How Do I Know If I’m in Perimenopause or Menopause?

Feeling “off” in your late 30s to early 50s? You’re not alone. Many women notice new anxiety, fatigue, brain fog, or irregular periods and wonder if these shifts mean perimenopause or menopause.

At Tia, we believe your hormones tell part of the story, but your symptoms tell the truth. This guide breaks down what’s happening, how to recognize the signs, and why a holistic women's health, symptom-based approach can bring real clarity.

Perimenopause vs. Menopause: What’s the Difference?

Perimenopause is the natural transition leading up to menopause, when your ovaries begin producing less estrogen. It is marked by hormonal changes and can start in your late 30s or 40s and last anywhere from a few years to a decade¹.

Menopause is a single point in time when you’ve gone 12 consecutive months without a period². The average age for menopause in the U.S. is 51 years old³.

More than 1 million women in the U.S. reach menopause each year, yet most aren’t prepared for the years of hormonal fluctuation that come before it⁴.

What Are the Early Signs of Perimenopause?

No two women experience this transition the same way. Symptoms can ebb and flow, sometimes appearing years before your last period. Your period may arrive earlier or later, skip months, or shift in flow. Irregular periods are often the first sign of perimenopause.

Changes in Your Cycle

Your period may arrive earlier or later, skip months, or shift in flow. Cycle irregularity is often the first sign of perimenopause ⁵.

Physical Changes

Hot flashes, night sweats, fatigue, sleep disturbances, and weight gain are among the most common symptoms ⁶. You might also notice joint aches, vaginal dryness, libido changes, or changes in your hair and skin as estrogen levels fluctuate⁷.

Mood & Mental Shifts

Mood swings, irritability, anxiety and perimenopause-related mood shifts, and “brain fog” are all linked to hormonal changes that affect neurotransmitters and sleep ⁸ ⁹.

How to Know If It’s Menopause

You’re considered “post menopausal” once you’ve gone 12 months without a menstrual period¹⁰. Many of the same symptoms may persist for several years as your body adjusts to lower estrogen levels¹¹.

Why At-Home Hormone Tests Can Be Misleading

It’s tempting to want a clear answer from a test, but during perimenopause your hormone levels (like estrogen and FSH) can swing dramatically from day to day¹². A single test might look “normal” one week and completely different the next, which is a hallmark of hormone changes.

At-home hormone tests may not account for this natural fluctuation and can lead to confusion or misdiagnosis ¹³.

At Tia, we use lab testing when appropriate, to rule out conditions like thyroid disorders, but we don’t rely on one number to define your stage. Your symptoms, history, and overall health picture matter more - this is the core of our holistic women's health approach.

When to Reach Out for Support

If your symptoms are disrupting your life, like your sleep, your relationships, your sense of self, it’s time to check in. You don’t have to “tough it out.” Care that centers your experience and listens to your body can make this next chapter one of vitality, not chaos.

Common questions about perimenopause & menopause

Can you test for perimenopause?

There’s no single test that can confirm it. Providers diagnose based on age, symptoms, and medical history¹⁶, which is why a proper perimenopause diagnosis relies on clinical assessment. While levels of FSH and estrogen can be measured, their fluctuation during this time means bloodwork is often supportive, not definitive. However, if testing is important to you, discuss this with your Tia provider and they can discuss the benefits and limitations so you can make the best decision for you.

What treatments help?

Treatment is individualized and may include lifestyle changes, stress management, supplements, acupuncture, or hormone therapy (HRT) when indicated¹⁵ ¹⁷. We believe in integrative perimenopause or menopause care that addresses both the hormonal and lifestyle factors.

How long does perimenopause last?

On average, 4–8 years, but symptom intensity and duration vary¹⁸.

I’ve been told I’m too young for perimenopause, but I have symptoms that bother me. Can you help?

Yes. While the average age for perimenopause is the early- to mid-40s, hormonal fluctuations can begin as early as your mid- to late 30s¹. Some women experience changes in mood, sleep, cycle regularity, or libido years before their final period, and that’s still normal.

At Tia, we care for women across this entire transition, regardless of age or lab results. Our providers practice holistic women's health by listening to your symptoms, ruling out other possible causes, and design a personalized plan that can include nutrition, supplements, stress support, or Hormone Replacement Therapy (HRT) when appropriate. The goal is to help you feel better now, not wait until your symptoms “qualify.”

The Bottom Line

While culturally, women are taught to believe that as their reproductive years wane, so does their vitality, but we reject that narrative. At Tia, we see perimenopause and menopause as a powerful, natural evolution, not an ending.

This transition is worthy of understanding, celebration, and care that honors your whole self. With the right support, clarity, and partnership, you can move through this stage not just intact, but more connected to your body than ever before.

Citations

1. North American Menopause Society. Stages of Reproductive Aging Workshop (STRAW + 10). Menopause. 2012.
2. National Institute on Aging (NIA). Menopause: Time of Change.
3. Mayo Clinic. Menopause overview. Updated 2024.
4. The Menopause Society. Fast Facts: Menopause in the U.S.
5. Cleveland Clinic. Perimenopause: Symptoms and Causes.
6. Harvard Health Publishing. What happens during perimenopause? 2023.
7. NIH. Estrogen’s role in skin and joint health.
8. NAMS. Mood changes during perimenopause.
9. NIH. Sleep and mood in midlife women.
10. NIA. When does menopause officially begin?
11. Cleveland Clinic. Post-menopause symptom management.
12. ACOG Practice Bulletin. Perimenopausal transition diagnosis.
13. Harvard Health. The truth about at-home hormone testing. 2023.
14. NIH Office of Dietary Supplements. Magnesium & Vitamin D Fact Sheets.
15. NAMS Position Statement. Hormone Therapy, 2023 Update.
16. ACOG. Clinical guidance: Diagnosing perimenopause.
17. NIH. Hormone therapy and menopause: Benefits and risks.
18. NAMS. Duration of perimenopausal transition.