If you’ve been feeling off, your sleep is unpredictable, your mood shifts, and your period shows up early, late, or not at all. You are not alone. These changes often get blamed on stress or age, but they may be signs of perimenopause.
This phase before menopause affects hormones and can throw off your cycle, energy, and sense of balance. We spoke to Dr. Nicole Sparks, an OB-GYN and lifestyle content creator, about what to expect and when to speak up.
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The First Signs of Perimenopause
Perimenopause often begins subtly. Hormone levels shift, and these changes can manifest in various ways, such as trouble sleeping, mood swings, or irregular menstrual periods. Many people assume it is stress or aging, but these symptoms may be your body’s way of signaling something more specific.
“Some of the signs and symptoms associated with perimenopause are vague and non-specific,” says Dr. Sparks. “So, you may attribute them to stress or ‘getting older’ when it may be more serious than that. Hot flashes, sleep disturbances, and irregular periods are some of the first signs patients present with.”
She adds, “It’s ok to have occasional irregular periods. Maybe you’ve started exercising more than usual, or were traveling, and your period came early or late. But if you notice a pattern of persistent irregular periods and symptoms over time, that’s when you should seek help.”
How Perimenopause Impacts Black Women Differently
“Most women start having symptoms of perimenopause in their mid to late forties, but some experience them as early as their thirties,” says Dr. Sparks.
“Perimenopause usually lasts four to eight years and ends when you’ve gone one full year without a period.”
For Black women, the timeline may be earlier and the symptoms more intense. “Studies show that perimenopause can begin earlier in Black women,” she says. “Because of chronic stress and socioeconomic factors, symptoms like irregular periods, sleep disturbances, and hot flashes may be dismissed as normal, and women may not seek help.”
How Shifts in Estrogen Impact Hair, Weight, and Hormones.
Estrogen is often regarded as a reproductive hormone, but it also plays a crucial role in hair growth, metabolism, and the body’s fat storage. During perimenopause, as estrogen levels begin to decline, these systems start to shift in noticeable ways.
“All of the symptoms during perimenopause and menopause tie directly back to a decrease in estrogen,” Dr. Sparks explains.
“Estrogen helps promote the active growth phase of hair follicles. When it decreases, follicles stay longer in the resting phase, and you may notice increased shedding and thinning.”
Estrogen also affects metabolism and the body’s fat storage. “You may notice your metabolism slowing down in your late thirties and early forties,” she says. “You’re burning fewer calories at rest. Fat storage shifts, especially to the abdomen. And when estrogen drops, so does your insulin sensitivity, which can lead to weight gain and increased appetite.”
Estrogen also helps maintain bone strength, so when levels fall, the risk of osteoporosis increases. That is a condition where bones become weaker and more likely to break. Supporting your body with calcium, vitamin D, and weight-bearing movement like walking or resistance training can help protect your bones during this transition.
They Also Affect Our Mood, Brain, and Mental Health
Hormonal shifts during perimenopause also influence brain chemistry, including neurotransmitters like serotonin and dopamine. These are chemical messengers that help regulate mood, focus, and emotional stability.
Estrogen helps your brain produce and utilize serotonin, which supports emotional stability and sleep. It also affects dopamine, a neurotransmitter that plays a crucial role in motivation and attention.
Progesterone works with calming systems in the brain that help you feel settled and sleep well.
When these hormones start to rise and fall unevenly, it can throw off how your brain handles emotions, focus, and stress.
“It’s not all in your head, and you’re not alone,” says Dr. Sparks. “Serotonin and dopamine are neurotransmitters that help regulate mood. When estrogen and progesterone fluctuate, you may feel irritable one minute and fine the next.”
She continues, “You may notice brain fog, struggling to find words or remember lyrics, and have difficulty concentrating.
These hormone shifts can contribute to anxiety and depression. Add in sleep disturbances and insomnia, and it can make everything feel worse.”
Sleep Disruptions
Sleep changes during perimenopause can mean trouble falling asleep, waking up too early, or feeling unrested. Hormones such as estrogen and progesterone also influence melatonin, the hormone that helps regulate the sleep-wake cycle.
When melatonin is disrupted, your body may struggle to determine when it is time to wind down.
Simple changes, such as maintaining a regular bedtime, limiting screen time before sleep, and avoiding caffeine late in the day, can help. If insomnia persists, consult your doctor about treatment options tailored to your needs.
Can It Impact Your Diabetes or Hypertension?
“If you are living with diabetes or high blood pressure, it’s important to know how perimenopause can affect your conditions,” Dr. Sparks says. “Estrogen is a protective factor for our heart. When levels decline, it increases your risk for cardiovascular disease, which is the number one cause of death in Black women.”
She explains that lower estrogen can also lead to insulin resistance, which affects how well your body manages blood sugar.
“These changes can lead to higher blood pressure, higher blood sugar, and increased weight gain. Let your doctor know if you start to notice shifts in these numbers.”
Perimenopause often overlaps with the onset of chronic conditions. Bone density, cholesterol, and blood sugar levels can shift without apparent symptoms. Regular checkups and updates to laboratory tests, such as blood pressure, cholesterol, and hemoglobin A1c, can help detect changes early and guide your care.
Pregnancy Can Still Occur
Perimenopause doesn’t mean pregnancy is off the table. Ovulation can still happen, even if cycles are irregular or symptoms are hard to track.
Birth rates among women in their late 30s and early 40s have continued to rise, as more people choose to start families later in life.
This unpredictability can be stressful. If you’re trying to conceive, it may take longer and require fertility support. If you’re not trying to conceive, it’s worth reviewing your birth control options. The American College of Obstetricians and Gynecologists (ACOG) recommends seeking an infertility evaluation after six months of trying if you’re over 35, and before trying if you’re over 40.
Advocating for Better Care
“You aren’t married to your doctor,” says Dr. Sparks. “If your concerns are being dismissed, find a new provider. It’s unfortunate, but many women aren’t taken seriously when they bring up perimenopause.”
She encourages preparation. “Advocate for yourself. Bring a list of symptoms and why you’re concerned. Keep a diary so you can be specific. Ask if your symptoms could be related to perimenopause and what that means for your health.
“Make sure your labs, blood pressure, cholesterol, and diabetes screenings are current. If they aren’t, request updates. And if your provider still doesn’t listen, don’t hesitate to get a second opinion.”
You do not have to wait until things get worse. If you are noticing changes in your cycle, mood, sleep, or energy, start tracking them. The more specific you are, the easier it is to get answers and the care you deserve.
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