Is it perimenopause or do I just want to get a divorce? We asked experts to break down some of the most confusing symptoms

Group chats everywhere are exploding with messages from forty and fiftysomething friends complaining of weird symptoms like torrential “super periods” or mysterious weight gain. Women are taking to Reddit and Threads to share strange phenomena like their hairline moving backwards or incessant skin itching—and are often met with floods of anecdotal responses both science-backed and spurious. The question almost all of them are asking: Is it perimenopause?
The answer isn’t simple, because the fact of the matter is that perimenopause can be a complex, bewildering time.
Perimenopause refers to the time leading up to menopause, which occurs when you haven’t had a period for a year. Usually this begins between 40 and 50, lasting anywhere from four to eight years, and is characterized by a wide range of symptoms caused by fluctuating hormones. Mood swings, brain fog, sleep changes and hair loss can come and go and are often confused with something else.
Instead of heading to the message boards to self-diagnose, we asked experts to break down some of the most common complaints, to find out what’s actually going on.
With big hormonal fluctuations come big-time moods. One of the most confusing symptoms of perimenopause, mood swings can be hard to pinpoint as the exact cause is unique to the individual. “There’s a huge spectrum,” said Dr. Michelle Jacobson, a menopause specialist at Women’s College and Mount Sinai Hospital and assistant professor at the University of Toronto, obstetrics and gynecology. “Often, women will complain about anxiety, irritability, a lot of rage, having a short fuse, noticing a lack of patience, and potentially a low mood such as depression.” A telltale sign that it’s related to perimenopause is when mood swings worsen a week or two leading up to your period, said Dr. Alison Shea, a menopause specialist at Saint Joseph’s Health Care and associate professor of obstetrics and gynecology at McMaster University.
What to do: Track your moods along with your cycles, to help identify the root cause and seek treatment if needed.
With severe hormone swings in perimenopause, “we shed our hair just like when we shed our hair postpartum,” said Shea. “People may start to notice their hair begins to fall out due to estrogen receptors in the hair shaft.” Hair loss can take an emotional toll, but don’t panic. First, rule other hair-loss factors out, such as low vitamin D, zinc and iron, to ensure you’re not anemic. “Those are easy to check, and supplementation can help.” If it is related to perimenopause, hormone therapy can help stabilize it. But it can take until one year after the final menstrual period for hair shedding to stop.
What to do: Make an appointment with a dermatologist or trichologist to explore treatment options such as biotin, collagen or prescription minoxidil.
About half of perimenopausal people will experience insomnia, said Shea. “For some women, it’s difficult to get to sleep, but they often wake up in the middle of the night and feel jolted awake. They start thinking about things and might be up for 30 minutes or three hours and can’t get back to sleep,” she said. Complicating matters, sleep disorders such as obstructive sleep apnea and restless leg syndrome also become more common around this time of life. Either way, it can severely interfere with quality of life. “It’s so important to treat insomnia,” said Shea.
What to do: Ask your doctor about getting a sleep study assessment to determine what’s going on with your sleep.
Hot flashes are perhaps the most well-known menopause symptom—plenty of people think they’re all that happens to the body during “The Change.” But they’re not straightforward. “You can’t always assume that a hot flash, and the chills or clamminess that come afterward, is specifically menopause,” said Jacobson. There’s actually no textbook case of hot flashes; everyone experiences them differently. “Some people talk about a sense of profound anxiety or dread, while some people get very sweaty. Some people feel a sense of heat or an uncomfortable sensation like pins and needles.” The cause is dysfunction in thermoregulation; the body’s way of maintaining a stable temperature. “Hot flashes happen during perimenopause and menopause because there’s an area in the brain that’s responsive to changes in estrogen,” said Jacobson. “It grows when estrogen levels are either low or when there’s a sudden drop.” Check for a measured fever; that could be COVID or the flu. But “if it’s menopause related, it will be ongoing.”
What to do: To manage hot flashes, keep cool by using a fan or staying in air-conditioned spaces, and avoid triggers like caffeine, spicy foods and alcohol. If hot flashes are severely impacting your quality of life, consider talking to your doctor about hormone replacement therapy.
More than one-third of women experience changes in sex drive in perimenopause, as declining estrogen levels can cause a lack of interest in sex and problems with arousal. But that’s not the only factor. “Sex drive in women is very multifactorial, and it generally starts to decrease in your forties even before perimenopause starts,” said Shea. “There may be other things at play besides hormonal changes.” For instance, antidepressants can lower your sex drive, as can some blood pressure medication and oral hormones. “On top of that, we know that depression decreases sex drive. And if you have any other stressors, that will take over your mind more than your drive to have sex.”
What to do: Medications such as Addyi, known as “viagra for women” can help, and reading books such as Come as You Are or Better Sex Through Mindfulness, which can “shift how you think about your sex life,” said Shea. “If you’re willing to work on it with your partner, you can often get it back.”
“People will say they’re doing the same thing—exercising and eating healthy—but they’ve gained weight,” said Shea. “Starting in your late thirties and into your forties, you start to lose your skeletal muscle, your lean muscle mass, unless you’re actively trying to build it. Around perimenopause, your metabolism drops and, with it you get changes in how you metabolize carbohydrates.” The thyroid may be another contributor. “It’s common for your thyroid to change around the menopause transition, as changes in estrogen can affect thyroid hormones. So if you’re noticing a weight change, getting your thyroid checked is a good idea,” said Shea. “If that seems to be normal, then it’s a great idea to change your exercise routine and look at your diet.”
What to do: Consider cutting back on high-sugar and processed foods and eating mostly whole foods. Prioritize exercise, which can also improve your sleep and mood, doing 30 minutes of low-impact aerobic activity such as walking, swimming or cycling most days. Add strength training two or three times a week to help build muscle mass and boost metabolism.
Here’s something that takes some of us by surprise. “Many women have itchy skin in perimenopause as changes in estrogen lead to decreased collagen and natural oils in your skin,” said Shea. Changes in sensitivity during this time of hormone changes are common too. “They may become more sensitized to things they weren’t sensitive to before.” But skin itching can have many other causes, like contact dermatitis or allergic reactions. So how do you rule these out? “If you’re feeling quite itchy, the first step is to look at what you’re using on your body.”
What to do: Switch out body care and cleaning products that contain fragrances or certain preservatives—even swap out your laundry detergent to see if it makes a difference. “If you’re still feeling itchy, then there’s a good chance it has to do with changes in your hormone levels.”
It could well be. “In perimenopause, you get less predictable ovulation. And when you’re not ovulating regularly, you get a buildup of the endometrial lining and then unpredictable breakthrough bleeding, which can sometimes be very heavy,” said Jacobson. What fun. Here’s a bonus: “PMS gets a lot worse and more pronounced.” But there are other factors that could be contributing to torrential period flow, said Shea. “Things like fibroids and endometrial polyps can certainly make this worse. You want to make sure that your Pap tests are up to date, to make sure that any abnormal or heavy bleeding isn’t due to something like cervical cancer.”
What to do: Talk to your doctor about any persistent changes in your bleeding pattern; it’s not something to self-diagnose.