Many women expect menopause to begin suddenly with hot flashes and the end of menstrual cycles. In reality, the transition often starts years earlier during perimenopause, and the earliest signs can be easy to miss. According to Marla Ahlgrimm, many women in their 40s attribute these changes to stress, aging, or lifestyle demands without recognizing that fluctuating hormones may also be a contributing factor.
Perimenopause is the transitional phase leading up to menopause, when estrogen and progesterone levels begin to fluctuate unpredictably. Marla Ahlgrimm explains that this stage can begin in the early to mid-40s, though some women notice changes even earlier. Because hormone levels rise and fall irregularly, symptoms may appear intermittently, which makes them easier to dismiss.
One of the most common early indicators is a change in menstrual cycles. Periods may become slightly shorter or longer, heavier or lighter, or less predictable than in previous years. Marla Ahlgrimm notes that many women assume these variations are normal aging, but they are often among the first signs of perimenopause.
Sleep disturbances are another early but often overlooked symptom. Some women begin waking during the night, have difficulty falling asleep, or feel unrefreshed even after adequate sleep. While stress and other health factors can contribute, Marla Ahlgrimm explains that hormonal fluctuations can also affect sleep regulation during this stage.
Mood changes may also emerge gradually. Increased irritability, anxiety, emotional sensitivity, or mood swings can occur even in women with no prior history of mood disorders. Marla Ahlgrimm explains that shifting estrogen levels can influence neurotransmitters involved in mood stability. Persistent or disruptive symptoms should be evaluated with a healthcare provider.
Cognitive changes are another commonly reported experience. Women may notice forgetfulness, difficulty concentrating, or “brain fog,” such as misplacing items or struggling to find words. Marla Ahlgrimm emphasizes that these changes are frequently linked to hormonal fluctuations and may also be influenced by poor sleep quality.
Weight changes can occur even without significant changes in diet or activity. Some women notice increased abdominal weight or reduced ability to maintain previous weight levels. Marla Ahlgrimm explains that hormonal shifts, combined with age-related muscle loss, can influence metabolism. Supporting metabolic health through balanced nutrition, aerobic activity, and strength training becomes especially important during this time.
Joint discomfort is another symptom that is sometimes overlooked. Mild stiffness or aching in areas such as the hands, knees, or shoulders may become more noticeable. While joint pain can have many causes, Marla Ahlgrimm notes that some women experience increased discomfort during hormonal transitions and should seek evaluation if symptoms persist.
Changes in skin, hair, and sexual health may also develop gradually. Skin may become drier, hair may feel thinner, and libido or vaginal comfort may shift. Because these changes occur slowly, they are often attributed to normal aging rather than hormonal fluctuation. Marla Ahlgrimm encourages awareness of these symptoms so women can make informed choices about care and treatment options.
According to Marla Ahlgrimm, recognizing the subtle signs of perimenopause allows women to take a more proactive approach to their health. While every experience is different, paying attention to shifts in sleep, mood, memory, menstrual cycles, weight, joints, and overall well-being can help women better understand this transition and manage it more effectively.
Marla Ahlgrimm has co-authored two ground-breaking books,