What are the first signs that perimenopause is starting?

The earliest signs are often subtle changes to the menstrual cycle: periods that come earlier or later than usual, changes in the heaviness of bleeding or increasing irregularity. Alongside this, many women notice disrupted sleep, especially waking at night or trouble sleeping through, as well as changes in mood and energy or an unusual tiredness that rest does not improve. These symptoms can appear years before noticeably irregular periods and are easily put down to stress or a busy life. If several occur together, a hormone panel can clarify what is behind them.