8 Symptoms of Perimenopause (And How to Treat Them)

Perimenopause can feel like a mystery. One day, everything seems normal, but the next your body feels different. You might notice changes in your menstrual cycle, your mood, or your sleep patterns, and start wondering if something more is happening beneath the surface.

Perimenopause is the transitional stage that occurs before menopause, when the ovaries gradually produce less estrogen and progesterone. It is a natural part of aging, but for many women, the symptoms can be confusing and disruptive. Hormone changes can influence everything from metabolism to mood, which can affect your energy and confidence.

At Geneva Primary Care and Med Spa, our women’s health team in Alpharetta and Johns Creek provides personalized support to help women navigate this phase with clarity, balance, and compassion. We combine hormone testing, medical expertise, and lifestyle care to help you feel like yourself again.

Here is how to recognize the signs of perimenopause and find relief through personalized care:

What Causes Perimenopause?

Perimenopause begins as estrogen and progesterone levels start to fluctuate. These hormones help regulate menstrual cycles, fertility, metabolism, and even brain chemistry. As production becomes inconsistent, you may notice changes in period length, flow, temperature regulation, and emotional balance.

According to the Cleveland Clinic, perimenopause typically begins in a woman’s 40s and can last several years as hormone levels gradually decline. The duration varies from person to person, and understanding the hormonal changes at play is crucial for selecting the right treatment options.

If you are unsure when to see a doctor for perimenopause, here is what to know. Seek medical evaluation if symptoms interfere with sleep, work, relationships, or daily routines, or if bleeding becomes heavy or prolonged.

Symptom #1: Irregular Periods

One of the earliest signs of perimenopause is a change in your menstrual cycle. Periods may arrive closer together or farther apart, and bleeding may be lighter or heavier than usual. These shifts happen because hormone levels no longer follow a predictable monthly rhythm.

Treatment options:

• Track your cycles in a journal or app to identify patterns and triggers
• Use nutrition, stress management, and sleep routines to support regularity
• For heavy or prolonged bleeding, your provider may recommend hormone therapy or low-dose birth control

A healthcare provider can rule out other causes, such as thyroid imbalance or uterine fibroids, and ensure you are supported safely throughout this transition.

Symptom #2: Hot Flashes and Night Sweats

Hot flashes often start suddenly, with a wave of heat rising through the chest and face, sometimes followed by sweating or chills. At night, these sensations can interrupt sleep and cause fatigue the next day.

Relief strategies:

• Dress in layers and choose breathable fabrics
• Stay hydrated and reduce caffeine, alcohol, and spicy foods
• Practice relaxation and paced breathing to ease sudden heat surges

If sleep or focus are affected, medical treatments can help. Options include hormone replacement therapy, certain antidepressants such as SSRIs, or non-hormonal medications that stabilize temperature regulation. Your provider will tailor care to your health profile.

Symptom #3: Mood Swings, Anxiety, and Irritability

Hormone fluctuations can influence serotonin, the brain chemical that regulates mood and emotional balance. As estrogen levels decline, many women experience anxiety, irritability, or sadness even without a clear trigger.

Treatment paths:

• Daily movement, mindfulness, and stress reduction practices
• Counseling or therapy for coping tools and support
• Targeted hormone support to stabilize mood changes

At Geneva, we address both the physical and emotional aspects of perimenopause so you can regain steadiness and confidence.

Symptom #4: Sleep Problems and Insomnia

Many women notice that sleep becomes lighter or more fragmented. Night sweats can wake you repeatedly, and even after they pass, it can be difficult to fall back asleep. Over time, poor sleep contributes to fatigue, irritability, and brain fog.

Tips for better rest:

• Keep a consistent bedtime routine and limit screens in the evening
• Reduce caffeine and alcohol, which can disrupt deep sleep cycles
• Discuss hormone therapy or natural sleep aids with your provider if insomnia persists

Symptom #5: Weight Gain and Slower Metabolism

Maintaining your usual weight can become harder during perimenopause. Hormone changes affect how the body stores fat and uses energy. Lower estrogen levels can slow metabolism, while shifts in thyroid function may exacerbate the challenge.

