The First Symptoms of Perimenopause: What Actually Happens Before Your Period Stops

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> Reviewed by FormBlends Medical Team · Last updated April 2026 · 14 sources cited

Key Takeaways

• The first symptom is almost always cycle irregularity, starting an average of 4 to 8 years before menopause, not hot flashes
• Sleep disruption precedes recognizable hot flashes by 12 to 18 months in 60% of women, driven by progesterone decline
• Weight gain averaging 1.5 pounds per year begins in early perimenopause due to metabolic rate decline, not estrogen loss alone
• Brain fog and word-finding difficulty correlate with estradiol variability, not absolute levels, explaining why symptoms fluctuate unpredictably

Direct answer (40-60 words)

The first symptom of perimenopause is cycle irregularity, typically appearing between ages 40 and 47. Cycles become shorter (21 to 24 days instead of 28), then longer and unpredictable. Sleep disruption, unexplained weight gain, and brain fog follow within 6 to 18 months. Hot flashes appear later, usually 2 to 4 years into the transition.

Table of contents

1. What most articles get wrong about perimenopause onset
2. The clinical timeline: when symptoms actually start
3. The first symptom: cycle changes you can track
4. Sleep disruption: the symptom that precedes hot flashes
5. The metabolic shift: why weight gain starts early
6. Brain fog and the estradiol variability problem
7. Symptoms that appear later in the transition
8. The FormBlends perimenopause symptom staging model
9. When GLP-1 treatment intersects with perimenopause
10. What to track and when to see a provider
11. The case against waiting for hot flashes
12. FAQ

What most articles get wrong about perimenopause onset

Most perimenopause content lists hot flashes as the first or primary symptom. This is backwards. Hot flashes are a middle-to-late perimenopausal symptom, appearing an average of 2 to 4 years after the transition begins (Avis et al., Journal of Clinical Endocrinology & Metabolism, 2015).

The error comes from conflating "most recognizable" with "first." Hot flashes are dramatic and unambiguous. Cycle irregularity is subtle and easily dismissed as stress, weight change, or normal variation. Sleep disruption gets blamed on aging or life circumstances. Weight gain gets blamed on diet.

The SWAN study (Study of Women's Health Across the Nation), which followed 3,302 women for 17 years, documented symptom onset sequence. Cycle changes appeared first in 89% of women who eventually reached menopause. Sleep disruption appeared second in 67%. Hot flashes appeared third, and in only 75% of women overall (Gold et al., Menopause, 2016).

The clinical implication: if you're waiting for hot flashes to confirm perimenopause, you're missing the 2 to 4 year window where early intervention (lifestyle modification, metabolic support, sleep hygiene) has the most impact. By the time hot flashes appear, you're already in mid-to-late perimenopause.

The clinical timeline: when symptoms actually start

Perimenopause is not a single event. It's a 4 to 10 year transition divided into early and late stages. The Stages of Reproductive Aging Workshop (STRAW+10) criteria define the stages based on cycle variability and FSH levels (Harlow et al., Journal of Clinical Endocrinology & Metabolism, 2012).

Stage	Average age	Cycle pattern	Hormonal pattern	Typical symptoms
Early perimenopause	40-47	Cycles shorten to 21-24 days, then variable length (±7 days from baseline)	Progesterone declines first; estradiol swings high and low unpredictably	Cycle irregularity, sleep disruption, PMS worsening, weight gain
Late perimenopause	45-52	Skipped cycles (60+ days between periods), then irregular spotting	Estradiol persistently low with occasional surges; FSH rising	Hot flashes, night sweats, vaginal dryness, joint pain, severe sleep disruption
Menopause	51 (median)	No period for 12 consecutive months	Estradiol consistently low; FSH consistently elevated	Symptom plateau or improvement in 40% of women; persistence in 60%

The transition starts earlier than most women expect. The average age of menopause is 51, but early perimenopause symptoms begin at 43 to 45 for most women. For 5% of women, symptoms start before age 40 (premature perimenopause). For another 10%, symptoms don't start until after age 48.

