The Early Signs and Peri B.A.S.I.C.S.

By the end of this post, you will know how to recognize perimenopause early, understand the biological changes, and respond with empathy rather than confusion. You will learn to recognize the patterns most men miss, reduce avoidable conflict, and strengthen your relationship during a stage that tests every partnership.

What Exactly Is Perimenopause

The word perimenopause literally means “around menopause” and marks the beginning of the end of fertility. Biologically, it starts when a woman has roughly 5%-10% of her eggs left—about 1 to 10,000 follicles still active. At that point, the ovaries become less predictable. Estrogen and progesterone fluctuate wildly, ovulation becomes hit or miss, and cycles lose their rhythm.

Those changes disrupt the hormones that guide the menstrual cycle:

• Estrogen begins to swing sharply—sometimes higher than ever, sometimes suddenly low. Remember, estrogen affects mood, energy, memory, and body temperature, so these shifts ripple across daily life.
• Progesterone declines gradually, especially in months when ovulation does not occur. With less progesterone, sleep quality drops and mood stability weakens.
• FSH (follicle-stimulating hormone) rises as the brain pushes harder to get the ovaries to respond. Elevated FSH is often the first measurable sign that perimenopause has begun.

In short, perimenopause begins when egg supply runs low, hormonal communication between the brain and ovaries becomes less steady, and the body starts adjusting to a new hormonal balance.

Why Men Can Miss It

Most men miss perimenopause not because they do not care, but because they were never told it existed. Health education ends at puberty, and menopause gets one sentence in a textbook. Everything in between—often ten years of change—goes unmentioned.

The first signs often don’t look like hormones. They look like life: stress, exhaustion, or short tempers. A late period seems normal. A foggy day feels random. A rough week turns into a rough month, and no one connects the dots. Without context, men misread symptoms as personality shifts instead of hormonal changes.

There is also hesitation. Men are taught to stay out of women’s health, to avoid the subject entirely. But silence builds distance. Curiosity and empathy will build trust.

Understanding what is happening gives you an edge. It helps you see the pattern early and respond without taking it personally. You can reduce tension, protect connection, and help you show up as a better partner when it matters most.

You are not expected to know everything about hormones. You just have to care enough to learn what most men never do—and you’re already well on your way by reading this.

The Early Warning Signs - Remember the B.A.S.I.C.S. of Perimenopause.

We will dive deeper into symptoms in an upcoming post, but for now, I’ll cover what is happening to her body and what you’ll notice. If you start to see three or more of the peri B.A.S.I.C.S., the six early warning signs of perimenopause consistently, then she’s likely in perimenopause. The only way to know for sure is through a healthcare provider.

1) Body Changes

What happens:
Hormonal shifts, especially lower estrogen, alter how the body stores fat, builds muscle, and maintains collagen. Metabolism slows, joints may stiffen, and skin can feel less firm.

Data:
Research shows women gain an average of 5–8 pounds during perimenopause, mostly around the abdomen (Office of Women’s Health, 2025). Muscle mass also declines by about 1% per year after age 40 if not maintained through resistance training.

What you’ll notice:
She may mention feeling “puffy,” frustrated that her workouts don’t work the same way, or that her body feels foreign. Clothes might fit differently even if her weight hasn’t changed much.

Playbook Tip: Focus on health together. Exercise, nutrition, and less alcohol. Lead by example, not instruction.

2) Arousal (or changes in libido)

What happens: Falling estrogen and testosterone reduce blood flow and natural lubrication, which can make arousal slower and sex less comfortable. Emotional closeness may still feel strong, but physical desire often drops.

Data: 58% of women report changes in sexual desire or comfort during perimenopause (Khani, Azizi, et al, 2021).

What you’ll notice: Sex may happen less often, she may avoid it because it’s uncomfortable, or she may seem detached even when emotionally connected. Remember, this isn’t about attraction; it’s about hormones and physiology.