How to manage:

• Emphasize whole foods, lean protein, fiber, and steady hydration
• Add strength training two to three times per week to support muscle mass and metabolic health
• Seek medical support if lifestyle changes are not enough, so any potentially hidden metabolic or hormonal factors can be addressed

To learn more about weight management support, explore our Medical Weight Loss in Alpharetta complete guide to GLP 1 injections.

Symptom #6: Low Libido and Vaginal Dryness

Declining estrogen can reduce blood flow and natural lubrication in the vaginal tissue, leading to dryness, discomfort, or reduced desire. These changes are common and very treatable.

Treatment options:

• Vaginal moisturizers and lubricants for daily comfort
• Prescription estrogen creams or vaginal hormone therapy to restore moisture and elasticity
• Comprehensive hormone therapy when intimacy symptoms occur with other systemic changes

Symptom #7: Fatigue and Brain Fog

Perimenopause can leave you feeling drained or mentally sluggish even after a full night of rest. Hormone fluctuations, disrupted sleep, and stress may all contribute to a decrease in energy and focus.

Treatment paths:

• Test thyroid and hormone levels to identify imbalances
• Support energy through movement, hydration, and consistent meals
• Consider B12 injections or hormone balancing as part of a targeted plan

Geneva uses diagnostic testing to pinpoint causes, so your treatment plan is precise and effective.

Symptom #8: Urinary Changes or Discomfort

As estrogen decreases, tissues that support the bladder and urethra can become thinner and less elastic. This may lead to increased frequency, urgency, or mild leakage with exercise or coughing.

Treatment options:

• Hydration and reduction of bladder irritants, such as caffeine and carbonated drinks
• Pelvic floor exercises or guided pelvic therapy
• Topical estrogen or vaginal treatments to restore tissue health

When to See a Perimenopause Doctor

Some women have mild symptoms, while others may experience changes that significantly affect their quality of life. It is time to schedule a visit with a perimenopause doctor if you experience any of the following:

• Heavy, painful, or irregular bleeding
• Hot flashes or mood changes that disrupt daily life
• Persistent fatigue, brain fog, or trouble sleeping
• Weight gain, low libido, or new metabolic concerns

Geneva providers specialize in identifying whether symptoms are related to perimenopause or other hormonal shifts and in creating personalized treatment plans that bring your body back into balance.

How Geneva Helps Women Navigate Perimenopause

We take a comprehensive approach to women’s health that goes beyond symptom management. Our goal is to help you understand your body, regain control, and feel at ease throughout every stage of this transition.

• Detailed hormone and thyroid testing for accurate diagnosis
• Personalized hormone therapy tailored to your physiology
• Nutrition and lifestyle planning to support metabolism and energy
• Emotional wellness support for stress, mood, and resilience
• Ongoing monitoring and adjustments for lasting results

To learn more about Geneva’s primary care and women’s health programs, visit our Primary Care page.

Frequently Asked Questions

What are the first signs of perimenopause?

Many women first notice irregular periods, hot flashes, mood swings, or sleep changes. Fatigue, brain fog, and modest weight gain are also common early indicators.

When should I see a doctor for perimenopause symptoms?

Schedule a visit if symptoms disrupt your routine, cause anxiety or sleep loss, or lead to heavy bleeding. Early evaluation rules out other causes and guides targeted treatment.

How are perimenopause symptoms treated at Geneva Med Spa?

We combine hormone testing, lifestyle care, and medication when needed. Options may include hormone therapy, thyroid support, vitamin injections, and personalized nutrition plans.

Can lifestyle changes help relieve perimenopause symptoms?

Yes. Movement, nutrition, mindfulness, and consistent sleep routines can make a significant difference. Our providers create realistic plans that fit your life.

Find Relief and Rebalance with Geneva

Perimenopause is a natural transition, and with the right care, you can feel like yourself again. Our team provides compassionate and science-based support for every stage of this journey.

Schedule a Visit with a Perimenopause Doctor in Alpharetta