9 Signs to Determine You’re Approaching Menopause

Last updated 12.05.2023 | by Dr. Karen Pike | 12 Minutes Read

This article has been reviewed and fact checked by Dr. Karen Pike, a senior physician administrator and board-certified emergency room doctor actively working in northern California. Read more at our medical disclaimer page.

The average age of menopause in the United States is 51. But every woman goes through menopause at a different age, and there’s no guaranteed way to predict when the process might happen for you. However, there are several telltale signs that will let you know when you’re approaching this phase of life.

Having an idea of when menopause is likely to occur can help you prepare for the changes your body will go through and navigate this transitional time armed with the right tools and information.

I’ve met so many who have been caught off guard by new symptoms, not recognizing that they were a sign that menopause was on the way. 

So, do you want to enter menopause with a greater awareness of what’s happening in your body? If so, this post is for you.

Below, I’ll explain 9 of the most common signs that menopause could be near. 

But first, let’s recap the stages of menopause and the average ages they occur.

The Stages of Menopause

The term menopause can be broken down into three subcategories: perimenopause, menopause, and post-menopause.

Perimenopause is the build-up to menopause. This phase can begin as much as a decade before you officially reach menopause and your periods stop for good.

Most women start noticing signs of perimenopause in their mid-40s. During perimenopause, your ovaries are still releasing eggs, but ovulation is less regular. This makes it harder to conceive; however, getting pregnant is still possible.

But what about menopause? In medical terms, menopause is the point in a woman’s life when she has not had a period for more than twelve consecutive months. By this stage, the ovaries have stopped producing eggs, and it’s no longer possible to get pregnant.

Then, there’s postmenopause, the term used to describe the rest of your life after menopause.

Many of the most bothersome menopause symptoms begin to settle down once you enter post-menopause. However, they don’t vanish overnight, and it can take several years for them to disappear for good.

The Science of Menopause

All women are born with a certain number of eggs. And this finite egg reserve diminishes little by little for each month of our lives after our menstrual cycle begins.

As we slowly run out of eggs, our body’s hormone levels begin to change. Estrogen goes up and down within each cycle. However, over time, average levels gradually begin to fall.

Meanwhile, follicle-stimulating hormone (FSH) slowly begins to increase. FSH’s job is to keep promoting your ovaries to release eggs. But as each month passes, the reserves get lower. And so, FSH increases as estrogen begins to fall.

This hormonal dance is the reason why we experience the signs and symptoms of menopause.

9 Signs to Determine if You’re Approaching Menopause

Signs to Determine if You’re Approaching Menopause

The best way to know for sure that you’re approaching menopause is to have your hormone levels tested by a doctor. However, this isn’t always possible and isn’t necessary. There are plenty of telltale signs that can let us know what’s going on inside our bodies without needing to give a blood sample.

Throughout my research, I’ve spoken to numerous women about the symptoms they experienced when they were approaching menopause. Here’s a list of 9 of the most common ones I found.

1. Changes to Your Period

It’s often the very first sign that you are entering perimenopause. Hormonal changes may cause your usual monthly flow to change. You may experience light spotting, heavier bleeding, or a longer or shorter period than you’re used to. Your cycle may also become longer or shorter, and you may skip periods entirely.

These changes can be signs of perimenopause but could also be symptoms of another condition. Plus, a missed period could indicate that you are pregnant. So, if you’re concerned about changes to your period, it’s best to visit your doctor to find out the underlying cause.

2. Sleep Issues

Insomnia is one of the most commonly reported symptoms of menopause. I struggled with insomnia during my own menopausal transition, and my sleep began to be affected quite early on in perimenopause. In fact, it was one of the first symptoms I noticed.

Shifting hormones had me laying in bed for hours at night, failing to fall asleep. Other times, I’d drift off comfortably, only to awaken in the far-too-early hours of the morning. At one point, this cycle was happening night after night, and seriously impacted my energy levels during the day.

As a result, I was more tired than normal and unable to function at full capacity. 