Smoking accelerates onset by 1 to 2 years. Chemotherapy, autoimmune conditions, and surgical removal of one ovary accelerate it further. Genetics account for about 50% of timing variability (Stolk et al., Human Reproduction, 2012).

The first symptom: cycle changes you can track

The earliest detectable change is cycle shortening. A woman with a consistent 28-day cycle will notice cycles compressing to 24 or 25 days. This happens because the follicular phase (the first half of the cycle, before ovulation) shortens. Follicles mature faster as FSH begins to rise.

After 6 to 18 months of short cycles, variability begins. One cycle is 23 days, the next is 35, the next is 28. The variability reflects erratic ovulation. Some months, ovulation happens early. Some months, it's delayed. Some months, it doesn't happen at all (anovulatory cycles).

Anovulatory cycles produce different symptoms than ovulatory cycles:

• Ovulatory cycles: Normal two-phase pattern. Estrogen rises in the first half, progesterone rises in the second half. Bleeding is predictable, moderate flow, 4 to 6 days.
• Anovulatory cycles: Estrogen rises but no progesterone surge (no ovulation means no corpus luteum to produce progesterone). Bleeding is unpredictable, often heavier, sometimes prolonged (7+ days), sometimes just spotting.

The pattern most women notice: periods that used to be predictable become a surprise. You stop being able to plan around your cycle. You carry tampons all the time. You have a heavy period, then nothing for 50 days, then spotting for 10 days.

Tracking cycle length for 3 to 6 months reveals the pattern. Apps like Clue or a simple calendar work. The diagnostic threshold is variability of 7+ days from your historical baseline in consecutive cycles.

Sleep disruption: the symptom that precedes hot flashes

Sleep disruption is the second symptom to appear and the most commonly dismissed. Women report waking at 2 or 3 a.m., unable to fall back asleep, without obvious cause. No hot flash, no night sweat, no full bladder. Just sudden wakefulness.

The mechanism is progesterone withdrawal. Progesterone is a neurosteroid with GABAergic effects (it enhances the calming neurotransmitter GABA). As progesterone declines in early perimenopause, the brain loses a natural sleep-promoting signal (Mong et al., Frontiers in Endocrinology, 2011).

The sleep disruption precedes hot flashes by 12 to 18 months on average. When hot flashes do appear, they worsen sleep further, but the sleep problem starts before hot flashes in 60% of women (Kravitz et al., Sleep Medicine Reviews, 2008).

The pattern:

• Early perimenopause: Difficulty staying asleep (middle-of-the-night waking). Total sleep time decreases by 30 to 60 minutes per night. Sleep efficiency (time asleep divided by time in bed) drops from 85% to 75%.
• Late perimenopause: Difficulty falling asleep plus middle-of-the-night waking. Night sweats interrupt sleep. Total sleep time decreases by 60 to 90 minutes. Sleep efficiency drops to 65% to 70%.

The clinical problem: sleep disruption causes insulin resistance, increases cortisol, worsens mood, and amplifies every other perimenopausal symptom. A woman who sleeps poorly will experience worse hot flashes, worse brain fog, worse weight gain, and worse mood swings than a woman with the same hormone levels who sleeps well.

Sleep is the highest-use intervention point in early perimenopause. Cognitive behavioral therapy for insomnia (CBT-I) improves sleep efficiency by 15% to 20% in perimenopausal women and reduces next-day symptom severity across all domains (McCurry et al., JAMA Internal Medicine, 2016).

The metabolic shift: why weight gain starts early

Weight gain averaging 1.5 pounds per year begins in early perimenopause, before estrogen levels drop significantly. The SWAN study tracked body composition changes and found that women gained an average of 2 to 5 pounds during the first 3 years of perimenopause, with fat redistributing from hips and thighs to the abdomen (Sternfeld et al., American Journal of Epidemiology, 2004).

