your next appointment. Going in and finding out your hormones were behind it after all is a good day. The other way around is not.
- Chest pain or pressure, particularly with breathlessness, sweating, nausea, or pain spreading into the jaw, back, or arm. Heart attacks present differently in women and are underdiagnosed in exactly this age group.
- Sudden weakness or numbness on one side, a drooping face, or trouble speaking. Call 911.
- Fainting, or repeatedly coming close to it.
- Bleeding that soaks through protection every hour, or passing clots larger than a quarter.
- Bleeding between periods, after sex, or any bleeding at all once you have gone twelve months without one.
- A new breast lump, skin dimpling or puckering, or nipple discharge.
- A sudden severe headache unlike any you usually get.
- New shortness of breath, or pain and swelling in one calf.
- Unexplained weight loss, drenching sweats with fever, or a lump anywhere that is new and does not resolve.
If your mood symptoms include thoughts of harming yourself
Please do not wait this one out or save it for an appointment in six weeks. Perimenopause can hit your mood hard, and that is a reason to get support sooner, not a reason to talk yourself out of asking. In the US you can call or text 988 any hour of any day. Tell somebody today. What is causing the thoughts matters far less than you not sitting with them alone.
If you are told your labs are normal
Worth knowing before you go, because this one is counterintuitive.
The hormone they usually test is FSH. It climbs as your ovaries wind down, so a high number gets read as proof. But in perimenopause your ovaries aren't winding down steadily, they're sputtering. Estrogen still surges now and then, and every surge knocks FSH back down. You can test high one week and completely ordinary two weeks later. One blood draw catches one day. It can't see the pattern you're living in.
This isn't a fringe opinion either. Official guidance in the UK says it outright: if you're 45 or over, perimenopause should be worked out from your symptoms and your history, and testing FSH doesn't help, because the numbers bounce around and the result won't change what anyone does next. Testing earns its place if you're younger, and even then the advice is two samples several weeks apart rather than one.
So a normal result doesn't mean this isn't perimenopause. What you're experiencing is the evidence. If your labs come back fine and your symptoms haven't come up yet, that's a good moment to bring the list out.
Bloodwork still earns its place here, and its job is ruling out what else could be causing all this. Thyroid trouble and low iron both bring the tiredness, the hair changes, and the mood dips, and both are fixable. Ask for those two by name.
Questions worth asking
Check the ones you want to ask. They save and print right along with your symptom list, so you can hold both in the room.
Take it with you
A list you wrote at your kitchen table is much harder to talk yourself out of than one you are trying to remember while somebody looks at a screen. Bring it. Say the word perimenopause out loud, and ask whether it could explain the whole pattern rather than only the one symptom you led with. And if the answer does not sit right with you, asking again, or asking somebody else, is a perfectly reasonable next step.
This checklist is for awareness and education. It is not medical advice and it is not a diagnosis. Every symptom listed here has other possible causes, and a few of those causes need attention of a different kind, which is why the section on what to get checked matters as much as the list itself. Always talk with a healthcare provider about your symptoms and your options.
Tracy | Certified Menopause Coach | AliBee Founder | alibeeshop.com