Insomnia and sleep disturbances are a telltale sign of perimenopause. But if you’ve also missed a period, it’s worth considering if you could be pregnant. Sleep problems and fatigue are also common signs of pregnancy. So, if you’re in any doubt, take a test or visit your doctor to be sure.

3. Changes in Mood

Mood swings are something many women get used to at a certain time of the month. But if mood swings and irritability are becoming common and show up more often than usual, perimenopause could be to blame.

Fluctuating hormones can mean that even the most harmless comment from your partner sends you flying off the handle. Soon, you’re snapping at your kids, slamming doors, and getting frequent bouts of road rage.

But our changing moods might not be down to hormones alone. If insomnia keeps you awake at night, this can make any perimenopausal mood swings.

Plus, our mid to late 40s can be a challenging time of life for many of us. Kids are growing up and leaving home, parents are getting older, and life’s responsibilities can sometimes feel overwhelming. These factors combined mean it can be challenging to keep cool.

4. Lack of Sex Drive

You might have noticed that recently, it takes much longer to get ‘in the mood’ than it used to. And no matter how hard you try to make an effort in the bedroom, the sexual spark in your relationship just doesn’t seem to be there anymore.

Don’t worry; you or your partner probably aren’t to blame. Instead, it could be a sign of perimenopause. During this phase of life, decreasing estrogen levels can play havoc with your libido, and your once-active sex life can begin to suffer.

But thankfully, there are plenty of things you can do to reignite passion in the bedroom and rekindle romance in your relationship.

5. Weight Gain

Is your usual diet and exercise routine not cutting it anymore? Does your jeans keep getting tighter no matter how many salads you eat and sweet treats you swerve? Steady weight gain is another extremely common side effect of perimenopause, and it can begin relatively early on in the process.

Most women I’ve worked with say that added weight tends to go to their midsection rather than their hips, thighs, or breasts. This is extremely typical, and is due to the fact that estrogen helps to distribute fat to other areas rather than the belly. But when estrogen levels begin to dip, that redistributing effect disappears. 

Not all weight gain is a sign of perimenopause. After all, as we approach our late 30s and early 40s, our metabolisms naturally begin to slow down. However, if it’s in combination with any of the signs and symptoms above, it could be a clue that menopause is on the horizon. Thankfully, this type of mid-life weight gain isn’t inevitable, and with the right tools and some extra effort, you can reverse it. I’ve met many women who have successfully turned weight gain around, achieved fitness and health, and maintained these positive changes long after their menopausal transition was complete.

6. Hot Flashes and Night Sweats

Hot flashes and night sweats are actually the same phenomenon. It’s just that one happens during the day, and the other occurs when you’re lying in bed at night. But semantics aside, these symptoms are among the most common indications that menopause is on the way.

Hot flashes and night sweats can begin as much as a decade before menopause arrives. Most women I’ve spoken to say that these vasomotor symptoms were the first indication they had that menopause was on the way. During the earlier stages of perimenopause, they tend to strike mostly around your period.

During the day, you may notice hot flashes as a sudden feeling of heat that radiates from your core and spreads across your whole body. It can leave you red in the face and sweating profusely, even in a cold room.

Night sweats, on the other hand, tend to strike when we’re asleep. So, while you might not notice the heat building up inside your body, you will likely wake up with the sheets dripping in sweat. It can worsen an already existing sleep issue, as it can be difficult to fall back asleep once you’ve woken up to wet bedclothes.

If you notice hot flashes alongside the other signs and symptoms on this list, then you are on the road to this transitional phase. But if hot flashes and night sweats occur on their own, it’s a good idea to speak with your doctor, as they could be a sign of another underlying condition.

7. Brain Fog

Are you forever losing your keys, misplacing your phone, and forgetting important appointments? Brain fog is estimated to affect two-thirds of menopausal women, and many worry that it could be an early sign of dementia[1]. But thankfully, chances are that your clouded thinking is just another side effect of hormonal shifts occurring in your body.