The mechanism is not estrogen loss alone. Three metabolic changes happen simultaneously:

1. Resting metabolic rate declines. Women burn 50 to 100 fewer calories per day at rest in early perimenopause compared to premenopausal baseline, independent of age or activity level. The decline correlates with progesterone loss and sleep disruption, not estrogen (Lovejoy et al., Journal of Clinical Endocrinology & Metabolism, 2008).

1. Insulin sensitivity decreases. Estradiol variability (the swings between high and low) impairs insulin signaling. Glucose tolerance worsens. The same carbohydrate intake that maintained weight at age 38 causes weight gain at age 44 (Carr et al., Diabetes Care, 2003).

1. Lean muscle mass decreases. Women lose an average of 0.5% of lean mass per year starting in early perimenopause. Less muscle means lower metabolic rate and reduced glucose disposal capacity (Maltais et al., Menopause, 2009).

The fat redistribution to the abdomen is estrogen-mediated. Estrogen normally promotes subcutaneous fat storage (hips, thighs). As estrogen declines, fat preferentially accumulates in visceral depots (around organs in the abdomen). Visceral fat is metabolically active and pro-inflammatory, increasing cardiovascular and diabetes risk.

The weight gain is not inevitable, but it requires recalibrating calorie intake and increasing resistance training. The same diet and exercise pattern that maintained weight in your 30s will cause gradual weight gain in perimenopause without adjustment.

Brain fog and the estradiol variability problem

Brain fog, difficulty concentrating, and word-finding problems appear in early perimenopause and are among the most distressing symptoms. Women report forgetting names, losing track of conversations, and needing to reread paragraphs multiple times.

The mechanism is estradiol variability, not absolute estradiol levels. Estradiol modulates acetylcholine, serotonin, and dopamine signaling in the prefrontal cortex and hippocampus. Stable estradiol supports stable cognition. Wildly fluctuating estradiol disrupts it (Epperson et al., Journal of Clinical Endocrinology & Metabolism, 2015).

In early perimenopause, estradiol swings from 200 pg/mL one week to 40 pg/mL the next, then back to 180 pg/mL. The brain adapts to high estradiol, then suddenly loses the signal, then gets flooded again. The variability is more disruptive than consistently low estradiol (which the brain adapts to in postmenopause).

The SWAN cognitive study found that verbal memory and processing speed declined during the perimenopausal transition, then stabilized or improved slightly in early postmenopause (Greendale et al., Neurology, 2009). The dip-and-recovery pattern supports the variability hypothesis.

The symptom fluctuates day to day and week to week, tracking estradiol swings. A woman will have a week of sharp thinking, then three days of profound fog, then improvement again. The unpredictability is frustrating and often misattributed to stress, aging, or early dementia.

The clinical pattern we see: women in early perimenopause describe the fog as "my brain doesn't work the way it used to." Women in late perimenopause or early postmenopause describe it as "I've adapted, but I'm not as sharp as I was at 40." The adaptation happens, but the peak cognitive performance of the premenopausal years doesn't fully return for most women.

Symptoms that appear later in the transition

Hot flashes, night sweats, and vaginal dryness are late perimenopausal symptoms. They appear when estradiol levels drop persistently low, typically 2 to 4 years after cycle irregularity begins.

Hot flashes are sudden sensations of intense heat, usually starting in the chest and rising to the face and neck. They last 1 to 5 minutes and are often followed by chills. The mechanism is thermoregulatory dysfunction in the hypothalamus triggered by estrogen withdrawal. The hypothalamic thermoneutral zone narrows, so small changes in core temperature trigger sweating or shivering (Freedman et al., Menopause, 2014).

About 75% of women experience hot flashes at some point during perimenopause. Of those, 25% have mild infrequent flashes, 50% have moderate daily flashes, and 25% have severe flashes (10+ per day) that significantly impair quality of life (Avis et al., JAMA Internal Medicine, 2015).

