6 Signs of Perimenopause Every Woman Over 40 Should Know

Perimenopause symptoms can look very different than most women expect. For women over 40, the signs of perimenopause often show up long before menopause, missed periods, or classic hot flashes.

Many women experience changes across their nervous system, metabolism, sleep, mood, heart, and body without realizing these symptoms can be connected to perimenopause.

In this episode, I walk through six common signs of perimenopause and explain why these changes can feel scattered, subtle, and hard to recognize at first. Understanding how hormone fluctuations affect multiple systems helps you stop blaming yourself and start recognizing patterns.

I’m a physician assistant, and like many clinicians, I wasn’t trained to recognize early perimenopause this way. This conversation is meant to give you clarity, language, and a framework for what your body may be doing during this transition.

RESOURCES
Free "Why Your Body Feels Off" guide:
https://off.startwithembr.com/

If you’re looking for individualized support navigating perimenopause with clarity and confidence, you can learn more about my coaching program here
https://startwithembr.com

If this was helpful, consider subscribing or sharing it with a woman who’s been wondering if what she’s experiencing is normal.

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Kimberly Hoyt is a physician assistant with two decades of clinical experience who helps women navigate perimenopause and menopause with clarity and confidence. Her work focuses on midlife health and education, helping women understand what is happening in their bodies so they feel prepared, informed, supported and empowered. 

Medical Disclaimer: The information shared on this channel is for educational and informational purposes only and is not intended as medical advice. Kimberly Hoyt, PA-C, and associated content are not a substitute for professional medical care, diagnosis, or treatment. Viewing/Listening to this content does not establish a patient-provider relationship. Always consult your own healthcare provider before making changes to your health plan, starting supplements, or addressing medical concerns.

General Disclaimer: I am not a CPA, attorney, insurance/real estate agent, contractor, lender, or financial adv...

