When Does Perimenopause Really Start?

When Does Perimenopause Really Start?

The Top 5 Signs You’re in Perimenopause—and How to Treat Them Naturally

Many women are told that menopause happens sometime in your 50s and that maybe, just maybe, you’ll get a few hot flashes along the way. But here’s what I see in my practice every day:

Women in their late 30s and 40s feeling like something is “off,” even though their lab results look normal. They’re told to wait. To brush it off. To accept that “this is just what getting older feels like.”

But here’s the truth:

Perimenopause can start much earlier than we’re taught—and the symptoms can show up long before your period stops.

Let’s break it down: what perimenopause really is, the top 5 signs you’re “in it,” and the natural tools I recommend every day to support women through this powerful transition.

🌿 What Is Perimenopause, Really?

Perimenopause is the hormonal transition leading up to menopause. It can last anywhere from 4 to 10 years. During this time, your ovaries gradually produce less estrogen and progesterone, two key hormones that affect everything from mood and metabolism to sleep and cycle regularity.

Unlike menopause, which is defined as 12 months without a period, perimenopause is more subtle, more unpredictable—and often more frustrating.

It doesn’t arrive with a clear signpost. But your body will start whispering clues if you know what to listen for.

🔍 The Top 5 Signs You Might Be in Perimenopause

1. Your Sleep Has Changed—And Not for the Better

Suddenly waking up at 3 a.m.? Feeling exhausted but wired? Sleep disruptions are one of the earliest signs of perimenopause, often triggered by declining progesterone and rising cortisol (your main stress hormone).

🧘‍♀️ Natural Support:

  • Magnesium glycinate before bed

  • Calming bedtime routines (no screens, warm baths, herbal teas)

  • Cortisol-supporting herbs like ashwagandha and holy basil

2. You’re Gaining Weight (Especially Around Your Belly)

Even if you haven’t changed how you eat or move, many women notice stubborn weight gain in their 40s. This is often due to a mix of insulin resistance, lower estrogen, and chronic stress.

💪 Natural Support:

  • Strength training 3-4 times a week boosts lean muscle and improves insulin sensitivity

  • Prioritize protein and fiber-rich meals

  • Cut back on sugar and processed foods

  • Stabilize blood sugar and cortisol to support metabolism

3. Your Periods Are All Over the Place

Shorter, heavier, skipped altogether—these are all normal signs of fluctuating hormones. Progesterone typically drops first, which can cause heavier or longer bleeding, while estrogen spikes and dips unpredictably.

🌿 Natural Support:

  • Cycle tracking helps identify patterns (and empowers you in conversations with your doctor)

  • Vitex (chaste tree berry) supports progesterone levels

  • Seed cycling can gently regulate hormones

4. You’re More Anxious or Irritable Than Usual

Mood swings aren’t “just stress.” Estrogen plays a role in serotonin production, so when it fluctuates, your emotional resilience can take a hit. You might feel more reactive, tearful, or even flat-out overwhelmed.

🧠 Natural Support:

  • Prioritize cortisol regulation: try meditation, acupuncture, forest walks, or journaling

  • Nutrients like omega-3s and B-complex vitamins support mood

  • Reduce inflammatory foods that can worsen stress and hormone imbalance

5. You Just Don’t Feel Like Yourself

Maybe you’re tired all the time. Or your brain feels foggy. Or you’ve lost interest in things that used to light you up. This isn’t you “being dramatic”—this is your body asking for support.

💛 Natural Support:

  • Daily movement (especially resistance training) improves brain and body vitality

  • Reduce alcohol and caffeine, which can amplify symptoms

  • Work with a holistic practitioner to customize a plan that includes nutrition, herbs, and functional lab testing

🌸 The Good News? You Can Feel Like Yourself Again

Perimenopause isn’t the end of anything—it’s a powerful hormonal transition that, with the right support, can actually deepen your connection to your body and strengthen your long-term health.

At Denver Holistic Medicine, I work with women every day who are tired of feeling brushed off and want answers that make sense and care that feels personalized. Together, we look at your hormones, your lifestyle, your nervous system, and your goals—and build a plan that honors all of it.

If you’re wondering whether you might be in perimenopause—or you know you are and just need a better way forward—I’d love to help.

Holistic Health services in Denver 

As a leading functional medicine practice in Denver for over 17 years, Denver Holistic Medicine will help to create the most optimal exercise and nutrition plan for you, no matter yout age or stage in life. We utilize a variety of natural and safe treatment options including functional labs , nutraceutical supplementation, nutritional guidance, stress management education, immune and endocrine support, and more…

We work with all our patients on an individualized basis to develop the safest and most effective treatment plan for you. Schedule an appointment today to get started.

Simone Sturm