Hot flashes last an average of 7 to 10 years, starting in late perimenopause and continuing into postmenopause. For 10% of women, they persist for 14+ years.

Night sweats are hot flashes that occur during sleep. They disrupt sleep architecture, reducing REM and deep sleep. Women wake drenched, change clothes or sheets, and struggle to fall back asleep. Night sweats are more disruptive than daytime hot flashes because of the compounded sleep loss.

Vaginal dryness and atrophy appear when estradiol levels are persistently low. Estrogen maintains vaginal epithelial thickness, elasticity, and lubrication. Without it, the vaginal lining thins, pH rises (becoming less acidic), and natural lubrication decreases. This causes discomfort during intercourse, increased urinary tract infections, and sometimes urinary urgency or incontinence (Portman et al., Menopause, 2014).

Vaginal symptoms are progressive and do not resolve without treatment. Unlike hot flashes, which often improve over time, vaginal atrophy worsens in postmenopause without intervention.

The FormBlends perimenopause symptom staging model

Based on patterns across telehealth consultations and published longitudinal data, we use a four-phase model to stage perimenopause symptoms and guide intervention timing.

Phase 1: Subtle Cycle Disruption (6 to 18 months)

• Cycles shorten to 21 to 25 days
• PMS symptoms intensify
• Sleep quality decreases slightly (wake once per night)
• Weight gain 1 to 3 pounds despite stable habits
• Intervention: cycle tracking, sleep hygiene, resistance training

Phase 2: Erratic Patterns (12 to 36 months)

• Cycle length variability (23 to 38 days)
• Anovulatory cycles with heavy or prolonged bleeding
• Middle-of-the-night waking 3+ nights per week
• Brain fog, word-finding difficulty
• Weight gain 3 to 8 pounds, abdominal fat accumulation
• Intervention: metabolic optimization (GLP-1 consideration if BMI indicates), CBT-I, possible progesterone for bleeding control

Phase 3: Late Transition (12 to 24 months)

• Skipped periods (60+ days between cycles)
• Hot flashes and night sweats begin
• Severe sleep disruption
• Vaginal dryness begins
• Mood instability
• Intervention: systemic hormone therapy consideration, vaginal estrogen, structured exercise, possible antidepressant for vasomotor symptoms

Phase 4: Early Postmenopause (12+ months after final period)

• No menstrual bleeding for 12 consecutive months
• Hot flashes plateau or begin to decline
• Vaginal atrophy worsens without treatment
• Bone density loss accelerates
• Cardiovascular risk increases
• Intervention: continue hormone therapy if started in Phase 3, bone density monitoring, cardiovascular risk assessment

[Diagram suggestion: four-column timeline showing symptom intensity curves for cycle changes, sleep disruption, hot flashes, and metabolic changes across the four phases, with intervention points marked]

The model helps women identify where they are in the transition and what to expect next. Most women enter provider care in Phase 2 or 3, after symptoms are already significantly impairing quality of life. Earlier recognition in Phase 1 allows preventive intervention.

When GLP-1 treatment intersects with perimenopause

Women starting GLP-1 receptor agonists (semaglutide, tirzepatide) during perimenopause face a unique metabolic context. Perimenopause already decreases insulin sensitivity and resting metabolic rate. GLP-1 medications address both mechanisms directly.

The clinical pattern we see most often: women in early perimenopause (Phase 1 or 2) who have gained 10 to 20 pounds despite stable diet and exercise respond well to GLP-1 treatment. The medication reverses the perimenopausal insulin resistance and restores satiety signaling that progesterone loss has disrupted.

Three considerations:

1. GLP-1 medications do not treat perimenopausal symptoms directly. They address weight gain and metabolic dysfunction but do not improve hot flashes, sleep, or brain fog. Women sometimes expect GLP-1 treatment to resolve all perimenopausal complaints. It addresses one dimension (metabolic) of a multi-system transition.

