What I wish I had known before perimenopause

When it comes to menopause, most individuals who experience menopause know to expect hot flashes and that periods eventually stop. What often comes as a surprise is everything that can happen before that. 

Canadian research found that 95 per cent of women experienced symptoms, with an average of seven symptoms each. At the same time, 46 per cent said they felt unprepared for perimenopause and menopause. 

If you do not know that symptoms could be related to perimenopause, it is easy to blame stress, getting older, being too busy, or simply not coping as well as you used to. 

There is no way to know exactly what perimenopause will look like for you. But knowing what to watch for, what is worth acting on, and when to ask for help can make the transition a lot less confusing. 

It can start earlier and look very different than you expect

Perimenopause can begin years before your periods stop. Changes in your cycle may be one of the first signs, but not always. 

Sleep problems, anxiety, mood changes, headaches, heart palpitations, joint and muscle discomfort, low energy, and changes in memory and concentration can all be part of the transition. 

A lot of these are easy to explain away. You wake up at 3 a.m. and assume you are stressed. You lose your train of thought in a meeting and cannot find a familiar word. You get through a normal day and feel much more drained than you used to. 

Knowing that these symptoms can be connected helps you spot patterns sooner. It does not mean every new symptom is hormonal. Persistent, unusual, or concerning changes still need to be checked out. 

Feeling less like yourself is more common than you realize

Some of us feel more anxious, irritable, or emotional than usual. Others notice changes in concentration, memory, or confidence. Headaches or migraines may appear for the first time or start to behave differently. 

If this is happening to you, you are far from alone. In a recent Society of Obstetricians and Gynaecologists of Canada (SOGC) survey of nearly 13,000 people, 84 per cent reported sleep disturbances, 81 per cent fatigue, and 80 per cent brain fog or memory issues. 

These changes can be unsettling when your day still requires you to think clearly, make decisions, remember details, and be present for other people. It is easy to wonder why things that once felt straightforward suddenly take more effort. 

Look for patterns. Are your periods getting heavier, longer, closer together or more unpredictable? Are you waking at the same time most nights? Are headaches happening more often? Does anxiety or irritability seem to spike at certain points in your cycle? Are you struggling more with concentration after a poor night of sleep? 

A few notes over several weeks or months can make those changes easier to see. The Menopause Foundation of Canada has a symptom tracker endorsed by the Canadian Menopause Society that can help. 

Do not ignore changes in your period

Periods can become irregular during perimenopause, but they can also become heavier, longer, or closer together. 

If your bleeding changes significantly, mention it to your healthcare provider. If you are also unusually tired, weak, dizzy or short of breath, ask whether your iron levels should be checked. 

Gradual changes are easy to normalize. Knowing your usual pattern helps you notice when something has really shifted. 

Nutrition can make a noticeable difference

There is no special perimenopause diet, but protein, fibre, calcium, and vitamin D deserve a little more attention in midlife. 

Protein supports muscle maintenance and recovery and can help meals feel more satisfying. Eggs, yogurt, fish, poultry, tofu, beans, lentils, nuts, and seeds are all good options. 

Fibre supports digestive health, healthy cholesterol levels, and blood sugar regulation, and can also help with fullness. Whole grains, vegetables and fruit, beans, lentils, nuts, and seeds are all useful sources. 

In a busy day, meals and snacks that include both protein and fibre can help support steadier energy and reduce the chance of getting overly hungry between meals. 

Calcium and vitamin D matter more now too. Estrogen helps protect bone, and bone loss accelerates around the menopause transition. Making sure you are getting enough calcium and vitamin D, together with weight-bearing and resistance exercise, helps support bone health at a time when that protection is starting to change. 

You do not need to overhaul the way you eat. Look at one meal or snack that could use a little more staying power and start there. 

Start thinking about strength sooner

Walking, cardio, and staying active are all valuable. Strength is the part many of us were never encouraged to think much about. 

Maintaining muscle becomes more important as we age, and resistance and weight-bearing exercise help support both muscle and bone health. 

