Perimenopause: What's happening to your hormones?

Published August 25, 2026

Perimenopause is the period when a woman’s body starts to transition into menopause. Hormones fluctuate and estrogen begins to drop during this time. The changes you’re going through can lead to a wide range of symptoms.¹

Testing your hormones can help you track how your body is moving through this transition. At questhealth.com, you can buy a wide range of hormone tests—no doctor visit or insurance required. You even have the ability to speak to an independent healthcare provider about your test results.

What is perimenopause?

Perimenopause can start as early as your mid-30s or as late as your mid-50s. How long it lasts varies from months to years, but on average it lasts about 4 years.¹

In perimenopause, your body is entering the end of its reproductive years, and your ovaries are making less hormones. When you’ve gone 12 consecutive months without a menstrual cycle, you’ve officially reached menopause.¹

Perimenopause can be a challenging time. Your body is going through a lot of changes that affect you from head to toe. Symptoms vary widely from person to person[¹⁻³]:

• Irregular menstrual cycles
• Periods that are heavier or lighter than usual
• Hot flashes or night sweats
• Difficulty sleeping
• Mood changes, depression, anxiety, irritability
• Lack of desire for sex
• Pain during sex
• Vaginal dryness
• More urgency to urinate or urinating more frequently
• Difficulty maintaining your weight
• Brain fog
• Joint pain and muscle aches
• Heart palpitations
• Hair loss
• Skin changes

How can I prepare for this life change?

The transition begins about 8 to 10 years before menopause. The experience varies from person to person. Some can start early and have symptoms for years, while others may jump in fast and move through it quickly.¹

There’s no standard perimenopause experience. On top of hormone fluctuations, you may be facing career pressures, raising kids, or looking after aging parents. Some days the combination can feel overwhelming. Perimenopause is a natural part of life, but you can also get help for symptoms that affect your daily life.

Lab tests can help monitor your hormones and signs of other health conditions. Bone loss and risks for heart disease also increase during this time. It’s important to be aware of changes in your body and talk with your doctor about them.¹

Some people have mild symptoms they can manage through lifestyle habits. Others have more severe, uncomfortable symptoms that affect their daily lives. It’s not just physical changes. Your brain and how you respond to stress can also change. You may feel irritable, have low energy, or have trouble concentrating.

Emotional challenges during this time have been coined “perimenopausal mood instability.” You’re not unstable, but your hormones are. Depression and anxiety can also occur, with or without mood instability. Symptoms from depression and anxiety can be severe and affect your ability to move through your day. It’s important to talk to a mental health professional if you’re struggling with mood, stress, or anxiety.⁴

Key hormones to understand

It’s common for your hormone levels to fluctuate during perimenopause. The primary hormone driving symptoms is estrogen. Your ovaries make estrogen, and as you go through perimenopause, production slows down and your estrogen levels drop. Other hormone levels can fluctuate in response, affecting symptoms and fertility.¹

A single hormone test doesn’t diagnose perimenopause. Testing can give you a sense of how your hormones are trending. Some hormone levels help signal that you’re in perimenopause[¹,⁵⁻⁷]:

• Estrogen: A hormone produced in the ovaries that controls your menstrual cycle. Throughout perimenopause, your estrogen levels decrease. Drops in estrogen can cause other hormone levels to fluctuate
• Progesterone: Another hormone produced in the ovaries. Progesterone increases when you ovulate. As you ovulate less often or stop ovulating, these levels may stay low
• Follicle-stimulating hormone (FSH): A hormone produced by the pituitary gland. FSH stimulates ovaries to release an egg. When FSH is high, your body produces more estrogen. When FSH drops, estrogen also drops
• Luteinizing hormone (LH): A hormone also produced by the pituitary gland. LH helps to manage periods and trigger ovulation. LH increases as estrogen drops
• Prolactin: A hormone produced by the pituitary gland responsible for lactation after giving birth. High levels of prolactin can cause menopause-like symptoms, including irregular periods, low libido, and infertility
• Thyroid-stimulating hormone (TSH): High levels of TSH can cause symptoms similar to menopause. Women are often diagnosed with thyroid disorders around the time they’re going through menopause⁷

Getting pregnant in perimenopause

More and more women are waiting later in life to get pregnant. Nearly 19% of pregnancies are in women over age 35.8 Although you may have entered perimenopause, you can still start or expand your family. If you’re having a period, you can get pregnant.¹

Lab testing may be an important part of the fertility journey. A few tests can help you better understand your fertility:

• Ovulation: As your periods become inconsistent, it can be harder to tell when or if you’re ovulating. PdG (pregnanediol glucuronide) or progesterone testing help confirm whether ovulation happened. They don’t tell you when your most fertile days are. PdG is a progesterone metabolite. Measuring PdG levels takes a simple urine test you can do at home. A progesterone test is a blood test that measures this hormone at one moment in time to confirm ovulation happened
• Ovarian reserve: Learning more about your ovarian reserve can help you make informed fertility decisions with your doctor. You are born with a set number of eggs. As you age, the number and quality of eggs decreases. A lab test that measures anti-Mullerian hormone (AMH), FSH, estradiol, LH, and inhibin B can help estimate ovarian reserve and egg quality⁸

These tests do not diagnose infertility or other fertility issues. They help you better understand what your body is going through and inform conversations with your healthcare provider.

If you’re not looking to get pregnant at this stage, use protection or talk to your doctor about birth control options.

How to help manage perimenopause symptoms

Awareness of perimenopause has grown in recent years, as have the list of treatment options. Lifestyle habits are key to managing perimenopause symptoms. Estrogen also supports bone and heart health. Consistent exercise and following a balanced diet can help manage symptoms and protect your bones and heart.¹ Quit smoking, and limit caffeine and sugar.⁴

Regular sleep is also important to balance your mood and help regulate hormones. Your doctor can help you decide whether medications for vaginal dryness, anxiety, overactive bladder, or hot flashes are right for you. Your doctor can also advise on hormone replacement therapy.¹