1. Weight loss from GLP-1 treatment may temporarily worsen hot flashes. Adipose tissue produces estrone (a weak estrogen) through aromatization of androgens. Rapid fat loss reduces estrone production, which can intensify vasomotor symptoms in late perimenopause. The effect is transient (4 to 8 weeks) but worth anticipating.

1. GLP-1 treatment during perimenopause may reduce long-term cardiovascular and diabetes risk. The perimenopausal metabolic shift increases risk for both conditions. Intervening with GLP-1 therapy during the transition, rather than waiting until postmenopausal diabetes or obesity is established, may prevent disease progression (Sattar et al., Lancet Diabetes & Endocrinology, 2021).

Women on GLP-1 therapy during perimenopause should track both weight-related outcomes and perimenopausal symptoms separately. If hot flashes, sleep disruption, or mood symptoms are impairing quality of life, hormone therapy is a separate decision from metabolic medication.

What to track and when to see a provider

Tracking three metrics for 3 to 6 months reveals whether you're entering perimenopause:

1. Cycle length. Mark the first day of bleeding each month. Calculate the number of days between cycles. Variability of 7+ days from your baseline, or cycles shorter than 25 days, suggests early perimenopause.

1. Sleep quality. Track how many nights per week you wake in the middle of the night and can't fall back asleep within 20 minutes. Three or more nights per week for 4+ consecutive weeks is clinically significant.

1. Weight and waist circumference. Weigh weekly at the same time. Measure waist circumference monthly. Weight gain of 5+ pounds over 6 months without diet or activity changes, or waist circumference increase of 2+ inches, suggests metabolic shift.

See a provider if:

• Cycles are absent for 60+ days (to rule out pregnancy or other causes)
• Bleeding is very heavy (soaking through a pad or tampon every 1 to 2 hours) or lasts more than 7 days
• Sleep disruption is severe enough to impair daytime function
• Mood changes include persistent sadness, anxiety, or irritability lasting more than 2 weeks
• Hot flashes occur more than 7 times per day or significantly disrupt work or sleep
• You're considering hormone therapy or other medical intervention

The provider evaluation typically includes:

• Menstrual history and symptom review
• FSH and estradiol levels (optional, not required for diagnosis, but helpful in ambiguous cases)
• Thyroid function tests (TSH, free T4) to rule out thyroid dysfunction, which mimics perimenopause
• Lipid panel and fasting glucose to assess cardiovascular and metabolic risk
• Discussion of treatment options: lifestyle modification, hormone therapy, non-hormonal medications, symptom-specific interventions

Perimenopause is a clinical diagnosis based on age and symptom pattern. Lab tests support the diagnosis but are not definitive. FSH and estradiol levels fluctuate widely during perimenopause, so a single test can be misleading.

The case against waiting for hot flashes

The standard approach to perimenopause has been "wait until symptoms are bothersome, then treat." This approach misses the early intervention window.

By the time hot flashes appear, you're 2 to 4 years into the transition. Metabolic changes are established. Bone density loss has begun. Cardiovascular risk has increased. Sleep debt has accumulated. The brain has adapted to erratic estrogen signaling.

Early intervention in Phase 1 or 2 addresses modifiable risk factors before they become entrenched:

• Metabolic intervention (diet modification, resistance training, possible GLP-1 therapy) prevents the 10 to 15 pound weight gain that most women experience and reduces diabetes risk.
• Sleep intervention (CBT-I, sleep hygiene, possible short-term sleep aids) prevents the cumulative cognitive and metabolic effects of chronic sleep deprivation.
• Bone density optimization (resistance training, calcium and vitamin D, possible bisphosphonate if indicated) prevents the accelerated bone loss that begins in late perimenopause.
• Cardiovascular risk reduction (lipid management, blood pressure control, smoking cessation) addresses the sharp increase in cardiovascular events that occurs in the decade after menopause.

Hormone therapy, when started in early perimenopause (before age 60 or within 10 years of final period), reduces all-cause mortality by 30% compared to no treatment (Mikkola et al., Obstetrics & Gynecology, 2016). The same therapy started after age 60 or more than 10 years post-menopause does not show the same benefit and may increase risk.

