The Subtle Signs Of Perimenopause You Need to Know About Now

Not a hot flash in sight? There are lots of far less obvious symptoms.

An illustration of a woman surrounded by the not so obvious signs of perimenopause.
Marta Monteiro

Perimenopause? Psssh. You’re way too young. (Aren’t you?) Besides, your period still makes an appearance every month. And you’re pretty sure you would have noticed any sweltering hot flashes.

But there are other, subtler signs of perimenopause that can set in even before you’re waking up soaked in sweat, says JoAnn Pinkerton, M.D., executive director of the North American Menopause Society (NAMS) and a professor of obstetrics and gynecology at the University of Virginia Health System in Charlottesville. “The average age of menopause is 51, but symptoms of perimenopause can begin years earlier, even as early as your 30s,” she says. Below, she explains a few changes you may not be expecting — but are already experiencing.

Thinning hair. If your shower drain is suddenly clogged after every shampoo, perimenopause may be to blame. Estrogen and progesterone help hair grow faster and stay on your scalp for longer, according to Pinkerton. Your production of both hormones dips during perimenopause, yet your production of male hormones (yes, your body makes those, too) remains constant — boosting their impact. Called androgens, these hormones can shrink hair follicles, making your ponytail even thinner.

Heart palpitations. Decreasing estrogen levels can lead to a faster heart rate — occasionally causing palpitations and nonthreatening arrhythmias, says Pinkerton. Still, if you’re experiencing this symptom, it’s a good idea to bring it up with your doctor to rule out more serious causes.

Brittle nails. Estrogen plays a key role in water retention, and women tend to have higher overall hydration levels before perimenopause. As estrogen decreases, the ensuing dehydration can result in drier hair, drier skin, and cracked, brittle nails. To help restore the moisture, guzzle plenty of water throughout the day.

Heavier or more frequent periods. Yeah, we know — you were expecting your periods to wind down during perimenopause, not rev up. But your hormone levels don’t just take a long, slow dive during this time. Instead, they can fluctuate wildly, causing an unpredictable mix of long cycles, short cycles, spotting, and heavy periods. If the bleeding is really getting to you, consider talking to your doctor about the Pill, which can smooth out those hormonal ups and downs.

Trouble "holding it in.” This is exactly why your gyno is always preaching the virtues of Kegels. During perimenopause, decreased estrogen levels can cause your pelvic muscles to weaken, making it harder to control your bladder. Urinary symptoms often get worse over time — so unless you want to start changing your underwear after every sneeze, boost your reps on those pelvic floor exercises.

Bleeding gums. Spitting pink in the sink? Estrogen is crucial for maintaining your salivary glands, and the amount of saliva you make may decline during perimenopause. This can lead to not only dry mouth but an increased risk of gingivitis, since saliva contains oxygen that helps rid the mouth of bacteria. One step that can help: Simply drinking more water.

Crying over nothing. If the tears are flowing faster than you can say “ASPCA commercial,” it’s not just because you’re getting sappy in your old age. Pinkerton says that during perimenopause and menopause, levels of an important brain enzyme called monoamine oxidase A (MAO-A) become elevated. Studies have found that women with high MAO-A levels in the prefrontal cortex (the front part of your brain) also have a higher tendency to cry.