Perimenopause, the window of up to 10 years that transition into menopause, is a time when all the changes that women usually think of as menopause actually begin. For many, it’s clearly a time of “what is going on with my body.”

Some may be trying to have a baby and this is the absolute worst thing that could be happening. For others, they are done with having babies and would like to stop having periods and stop needing birth control.

But how do you suspect that you are in perimenopause? What are the symptoms?

Below are 7 symptoms that taken together are a pretty good sign that perimenopause is at hand:

1. Irregular periods. As hormones become more and more unbalanced, ovulation becomes more unpredictable.  The time between periods may be longer or shorter, and menstrual flow may be lighter or heavier. You may occasionally skip some periods. If your cycles consistently become seven days or more further apart, you may be entering perimenopause. Eventually, cycles will become 60 days or more apart.
2. Decreasing fertility. Menstrual cycles are regular because hormones are balanced. But in perimenopause, hormones become more and more unbalanced, cycles get further apart, and ovulation becomes irregular. That leads to lower fertility. Instead of ovulation 12 to 13 times a year, you may only ovulate half that often. That means your chances of getting pregnant are lower than they were. But before you throw away your contraception, remember – it ain’t over till it’s over. Don’t stop using birth control until you have gone at least one year without a period.
3. Hot flashes and sleep problems. Perimenopause is the start of hot flashes. Of course they can be due to other causes such as low thyroid or diabetes. And just because you have one thing doesn’t mean you can’t have the other. Hot flashes that happen at night, called night sweats, are a common and bothersome cause of poor sleep.  And poor sleep leads to a stressful day, which can increase the frequency of hot flashes.
4. Mood swings and other irritable things. The hormone imbalances the come with perimenopause can feel like a bad case of PMS. Mood swings, irritability or increased risk of depression are things that many women complain of in perimenopause. Women who have had bad PMS in the past, or postpartum depression or a prior clinical depression are at more risk.
5. Vaginal and bladder problems. As perimenopause continues, estrogen levels become lower and lower. Since vaginal moisture and vaginal tissue health depend on estrogen, lower estrogen levels can result in a loss of vaginal moisture. That can lead to painful sex. The bladder tissues also depend on estrogen to function at their best and lower estrogen levels that begin in perimenopause can lead to a more sensitive bladder and more frequent urination. There is also a greater risk of bladder infections. Most women don’t let their doctors know about these issues and most doctors don’t ask about them. Let your healthcare provider know so you can get the help you need. This is very treatable.
6. Changes in bone health and cholesterol levels. Once again, lower estrogen has an effect on a woman’s body. Perimenopause is a time of rapid bone loss. It’s a good time to check your bone health with a bone density and start taking calcium supplements if your diet doesn’t contain about 1,000 mg of daily calcium.  This is particularly important if you begin perimenopause at an earlier age. Women lose about 10 percent of their bone mass in the first several years after menopause. Women who are lactose intolerant are at increased risk. Lower estrogen levels can also increase “bad” cholesterol (low-density lipoprotein (LDL) cholesterol, and lower “good” cholesterol” (high-density lipoprotein (HDL) cholesterol). That combination can increase the risk of heart disease. Perimenopause is a great time to ask your doctor to check your cholesterol levels.
7. Mojo is a no show. During perimenopause, changes is sexual desire are common. You may be less interested, or take more time to be aroused. The good news is that most women who are having a satisfactory sex life before perimenopause will continue to have one. But don’t be shy about telling your doctor about it. He or she may not ask you. If it’s a problem that is causing you distress, let your doctor know. Lower libido can continue beyond perimenopause unless you take action. So don’t suffer in silence.

Perimenopause can begin in women in their 30s and early 40s. If you notice these symptoms happening to you, or if you just feel like something is going on with my body that is really strange to me, talk with your doctor. Get tested for perimenopause and get the treatment you need from the start, so you can feel better and look better in perimenopause, menopause and beyond.