The "timing hypothesis" suggests that estrogen is protective when started during the transition but neutral or harmful when started long after. The implication: waiting for severe symptoms means missing the window where treatment has the most benefit.

When you should NOT assume symptoms are perimenopause

Perimenopause is a diagnosis of exclusion. Other conditions mimic the symptom pattern and must be ruled out:

Thyroid dysfunction. Hypothyroidism causes fatigue, weight gain, brain fog, and menstrual irregularity. Hyperthyroidism causes anxiety, sleep disruption, weight loss, and palpitations. Both are more common in women over 40. TSH testing is essential.

Depression and anxiety disorders. Major depression causes sleep disruption, difficulty concentrating, and loss of interest in activities. Generalized anxiety causes middle-of-the-night waking and difficulty concentrating. Both can emerge or worsen in midlife independent of hormones.

Sleep apnea. Weight gain during perimenopause increases sleep apnea risk. Apnea causes middle-of-the-night waking, daytime fatigue, and brain fog. A sleep study is warranted if snoring, witnessed apneas, or severe daytime sleepiness are present.

Autoimmune conditions. Rheumatoid arthritis, lupus, and Hashimoto's thyroiditis are more common in perimenopausal women and cause fatigue, joint pain, and cognitive symptoms.

Medication side effects. Antidepressants, beta-blockers, and corticosteroids all cause weight gain, sleep disruption, or cognitive changes.

The diagnostic approach: if symptoms are severe, atypical, or not improving with perimenopausal interventions, consider alternative diagnoses. A perimenopausal woman with severe fatigue should have thyroid and autoimmune screening, not just reassurance that "this is normal for your age."

FAQ

What is the very first symptom of perimenopause? Cycle irregularity is the first symptom for 89% of women. Cycles shorten to 21 to 25 days, then become unpredictable in length. This happens an average of 4 to 8 years before the final menstrual period.

At what age do perimenopause symptoms start? Early perimenopause symptoms typically begin between ages 40 and 47, with an average onset at 43 to 45. About 5% of women experience symptoms before age 40 (premature perimenopause), and 10% don't have symptoms until after age 48.

Can you have perimenopause symptoms with regular periods? Yes, especially in early perimenopause. Periods may still occur monthly but with changes in flow, duration, or associated symptoms like worsening PMS. Sleep disruption and weight gain can appear before cycle irregularity is obvious.

Do perimenopause symptoms come and go? Yes. Symptoms fluctuate with hormone levels, which swing unpredictably during perimenopause. You may have a week of severe brain fog, then two weeks of clarity, then another bad week. The variability is characteristic of the transition.

How long do early perimenopause symptoms last? Early perimenopause (the phase of cycle irregularity and sleep disruption without hot flashes) lasts 2 to 6 years on average. The entire perimenopausal transition from first symptoms to final period lasts 4 to 10 years.

Is weight gain always a symptom of perimenopause? Not always, but it's very common. About 70% of women gain weight during perimenopause, averaging 1.5 pounds per year. The weight gain is driven by metabolic rate decline, insulin resistance, and sleep disruption, not estrogen loss alone.

Can perimenopause cause anxiety? Yes. Estradiol and progesterone both modulate neurotransmitters involved in mood regulation. Fluctuating levels can trigger or worsen anxiety. About 23% of perimenopausal women report new or worsening anxiety symptoms (Bromberger et al., Psychological Medicine, 2013).

Why do I wake up at 3 a.m. during perimenopause? Progesterone decline reduces GABA signaling, which disrupts sleep maintenance. The middle-of-the-night waking happens even before hot flashes appear. Night sweats worsen the problem in late perimenopause, but the sleep disruption starts earlier.

Can you get pregnant during perimenopause? Yes. Ovulation is irregular but still possible until you've gone 12 months without a period. Contraception is recommended until menopause is confirmed. Pregnancy after age 40 carries higher risks but is not impossible.

