Perimenopause — the transition leading up to menopause — can begin years before periods stop, often in the late 30s or 40s. Because the symptoms are broad and gradual, many people don't connect them to hormones at first. Naming what's happening is the first step toward doing something about it.
Signs that are easy to miss
Beyond the well-known hot flashes and night sweats, the transition commonly shows up as:
- Sleep that's harder to fall into or stay in
- Mood changes — more irritability, anxiety, or low mood than usual
- Brain fog and word-finding trouble
- Energy that's flatter than it used to be
- Changes in metabolism, weight distribution, or joint comfort
- Shifts in intimacy and libido
Any one of these can have many causes. Together, and around the right age, they're worth raising with a clinician.
What the science actually says
Hormone therapy is studied primarily in the context of relieving menopausal symptoms, and the evidence there is meaningful. In late 2025, U.S. regulators moved to update longstanding warning language on menopausal hormone therapy, reflecting evolving evidence and helping reduce decades of stigma around the treatment.
Why testing isn't always the whole answer
Hormone levels fluctuate dramatically day to day and even hour to hour, so a single lab value doesn't tell the whole story. Good care combines your symptoms, history, and labs — interpreted by a provider — rather than chasing one number.
When to talk to a provider
If these changes are affecting your sleep, mood, focus, or quality of life, that's reason enough for an evaluation. You don't have to wait until symptoms are severe, and you don't have to navigate it alone.