Playbook Tip: Don’t take it personally or push for frequency. Focus on safety, affection, and comfort first. There are other ways to be intimate without having sex. If she mentions pain or dryness, encourage her to talk to her doctor—solutions like topical estrogen and/or lubricants can make a major difference. I will post a link to a popular product at the end of this post in the resources section.

3) Sleep Problems

What happens:
Falling estrogen and progesterone levels disrupt the body’s temperature control and circadian rhythm. Night sweats can cause her to wake up suddenly, and lower progesterone, once a natural sedative, will make it harder to fall back asleep. Poor sleep doesn’t just make you tired. It worsens mood, focus, weight regulation, and even pain. Over time, it chips away at energy, confidence, and the ability to function. When sleep goes, everything else follows.

Data:
Around 40–60% of women in perimenopause report trouble sleeping. The most common pattern is waking between 2–4 a.m. and struggling to get back to sleep.

What you’ll notice:
She may seem tired, short-tempered, or mentally foggy in the morning. You might hear her moving around at night, or she may start sleeping separately just to cool down.

Playbook Tip: Don’t take distance personally. Help by keeping the room cool, swapping heavy bedding for breathable fabrics (Hello Linen!), and limiting screens or alcohol before bed. A good night’s sleep can do more for her mood than any advice. Protect it.

4) Irregular Periods

What happens:
As estrogen and progesterone levels fluctuate, ovulation becomes inconsistent. This causes cycles to shorten, lengthen, or skip entirely. Flow can also change—heavier, lighter, or lasting much longer than before.

Data:
Over 90% of women experience noticeable changes in their menstrual cycle during perimenopause. Periods can range from 21 to 60 days apart and sometimes last more than 10 days. About 10–15% of women experience prolonged bleeding lasting more than 2 weeks. In rare circumstances, around 2–5% can have bleeding that stretches into multiple months. My mother experienced this when she was in perimenopause, and one of the reasons why I started this substack. It’s not normal. Any period lasting longer than 14 days should be medically evaluated to rule out other conditions.

What you’ll notice:
She might mention her period feels unpredictable or overwhelming. Some months may bring heavy bleeding and fatigue; others nothing at all. It can cause anxiety or embarrassment when it catches her off guard.

Playbook Tip: Don’t dismiss it as “normal female stuff.” Be practical. Keep pads or tampons handy at home or in the car and offer to help with laundry and cleanup or errands when she’s feeling drained. Predictability disappears for a while. Empathy matters more.

5) Cognitive (Brain Fog and Mood)

What happens:
Estrogen supports the brain chemicals that control focus, memory, and emotional stability. When levels fluctuate, concentration, word recall, and emotional regulation all take a hit. Many women describe it as “not feeling like myself.”

Data:
More than 60% of women in perimenopause report problems with memory, focus, or mood swings. Fluctuating estrogen is linked to changes in serotonin and dopamine—neurotransmitters that affect motivation and calm.

What you’ll notice:
She may seem distracted, forgetful, or unusually irritable. Tasks she normally handles easily might overwhelm her. Small frustrations can trigger outsized reactions, followed by guilt or tears.

Playbook Tip: Don’t correct, criticize, or tell her to relax. Listen first. Names, appointments, or tasks will slip through the cracks. Help with reminders. Shared calendars is a great idea. What can look like disinterest or moodiness is often her brain struggling to rebalance.

6) Sweats and Hot Flashes

What happens:
Falling estrogen throws off the brain’s thermostat (the hypothalamus). It misreads normal body temperature as too hot and triggers a full cooling response—flushed skin, racing heart, and sudden sweating. These waves can hit any time, day or night.

Data:
About 75% of women experience hot flashes or night sweats during perimenopause. For roughly a third, symptoms last more than five years.

What you’ll notice:
She might suddenly strip off layers, fan herself, or wake drenched in sweat. Sleep can be disrupted for days, leaving her drained and irritable.