Should I get my hormones tested if I think I'm in perimenopause? Testing is optional. Perimenopause is diagnosed based on age and symptom pattern. FSH and estradiol levels fluctuate so widely during perimenopause that a single test can be misleading. Testing is useful if the diagnosis is uncertain or if you're considering hormone therapy.

Do all women get hot flashes during perimenopause? No. About 75% of women experience hot flashes at some point, but 25% never do. Hot flash severity varies widely. Some women have mild infrequent flashes; others have severe daily flashes that last for years.

Can perimenopause cause heart palpitations? Yes. Estrogen affects autonomic nervous system regulation. Fluctuating estrogen can cause palpitations, especially at night. If palpitations are frequent, prolonged, or accompanied by chest pain or shortness of breath, see a provider to rule out cardiac issues.

Is brain fog during perimenopause permanent? No. Cognitive symptoms are worst during the transition when estrogen levels are fluctuating. Most women see stabilization or modest improvement in early postmenopause once hormone levels are consistently low and the brain adapts.

Can exercise reduce perimenopause symptoms? Yes. Resistance training preserves muscle mass and metabolic rate. Aerobic exercise improves sleep quality and reduces hot flash frequency by 40% to 50% in some studies (Daley et al., Cochrane Database of Systematic Reviews, 2014). Exercise does not eliminate symptoms but reduces severity.

Should I start hormone therapy in early perimenopause? It depends on symptom severity and personal risk factors. Hormone therapy is most effective and safest when started during the perimenopausal transition, before age 60. If symptoms significantly impair quality of life, discuss options with a provider. If symptoms are mild, lifestyle interventions may be sufficient.

Sources

1. Avis NE et al. Duration of menopausal vasomotor symptoms over the menopause transition. JAMA Internal Medicine. 2015.
2. Gold EB et al. Longitudinal analysis of the association between vasomotor symptoms and race/ethnicity across the menopausal transition: Study of Women's Health Across the Nation. American Journal of Public Health. 2016.
3. Harlow SD et al. Executive summary of the Stages of Reproductive Aging Workshop +10: addressing the unfinished agenda of staging reproductive aging. Journal of Clinical Endocrinology & Metabolism. 2012.
4. Stolk L et al. Meta-analyses identify 13 loci associated with age at menopause and highlight DNA repair and immune pathways. Nature Genetics. 2012.
5. Mong JA et al. Sleep, rhythms, and the endocrine brain: influence of sex and gonadal hormones. Frontiers in Endocrinology. 2011.
6. Kravitz HM et al. Sleep disturbance during the menopausal transition in a multi-ethnic community sample of women. Sleep Medicine Reviews. 2008.
7. McCurry SM et al. Telephone-based cognitive behavioral therapy for insomnia in perimenopausal and postmenopausal women with vasomotor symptoms. JAMA Internal Medicine. 2016.
8. Sternfeld B et al. Physical activity and changes in weight and waist circumference in midlife women: findings from the Study of Women's Health Across the Nation. American Journal of Epidemiology. 2004.
9. Lovejoy JC et al. Increased visceral fat and decreased energy expenditure during the menopausal transition. International Journal of Obesity. 2008.
10. Carr MC et al. The emergence of the metabolic syndrome with menopause. Journal of Clinical Endocrinology & Metabolism. 2003.
11. Epperson CN et al. Cortical γ-aminobutyric acid levels across the menstrual cycle in healthy women and those with premenstrual dysphoric disorder. Archives of General Psychiatry. 2015.
12. Greendale GA et al. Effects of the menopause transition and hormone use on cognitive performance in midlife women. Neurology. 2009.
13. Freedman RR et al. Reduced thermoneutral zone and increased core temperature in postmenopausal women. American Journal of Physiology. 2014.
14. Portman DJ et al. Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the International Society for the Study of Women's Sexual Health and the North American Menopause Society. Menopause. 2014.

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