Perimenopause: Why Your Periods, Mood, Sleep, and Skin Start to Change

If you’re in your late 30s or 40s and thinking, “Something feels off, but I don’t know why,” you’re not imagining it. Perimenopause is the transitional phase before menopause, and it can quietly begin years before periods stop altogether. During this time, shifting hormones—especially estrogen and progesterone—can affect nearly every system in your body.

Let’s break down the most common changes women notice and what’s really happening underneath.

Changes in Your Periods: Irregular Is the New Normal

One of the earliest signs of perimenopause is a change in menstrual patterns.

You may notice:

• Shorter or longer cycles

• Heavier or lighter bleeding

• Skipped periods, then back-to-back cycles

• More intense PMS or cramping

• 
  

Why this happens: Ovulation becomes inconsistent. Progesterone (the hormone that stabilizes cycles) often drops first, while estrogen fluctuates—sometimes high, sometimes low—leading to unpredictable bleeding patterns.

Mood Changes: Anxiety, Irritability, and Low Mood

Many women are surprised to learn that mood changes can be one of the earliest and most disruptive perimenopausal symptoms.

Common experiences include:

• Increased anxiety or panic

• Irritability or sudden anger

• Low mood or depressive symptoms

• Feeling emotionally “flat” or overwhelmed

Why this happens: Estrogen directly affects serotonin, dopamine, and GABA—key brain chemicals for mood regulation. Rapid hormone shifts can make your nervous system more reactive, especially if you already have a history of anxiety, depression, or chronic stress.

Sleep Problems: Wired but Tired

Sleep often suffers during perimenopause, even in women who previously slept well.

You may experience:

• Trouble falling asleep

• Nighttime awakenings

• Early morning waking

• Night sweats or feeling “hot” at night

Why this happens: Progesterone has a calming, sleep-promoting effect. As levels decline, sleep becomes lighter and more fragmented. Estrogen fluctuations can also disrupt body temperature regulation and melatonin production.

Skin & Hair Changes: Dryness, Thinning, and Texture Shifts

Hormonal changes don’t just affect how you feel—they show up on your skin and hair, too.

Common changes include:

• Dry, itchy, or sensitive skin

• Worsening acne or rosacea

• Thinning hair or increased shedding

• Changes in skin elasticity and fine lines

Why this happens: Estrogen supports collagen production, hydration, and blood flow to the skin. As estrogen declines, skin can lose moisture and firmness, and hair follicles may become more sensitive to hormonal shifts.

You’re Not “Losing It”—Your Body Is Changing in Perimenopause

Perimenopause is not a disease, but it can feel destabilizing—especially when symptoms are dismissed or attributed solely to stress or aging. The key is understanding that these changes are biological, common, and treatable.

A thoughtful approach may include:

• Hormonal evaluation (not just “normal” lab ranges)

• Lifestyle and stress support

• Sleep and nervous system regulation

• Targeted nutrition and supplementation

• When appropriate, hormone therapy or non-hormonal medical support

Final Thoughts

Perimenopause is a powerful transition—not a personal failure. When you understand what’s happening in your body, you can make informed choices and feel more like yourself again.

If your periods, mood, sleep, or skin have changed and you’ve been told “everything looks normal,” it may be time for a deeper conversation.

You deserve a provider that listens, explains, and supports you through this phase—not one that minimizes it. Whenever you are ready, I am here for you. Book your appointment here.

Xenia