Medically reviewed by Anand Thakkar, MD, MSCP. Last updated: September 28, 2026.
Perimenopause symptoms can start years before your last period, and they often sneak up on you. One month your cycle is off. The next, you wake up drenched at 3 a.m.
What Is Perimenopause?
Perimenopause is the time leading up to menopause. Your ovaries make less estrogen, and hormonal fluctuations become uneven. You reach menopause after 12 months in a row without a period.
This menopause transition often begins between ages 40 and 45, though it can start earlier. Cleveland Clinic notes it lasts about four years on average, and up to eight for some women.1
Why Patients Choose Bliss MD for Perimenopause Care
Many women arrive after hearing “your labs are normal” while still feeling off. As a menopause specialist Chicago women can see at two clinics, Dr. Thakkar takes those concerns seriously.
- Menopause-focused training. Dr. Anand Thakkar holds the MSCP credential from The Menopause Society.
- Broad experience. In practice since 2011, he holds ABIM certification in Internal Medicine plus Anti-Aging and Regenerative Medicine (A4M/ABAARM).
- Two clinics. Choose Lincoln Park or our Schaumburg-area clinic in Hanover Park.
Common Perimenopause Symptoms
Hormone swings touch almost every system, so perimenopause symptoms look different from one woman to the next.
Menstrual cycle changes
- Irregular periods that come closer together or further apart
- Heavier, lighter or skipped periods
Hot flashes and night sweats
The Menopause Society calls these the most common symptoms of the menopause transition.2 A flash brings sudden heat to the face and chest, then passes within minutes.
Sleep, mood and focus
- Trouble falling asleep or waking too early
- Mood swings, anxiety or irritability with no clear trigger
- Brain fog or trouble finding words
Body and sexual health changes
- Weight gain around the waist
- Low sex drive
- Vaginal dryness or pain with sex
Lesser-Known Perimenopause Symptoms
Women are often surprised that these can be hormone-related:
- Achy joints or stiff muscles
- A racing or pounding heartbeat
- New or worse migraines
- Dry skin or thinning hair
These perimenopause symptoms overlap with thyroid disease, anemia and heart disease. That is why a proper workup matters.
Is It Perimenopause or Something Else?
A racing heart can come from hormone swings, but also from thyroid disease, anemia or a heart rhythm problem. New anxiety can be hormonal or a separate condition that needs its own care. We check thyroid, iron and a blood count, and order heart testing when your symptoms call for it. The Menopause Society notes that a rapid heartbeat can come with hot flashes.
Perimenopause Symptoms That Mean You Should See a Doctor
Some changes are normal. Book a visit if you notice:
- Very heavy bleeding. You soak a pad or tampon every one to two hours, or pass large clots.
- Bleeding between periods or after sex.
- Any bleeding after 12 months with no period.
- A lower quality of life. Poor sleep, hot flashes or mood changes are hurting work or relationships.
- Low mood that will not lift. If you have thoughts of self-harm, call or text 988 right away.
Chest pain, fainting or sudden shortness of breath need emergency care. Call 911.
Track Your Perimenopause Symptoms Before Your Visit
A two-week log turns “I just feel off” into a clear pattern. Note these each day:
| Track this | Why it helps |
|---|---|
| Period start date and flow (light, normal, heavy) | Shows cycle changes and heavy bleeding |
| Number of hot flashes and night sweats | Measures how much symptoms affect you |
| Hours of sleep and night wakings | Separates hormone-related sleep loss from other causes |
| Mood, anxiety or brain fog (rate 1–5) | Shows whether mood follows your cycle |
| Heart racing, headaches or joint pain | Flags symptoms that need a broader workup |
Bring the log to your first visit. It helps us tell perimenopause symptoms apart from thyroid problems, anemia or stress. The Menopause Society also suggests tracking bleeding on a calendar or app.
Hormone Disruptors and Your Perimenopause Symptoms
Your own hormones are already in flux. Some chemicals in daily life, called endocrine disruptors, can add to that load. The ones that act like estrogen are known as xenoestrogens.
