Posted on: October 21, 2025
Now more than ever, patients are coming to me wondering if they are in perimenopause. The awareness around menopausal symptoms have significantly increased. Although this movement has been amazing to provide women with the resources and support they need, it can also result in over-diagnosis and can prevent the assessment of other causes for your symptoms. As many of you know, the list of potential perimenopausal symptoms is vast and most overlap with other conditions. For example, if fatigue and brain fog is assumed to be due to perimenopause, you may miss the necessary assessment to rule out iron deficiency, another common cause of fatigue and brain fog.
When Does Perimenopause Usually Start?
Perimenopause meaning “around menopause” is the first part of the menopausal transition and is the most symptomatic time for women. The average age of onset is 45 years and the length of time in this phase can vary significantly, lasting up to a decade. Menopause is considered the 1 year anniversary of your final menstrual period. The average age of menopause in North America is 52 years. Everything after this anniversary is considered postmenopause.
How to Know If You’re in Perimenopause. Is There a Test for Perimenopause?
There is NO assessment for perimenopause. Determining if you are perimenopausal is based on SYMPTOMS and NOT blood work. The key symptoms to determine if you are in perimenopause are menstrual cycle changes. According to the North American Menopause Society, this is determined by cycles that vary 7 days in length for 10 consecutive cycles. This does not apply to patients that have never had regular cycles. For example, in a patient with a history of PCOS (polycystic ovarian syndrome), they often experience new onset regular cycles in perimenopause. The key piece is that there should be a change in your menstrual cycles.
Early vs. Late Perimenopause: What’s the Difference?
Perimenopause can then be divided into early (described above) and late. The criteria for late perimenopause involves a period of amenorrhea (no period) for at least 60 days, essentially “skipping” a period. Vasomotor symptoms, like hot flashes and night sweats are more prominent in this phase.
What if you do not fit in this criteria and still think you are in Perimenopause?
I have worked with many patients who have a number of symptoms without menopausal cycle length changes. Particularly new onset mental health challenges, brain fog, weight gain, heavier menstrual flow or “just not feeling myself”. I do believe there is a continuum of hormonal changes that can present before menstrual length changes. There are still supports in this phase that can improve a patient’s health and resiliency.
If you have questions about new onset symptoms that may not fit what I have described above, it is important to still have them assessed. There are many other things that can influence hormonal changes that could validate some of the symptoms you are experiencing. Know that you are not alone and we are here to help.
Book your Perimenopause Naturopathic Initial Consultation with Dr. Deanna today by clicking below.
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Reference:
The North American Menopause Society. (2019). Menopause practice: A clinician’s guide (6th ed.) [PDF e-book]. The North American Menopause Society.
Deanna Walker, Doctor of Naturopathic Medicine
Sage Naturopathic Clinic