Brain fog can be made even worse by sleep disturbances such as insomnia, another common symptom of menopause. This was certainly the case for me. When I was struggling with menopause related insomnia, I often felt sluggish during the day and I struggled to focus with the same clarity that I normally do. When our brains are tired, we lose the ability to respond quickly, and our cognitive functions become even more impaired. So it’s no wonder the symptoms of brain fog affect so many of us during menopause.

8. Painful Intercourse

During perimenopause, a drop in the body’s natural estrogen levels can lead to vaginal atrophy; a condition where the walls and tissues of the vagina become weaker, thinner, dryer, and more inflamed[2].

A dip in estrogen also causes the walls of the vagina to become less stretchy than they once were, and so sexual intercourse becomes painful. In some cases, it can even result in tearing and bleeding.

If you’ve noticed these signs and symptoms of vaginal atrophy, chances are that menopause is on the way. However, there are treatment options available, including topical estrogen creams, which can improve the condition and allow you to continue enjoying an active sex life.

9. Increased UTIs

Most women experience an occasional urinary tract infection (UTI.) However, once menopause gets underway, it can become much more common.

This is due to a decrease in estrogen. Estrogen helps to regulate the balance of healthy bacteria in the vagina, bladder, and urinary tract. However, a decline in estrogen can have a negative impact on the microbiome, meaning that harmful, infection-causing bacteria are more likely to proliferate.

Another related symptom of menopause is urinary incontinence, which can also play a role in the increase of UTIs.

If you suspect you have a UTI, visit your healthcare provider as soon as possible. Most cases are easily treated with antibiotics. However, if left untreated, a UTI can lead to a kidney infection, which can be serious or even life-threatening.


Are there any tests that can determine if I’m approaching menopause?

Yes. Your doctor may refer you for a simple blood test to check your levels of FSH (follicle‑stimulating hormone). FSH increases as you enter perimenopause, so higher levels are a good indicator that you are approaching this phase of life.
Home menopause testing kits are another alternative. They also test your levels of FSH without needing to go to the doctor’s office. However, the best way to determine if you are in perimenopause is with the guidance of a healthcare professional. They can also consider any symptoms you might be having and make a more informed diagnosis.

Is it possible to slow down menopause?

If you’re approaching the average age of menopause, there’s not much you can do to delay its onset. But, research suggests that throughout your lifetime, several lifestyle factors could lead to an increase in your years of fertility- aka, a later menopause[3].
Becoming pregnant and breastfeeding babies has been linked to later onset of menopause in some women. Likewise, studies suggest that taking the contraceptive pill during your fertile years, drinking a low to moderate amount of alcohol, and eating a diet rich in proteins, fruits, and healthy calories may all also lead to a delay in menopause.

How long does perimenopause last for?

Perimenopause can last for up to 10 years before you finally hit menopause, and your periods stop for good. But for most women, the time frame is a little shorter. The average length of perimenopause for women in the US is four years.


As your body approaches menopause, hormonal changes cause a variety of symptoms. And while no one looks forward to irregular periods, insomnia, mood swings, loss of libido, weight gain, and hot flashes, it’s important to be able to recognize the symptoms when they arise so that you can be prepared for what’s to come.

Remember, menopause is a natural part of the aging process. In many cultures, it’s celebrated as a significant milestone in a woman’s life.

So, if you suspect you’re entering your perimenopausal years, try to embrace this next phase of life with positivity and look forward to the newfound freedom and wisdom that comes with it.


  • Dr. Karen Pike

    Dr. Pike is a senior physician administrator and board-certified emergency room doctor actively working in northern California. She received her undergraduate degree at Dartmouth College, where she graduated Phi Beta Kappa and played collegiate soccer. She attended Georgetown University for medical school and performed her residency in emergency medicine at Stanford University. She was part of the first-ever, women-majority emergency medicine program in United States. Dr. Pike is also the primary medical consultant for “Grey’s Anatomy,” a role she has held since the pilot episode when she partnered with Shonda Rhimes as the show’s original medical consultant. At her hospital, she was the second woman Chief of Staff. Today serves as the Director of the Emergency Department. Whether in leadership or direct patient care, her dedication to excellence in communication, quality, and collaboration is unwavering.

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