Transcript

Kimberly Hoyt 0:00

If you've been feeling like everything in your body is changing at once, your sleep, your mood, your weight, your heart, your joints, your patience, and you're wondering how this can all possibly be connected, this video is for you. Today I want to walk through how perimenopause affects the body, system by system, and more importantly, why that happens. Not as a checklist, but as a framework that helps things finally make sense. Perimenopause is often confusing because it doesn't arrive all at once and it doesn't announce itself clearly. Hormones don't simply decline in a straight line. Estrogen and progesterone fluctuate sometimes dramatically, especially estrogen And those fluctuations affect how stable different systems in the body feel day to day. Because estrogen receptors exist throughout the body, changes in estrogen don't just affect reproduction. They affect the brain, the nervous system, blood vessels, metabolism joints, skin, and the urinary tract and more. So instead of one obvious symptom, women experience a pattern of changes across the entire body, and without that context, it's easy to think"why is everything suddenly off?" All right, let's get into the nervous system and why this system is so sensitive. Estrogen and progesterone both interact with neurotransmitters like serotonin, gaba, and norepinephrine. As these hormones fluctuate, the nervous system loses some of its ability to self-regulate. The stress response becomes easier to trigger and harder to shut off. Sleep disruption often compounds this effect making everything feel louder and less tolerable. How does it show up? Women often describe feeling on edge without a clear external reason. Emotional reactions feel faster and stronger. Cognitive clarity comes and goes, this brain fog, this is not a loss of resilience, It's just a loss of that hormonal buffering. As you see here, there are a ton of symptoms that go along with this. Like the anxiety and panic without clear triggers, feeling overwhelmed more easily, or trouble falling or staying asleep. All of this has to do with the fluctuations of our hormones as it relates to our nervous system. Number two, cardiovascular system. Why the heart suddenly feels louder. What is going on? Why is our heart beating out of our chest? Estrogen influences vascular tone, nitric oxide production, and the on autonomic nervous system. Our autonomic nervous system. We have our fight and flight, which is our sympathetic drive and our rest and digest, which is our parasympathetic drive. When estrogen fluctuates, blood vessels can become more reactive and heart rate regulation less stable. This doesn't mean that the heart is structurally unhealthy. It means regulation is less smooth. So how does this show up? Sometimes women become more aware of their heartbeat. Sensations that were always there, but filtered out are now noticeable. And this can be frightening, especially when testing comes back normal. Perimenopause cardiovascular symptoms can include all of these things that you see here. Palpitations, racing, heart skipped beats, increased heart rate. It can be scary or unnerving. I want to pause here and say, if you are having any of these symptoms, if you feel like something more is going on, go get it checked. It's better to make sure there isn't anything else causing this, because this is probably gonna be a diagnosis of exclusion, meaning we rule out all the big bad things first and then say. Yep. It probably is related to perimenopause. So don't wait. Especially if you have symptoms like chest pain with exertion or excessive shortness of breath that doesn't seem related to your activities, go get it checked. Number three, metabolism and why the body starts responding differently to the same inputs. Here's what's happening. Estrogen plays an incredible role with insulin sensitivity, fat distribution, and energy utilization as estrogen fluctuates, insulin resistance can increase, and fat storage patterns shift particularly to around the middle. Muscle mass may also decline subtly, and that further lowers your metabolic efficiency. How does it show up? Women feel like their bodies stopped listening to what used to work. Efforts feel less effective, not because discipline changed or what you were doing changed, but because the physiology did. As you can see here, perimenopausal metabolic symptoms have a wide range weight gain, especially around the midsection. We call that visceral fat. It could be difficulty losing weight, changes in appetite, increased cravings, especially for carbohydrates. These things can feel disturbing because it feels like the system changed because it did without you doing anything different, and that can be frustrating. Number four, the GI system, why digestion feels less predictable. What is going on here? Estrogen affects gut motility and especially the gut microbiome. Fluctuations can slow digestion, alter gut bacteria balance, and increase visceral sensitivity. Stress, and sleep disruptions further impact GI function. How does this show up? Foods that once felt fine suddenly don't, bloating increases digestion may feel sluggish or unpredictable. As you see here, symptoms can vary. Slower digestion, constipation, diarrhea, increased gas, food sensitivities. Lots of things play a role in here. It can feel like the wild, wild West as your gut microbiome and your hormones are interacting with each other. If you find this type of explanation helpful, liking the video and subscribing lets me know to keep creating content like this and sharing this video helps other women get the information earlier instead of feeling blindsided. Number five, the musculoskeletal system. And why the joints and muscles start talking back. Estrogen has anti-inflammatory effects and supports collagen production. As levels fluctuate, inflammation can increase, and connective tissue support can weaken slightly. Muscle recovery may slow down due to changes in protein synthesis and our sleep quality. How does it show up? Women notice stiffness, aches, longer recovery times, especially after workouts or periods of inactivity. There are a lot of symptoms that can seem ordinary muscle aches, slower recovery after exercise that we may just chalk up to, we worked hard, or maybe we didn't fuel ourselves appropriately before. Maybe it's increased soreness or joint pains and aches that seem to come out of nowhere. Tendon discomfort is another big one that women deal with. Number six, the genitourinary symptoms. We're gonna talk about why changes here are so common, but under discussed Estrogen maintains the health of the vaginal and urinary tract tissues. Fluctuations lead to thinning of the tissues, reduced lubrication and changes in the local microbiome. This increases sensitivity and infection risk. How does this show up? Symptoms may begin subtly and progress slowly, often being dismissed as aging rather than hormonal changes. The big things we see, vaginal dryness, pain with intercourse, urinary tract infections, urinary frequency, recurrent UTIs. Estrogen helps keep those tissues supple, helps increase our lubrication, and over time as that. as the estrogen decreases or fluctuates, we lose the structural integrity. Our tissues begin to thin, and that can lead to significant pain with intercourse, vaginal dryness. I've heard more than one woman say it's like the Sahara Desert it can be very painful. Number seven, we're gonna talk about skin and hair, part of the integumentary system and why outward changes are starting to mirror these internal shifts. Estrogen supports collagen, skin hydration, and hair growth cycles. As levels of estrogen fluctuate, collagen production declines and hair follicles may shift more quickly into the shedding phases. How does it show up? Changes often feel gradual, but emotionally impactful, especially when they don't align with how a woman feels internally. Women may notice their hair falling out more easily. They may notice that the plumpness in their skin is going down as it as our skin dehydrates and the collagen production decreases. One of the big symptoms that women can complain about with this is itchy ears. As the skin begins to dry out, it can create these areas of itchiness throughout your body. I have this spot on my back. It's one spot that has been itchy for years. I went through this problem with the itchy ears as well. Skin feels thin, dry. You may be more prone to rashes or be sensitive to different products. As you can see from this list, it's not just dry skin and hair falling out. Even the texture of your hair can change. You can notice more wrinkles as that collagen level shifts. When you step back and look at this system by system, the picture becomes clearer. Perimenopause isn't random, but it is wide reaching. Symptoms can shift from month to month because the hormones are fluctuating and not just because something new is going wrong. Understanding this framework helps you stop chasing isolated symptoms and start recognizing patterns, and that shift alone can reduce a lot of fear and self blame. If this helped you see your symptoms in a new way, I've linked some resources below, including a free guide and working with me, if you want support navigating perimenopause with more clarity and confidence. Your body isn't betraying you. It's adapting. And understanding what's happening is one of the most powerful tools you have during this transition. If you found this helpful, check out this video here that talks about some of the weird symptoms that perimenopause can bring about. Or check out this one here that talks about the six foods that help with perimenopause weight gain, and help boost your energy. I'll see you next time.