NIEHS reports that CDC testing found BPA in the urine of most Americans it sampled.3 Research on midlife women is still growing, but cutting back is a low-risk step.
Try a room-by-room reset:
- Kitchen. Use glass or stainless steel for hot food and drinks. Eat fewer canned foods, since some can linings contain BPA.
- Bathroom. Fragrance can hide phthalates, and some lotions contain parabens. Choose fragrance-free or paraben-free products as you run out.
- Produce. Wash fruits and vegetables well to lower pesticide residue. Buy organic when budget allows.
- Home. Dust and vacuum often, since chemicals collect in house dust.
Treatment Options for Perimenopause
Good menopause care starts with sleep, stress, nutrition, alcohol, movement and hormone disruptors.
When hormones fit, we use bioidentical hormones only:
- Progesterone, which some women use for sleep and cycle support
- Estradiol, by cream, pellet or other routes, for hot flashes
- Testosterone, in careful doses, for some women with low desire
- Vaginal estrogen for dryness and urinary symptoms
Non-hormone choices are in our menopause treatment options guide.
Our Process for Perimenopause Care at Bliss MD
First comes a free 15-minute discovery call. Next, Dr. Thakkar reviews your cycle, sleep, mood and perimenopause symptoms.
No single test proves perimenopause, because hormones swing from day to day. Labs help rule out other causes. A typical panel checks estradiol, progesterone, FSH, testosterone, thyroid, iron and a blood count.
For some women, we add DUTCH testing. This dried urine test shows how you process estrogen.
Then we build your plan together. We start low, watch for side effects and adjust your dose at follow-up visits.
See our full program for perimenopause Chicago patients. Wondering about price? Read how much hormone replacement therapy costs in Chicago.
Perimenopause Care in Lincoln Park and the Northwest Suburbs
You don’t have to wait until your periods stop to get help. Dr. Thakkar, a Menopause Society Certified Practitioner, sees women for perimenopause symptoms at our Lincoln Park clinic on Halsted. For the suburbs, visit our Schaumburg-area clinic in Hanover Park. Start with a free 15-minute discovery call, and bring your symptom log.
Patient Testimonials
Want to hear from women who have been where you are? Our patient testimonials share their own words. Individual experiences vary.
Frequently Asked Questions About Perimenopause Symptoms
At what age do perimenopause symptoms usually start?
Most women notice changes in their mid-40s. Some notice them in their late 30s.
Can I still get pregnant during perimenopause?
Yes. You can still ovulate at times. Use birth control until you have gone 12 months without a period.
Can a blood test confirm perimenopause?
Not on its own. Hormone levels swing too much for one test to be reliable. We combine symptoms, cycle history and labs.
Do I have to wait until menopause to start hormone therapy?
No. Many women start during perimenopause. Timing depends on your symptoms and health history.
Can perimenopause cause anxiety and heart palpitations?
Yes. Swinging estrogen levels can trigger anxiety and a pounding heartbeat. Because thyroid and heart problems cause the same symptoms, we check for them too.
Did the FDA change its warnings on hormone therapy?
Yes. In 2025–2026 the FDA removed several broad statements from the boxed warning on menopausal hormone therapy labels.4 Other risk information remains, and we review it with you before you start.
Begin Your Perimenopause Care Journey Today
Feel Heard, Then Feel Better
You do not have to push through perimenopause symptoms alone. Tell us what is going on, and we will help you choose a next step.
Serving Chicago and the Northwest Suburbs
Pick the office closest to home or work, including our Schaumburg-area clinic.
Bliss MD – Lincoln Park: 2707 N Halsted St, Chicago, IL 60614
Phone: (630) 289-0440
Bliss MD – Hanover Park: 1802 Irving Park Rd, Hanover Park, IL 60133
Phone: (630) 289-0440
Sources
- Cleveland Clinic. Perimenopause: Age, Stages, Signs, Symptoms and Treatment.
- The Menopause Society. Perimenopause.
- National Institute of Environmental Health Sciences. Bisphenol A (BPA).
- U.S. Food and Drug Administration. FDA Approves Labeling Changes for Menopausal Hormone Therapy Products. February 12, 2026.
