Your earliest perimenopause symptoms often get brushed off as normal, a gynecologist warns, leaving many women disconnected from what their body needs
A restless night here, a shorter temper there, and a period that suddenly feels harder than it used to. Many women in their 40s write these changes off as stress, even when their bodies may be entering perimenopause.
Gynecologist and obstetrician Laia Sánchez says that delay matters. In her new Spanish-language book, El poder de la progesterona a partir de los 40, or The Power of Progesterone After 40, she argues that progesterone deserves more attention because changes in ovulation can reduce its production before menstrual cycles become clearly irregular.
The overlooked hormone
Progesterone is made mainly after ovulation, when an ovary releases an egg. It helps prepare the uterus for pregnancy and limits excessive growth of the uterine lining under estrogen’s influence.
The hormone also plays an essential role in maintaining pregnancy. Sánchez, who previously worked at Hospital de Terrassa and Hospital Municipal de Badalona, says its wider effects may also touch sleep, mood, inflammation, bone health, and cardiovascular health, although not every symptom can be traced to one hormone.
Signs hiding in plain sight
Perimenopause is the transition leading to menopause, which is reached after 12 straight months without a period. It usually begins in the 40s and can last several years, bringing changes in bleeding, sleep, temperature control, vaginal comfort, concentration, and mood.
“The initial symptoms are often normalized or ignored,” the gynecologist said, especially when work, caregiving, and daily pressure already leave women running on empty.
Ovulation can change first
Progesterone rises after ovulation. As the ovaries age, ovulation can become less consistent, so progesterone production may weaken even while periods still look fairly regular.
Research supports that broader pattern. In one study, more than six in ten cycles during late perimenopause did not include ovulation, showing why hormone changes can be underway before the calendar makes them obvious.
Sleep and stress blur the picture
Sleep trouble, irritability, stronger premenstrual symptoms, and feeling overwhelmed can all appear during this transition. The American College of Obstetricians and Gynecologists reports that about four in ten women experience perimenopausal mood symptoms resembling premenstrual syndrome.
But hormones do not exist in a quiet laboratory. A rough night can make the next workday feel longer, and stress can make sleep even harder, so cause and effect often tangle together. That is why Sánchez places rest first rather than handing women an exhausting checklist of instant lifestyle changes.
What research says about progesterone
A review of randomized trials found that oral micronized progesterone improved some sleep outcomes, although most participants in those studies were already postmenopausal. The evidence is encouraging, but it does not show that progesterone is a universal sleep treatment.
A 2023 randomized trial followed 189 perimenopausal women with hot flashes and night sweats. Its main hot-flash result did not show a clear difference from placebo, but women taking progesterone reported better sleep and fewer night sweats, with no serious adverse events recorded.
Hormone therapy needs context
Sánchez describes progesterone therapy as a potentially useful tool when it is medically indicated, not a replacement for sleep, movement, nutrition, or emotional support. Treatment should reduce the burden of the transition, not add another layer of pressure.
The Menopause Society says systemic hormone therapy is the most effective treatment for bothersome hot flashes and night sweats. For a woman with a uterus who uses systemic estrogen, a progestogen is generally added to protect the uterine lining, while the overall risks depend on age, health history, dose, and delivery method.
No single test tells the whole story
Routine hormone testing is usually not needed to identify perimenopause because hormone levels can swing sharply from day to day. Clinicians generally look at age, symptoms, menstrual changes, medical history, and other possible explanations.
Tracking sleep, bleeding, hot flashes, mood, and cycle timing can make that conversation more useful. Heavy or unusual bleeding, bleeding after menopause, or severe mood symptoms should be evaluated rather than written off as “just hormones.”
A chance to reconnect
The emotional side of perimenopause is not an extra detail. “Many women reach this stage very disconnected from their own needs,” Sánchez said, and hormonal changes can arrive during demanding years filled with jobs, children, aging parents, and relationship pressures.
Her message is not that every difficult day after 40 comes from progesterone. It is that women deserve clearer information, realistic options, and permission to notice what their bodies are saying. Sometimes that awareness changes the next medical appointment. Sometimes it changes much more.
The original interview was published by La Vanguardia.