Playbook Tip: Stay calm and help her stay cool. Keep the bedroom temperature lower, use breathable bedding, and avoid comments about it being “just a hot flash.” It’s not trivial—it’s her body reacting to a hormonal surge she can’t control.

Misdiagnosis and Medical Gaslighting

Perimenopause is among the most overlooked and misdiagnosed phases in women’s health. Many spend years chasing symptoms—often being told the wrong thing—before someone even considers hormones.

What the data shows:

• About 1 in 3 women report receiving an incorrect diagnosis before realizing their symptoms were menopause-related. The Flow Space
• Only 31.3% of U.S. obstetrics/gynecology residency programs report having any menopause curriculum. PubMed
• Around 54% of women with menopausal symptoms ever seek medical help, despite over 80% experiencing one or more symptoms. PMC
• In a UK survey, 30% of women who saw a GP experienced delays in diagnosis. PMC
• Misdiagnosis rates for menopause are estimated up to 15% in some reports of clinical error and safety reviews. HQI

Women leave clinics with antidepressants, dismissals, or vague promises when what they often need is a hormonal evaluation, not just symptom control.

Playbook Tip: Be her advocate. If she leaves an appointment feeling unheard, dismissed or hopeless, help her find a doctor who understands menopause.

At the end of this post, I’ve included links to popular, credible websites where you can find a menopause specialist in your area. If all else fails, google it.

Remember, your job is not to be her doctor. Its to be her advocate for better care.

Your Playbook

You’ve seen the patterns. Here’s how to show up in the moments that matter.

1. Notice the cycle shifts. If her period timing or flow starts changing, pay attention. Don’t comment—just clock the pattern. It’s useful information, not a punchline.
2. Do not take mood swings personally. If she snaps or withdraws, don’t mirror it. Give it space, then reconnect when things settle.
3. Protect her sleep. If she’s up at night, take over morning duties or lighten her load. Sleep deprivation magnifies every symptom.
4. Support her focus. If she’s forgetting things, offer structure—shared calendars, reminders, lists. Not judgment.
5. Be her advocate in healthcare. If she leaves an appointment feeling unheard, help her find a doctor who understands menopause. Menopause specialists exist.
6. Lead by example. Eat better, drink less, exercise together. Shared effort lowers stress for both of you.

Checklist: The Peri B.A.S.I.C.S.

Take a photo of this. Screen capture it. Place it in a location where you can easily reference it.

• Body changes (weight gain, stiff joints, appearance changes)
• Arousal (libido, dryness, pain or discomfort)
• Sleep disruption
• Irregular periods
• Cognitive (brain fog and mood changes)
• Sweats and hot flashes

If you start to notice 3 or more of the BASICS consistently, then she’s likely in perimenopause. The only way to know for sure is to consult a healthcare provider, as symptoms vary, and other conditions can mimic perimenopause.

(Peri)Menopause Math

Sleep Loss + Mood Shifts = Conflict Risk
Awareness + Adaptation > Ignorance + Escalation

What to Remember

Perimenopause is the start of the transition, not the aftermath. Most men miss it because they do not know what they are seeing. Awareness changes that. When you understand what is happening, you can respond with empathy instead of confusion—and that makes all the difference.

Links and Useful Resources:

1. Join the WTFisMenopause Reddit Community
2. Weight gain and Menopause
3. The Prevalence of Sexual Dysfunction in the Different Menopausal Stages: A Systematic Review and Meta-Analysis
4. Menopause Shoppe - Sleep Supplements (Use code STACK15 for 15% off)
5. Menopause Shoppe - Libido Booster (Use code STACK15 for 15% off)
6. Find a Menopause Practitioner - The Menopause Society
7. Bonafide Health - Sexual Health Products

Disclaimer: The content shared in WTF is Menopause is for informational and educational purposes only. It is not intended to provide medical advice, diagnosis, or treatment. Always seek the guidance of your physician or qualified healthcare provider with any questions you may have regarding your health, hormones, or medical conditions. Never disregard or delay professional medical advice because of something you’ve read here.