Strength training can be simple. Weights, resistance bands, and body-weight exercises all count. 

If strength training is new to you, start with something manageable. A small routine you actually do is more useful than an ambitious plan that does not fit your life.

Protein and adequate nourishment work alongside strength training to support muscle maintenance and recovery. 

Think less about what exercise does to your body and more about what you want your body to keep being able to do. 

Poor sleep is worth addressing

Sleep problems can start before you ever have a hot flash. You may struggle to fall asleep, wake repeatedly, or find yourself wide awake much earlier than you want to be. 

The next day still goes ahead. You still need to concentrate, make decisions, be patient, and show up for other people. 

Regular movement, a comfortable bedroom, reasonably consistent sleep and wake times, and paying attention to how caffeine or alcohol affect you are all worth trying. 

But if you are doing those things and still sleeping badly, it may not be a sleep-hygiene problem. If poor sleep is regularly affecting your mood, concentration, or ability to function, bring it up with your healthcare provider. 

Some symptoms are rarely talked about

Changes in estrogen can affect vaginal and urinary health. Vaginal dryness, discomfort during sex, urinary urgency, bladder symptoms, and recurrent urinary tract infections can all be connected to perimenopause. 

A lot of women do not realize this, or they feel uncomfortable bringing it up. 

These symptoms are common and treatable. They are worth mentioning rather than quietly living with them. 

You do not have to wait until you are barely coping

Lifestyle changes can support your health and may help with some symptoms, but they are not the whole answer. Hormonal and non-hormonal treatment options are available when symptoms are affecting your quality of life. 

You do not need to know exactly what treatment you want before asking for help. Start with what you have noticed, how long it has been happening, and how it is affecting your day-to-day life. You also do not need to change everything at once. 

If there is one area that feels worth working on, start there. Maybe it is adding some strength training, getting more protein and fibre into your diet, protecting your sleep, or simply tracking symptoms for a few weeks. Pay attention to what helps and build from there. 

Perimenopause can be disruptive, but it is not only a story about symptoms. For many of us, midlife also becomes a time to pay more attention to what they need, let go of things that are no longer serving them, and become more intentional about their health. The transition can be challenging, but it can also bring more clarity, confidence, and a stronger sense of what matters. 

The goal is not to get through perimenopause perfectly. It is to understand what is happening, make changes that support you, and know when to reach out for help. 

For many of us, having that knowledge earlier would have made the transition feel much less confusing and a lot more manageable. 

How ASEBP supports you

ASEBP is here to support you on your health and wellness journey.   

• Prescriptions ASEBP covers all prescription medications for menopause that are licensed by Health Canada and have an approved indication. Coverage for newly approved medications may be added following appropriate national and provincial reviews.   

• Employee and Family Assistance Program (EFAP) ASEBP covered members and their dependents each have access to free yearly hours to access a range of supportive resources that can help you manage menopause-related changes. Connect with mental health counsellors, registered dieticians, fitness instructors, sleep consultants, and many other health practitioners who have experience supporting individuals through menopause to help support your health goals.   

• Health Spending Accounts (HSAs) that may be used to reduce eligible out-of-pocket medical expenses, after your ASEBP benefit plan, other benefit plan (if applicable), and provincial health care coverage have been exhausted.   

• Wellness Spending Accounts (WSAs) that may be used toward eligible wellness-related products, services, and activities that support your wellness, fitness, and personal growth.   

• Wellness Website Trusted wellness information and tools through ASEBP’s Wellness Hub, including resources on menopause, healthy living, and overall well-being.    

Coverage can vary by plan, so be sure to review your benefit details by logging in to My ASEBP or contacting a benefit specialist for assistance if you have questions or are unsure about your specific coverage.   

The information provided in this article is for personal use, reference, and education only. ASEBP does not provide medical advice. Before starting any medication, product, or treatment, you should always consult with your pharmacist, health care provider, or call Alberta Health Link at 811. 

Other Resources

Society of Obstetricians and Gynaecologists of Canada: Menopause Mythbusters