As women get older, they may start to notice more changes happening in their bodies. Hot flashes, mood swings, irregular periods, and changes in sexual function may all be signs that your body has entered the transitional phase of the reproductive years before menopause fully kicks in.
Gynecology for middle-aged women typically involves monitoring for symptoms of perimenopause, where a woman’s hormone levels—specifically estrogen and progesterone—begin to fluctuate more than usual. While this phase is a natural part of life for all women, severe symptoms may impact your day-to-day routine and overall well-being.
Here is everything you need to know about perimenopause symptoms and when to see your provider if symptoms become bothersome.
What Is Perimenopause?
Perimenopause, or “around menopause,” is the period of time when your body starts to make its natural transition to menopause, which is when the reproductive years end. It’s also referred to as the menopausal transition, since it describes the time when your menstrual cycles are oftentimes no longer predictable. Perimenopause is only a temporary phase before you no longer have your cycle anymore.
Perimenopause begins to happen when the level of estrogen in a woman’s body starts to rise and fall unevenly. During the reproductive years, levels of this female hormone typically stay consistent, but this changes during perimenopause. Your menstrual cycles may become longer or shorter, you may experience menopause-like symptoms, and you may not ovulate at all.
The age that women experience perimenopause can vary, but most women start to experience symptoms and menstrual irregularities sometime in their 40s. For other women, these changes can happen earlier in their mid-30s or even later in their mid-50s.
Although your fertility begins to decline during perimenopause, there is still a chance you can become pregnant. Once you’ve experienced 12 consecutive months without a menstrual period, you’ve officially reached menopause, and the perimenopause phase is over.
10 Most Common Signs of Perimenopause
There are several physical and emotional symptoms you can potentially experience during perimenopause. Many of these changes you experience as symptoms directly result from estrogen decreasing in your body. This is why there are usually changes to your menstrual cycle, and your body may:
- Release eggs less regularly
- Become less fertile
- Produce less estrogen and other hormones
- Experience more irregular or shorter menstrual cycles
There are many other common perimenopause symptoms, which we will discuss in more detail below.
1. Irregular Periods
Ovulation becomes unpredictable during perimenopause, meaning your period may be shorter, longer, heavier, or lighter than usual. You may even skip your period altogether some months.
2. Worsened Premenstrual Syndrome (PMS)
PMS symptoms may become more often or more severe as your hormones fluctuate. During perimenopause, your body is more estrogen-dominant, mainly because it begins to produce less and less progesterone. This leads to worsening PMS symptoms, such as anxiety, breast tenderness, headaches, edginess or impatience, and food cravings. These are all caused by unpredictable estrogen production. Fortunately, these symptoms tend to decrease once your period starts.
3. Hot Flashes and Night Sweats
Some of the most telltale signs of perimenopause among women are hot flashes, heavy sweating, and night sweats. A hot flash occurs when your body suddenly experiences a wave of body heat, accompanied by reddening of the skin, increased heart rate, and sweating. Hot flashes can cause night sweats if they happen while you’re sleeping, making it difficult to get enough rest.
4. Sleep Problems
Women may experience sleep disturbances, insomnia, or mood disorders like depression and anxiety due to the decline in estrogen and progesterone. Your sleep may also be disrupted by night sweats and the discomfort associated with them. Sleep problems during perimenopause are mainly attributed to the drastic decline in progesterone that your body faces.
5. Mood Changes
Changes in mood, such as irritability, depression, or a lack of concentration, are common during perimenopause. Mood swings can occur for many reasons, including hormone fluctuations, sleep disturbances, life stress, or poor overall health. Having a history of mental health disorders like depression puts you at a higher risk of experiencing mood changes during perimenopause.
6. Vaginal Dryness and Discomfort During Sex
As estrogen levels decrease in your body, your vagina will lose some of its lubrication and elasticity. This can lead to vaginal dryness, irritation, and itching, all of which can make sexual intimacy uncomfortable. Vaginal dryness and lowered estrogen levels can also leave you more vulnerable to vaginal infections.
7. Changes in Sexual Function
Pain and tightness during intimacy can also be attributed to decreased hormone levels, resulting in a lowered sex drive in many women. Women experience a significant drop in testosterone during perimenopause, which is a leading hormone that drives libido and energy levels. If sexual intimacy has become uncomfortable for you, your libido may also decrease.
8. Loss of Bone Density and Weight Gain
Hormonal changes during perimenopause can lead to a slower metabolism, causing weight gain and increased fluid retention. You may also lose bone density, increasing your risk for osteoporosis—a disorder that results in fragile bones. With weight gain and lower bone density, you may experience joint and muscle aches.
9. Changing Cholesterol Levels
You may notice rising cholesterol levels as your estrogen levels drop. More specifically, low-density lipoprotein cholesterol (the “bad” one) will increase while the high-density lipoprotein cholesterol (the “good” one) will decrease. Increased cholesterol puts you at a higher risk of developing heart disease.
10. Bladder Problems
Similar to how low estrogen levels leave you more vulnerable to vaginal infections, you’re also more likely to experience bladder problems, such as urinary urgency or incontinence. You may even experience urine leakage when you sneeze or cough.
When to See Your Doctor
There’s no way to tell how long perimenopause will last for you once symptoms begin. Some women may only experience perimenopause for a short time, while it can last two to ten years for others. Perimenopause symptoms also come on gradually, so you may not even recognize how they are all related to hormonal changes.
Most of the time, symptoms related to perimenopause won’t require a visit to your provider. However, symptoms like abnormal bleeding may become concerning in certain instances and should be discussed with a doctor. These may include:
- Periods that have blood clots
- Extremely heavy periods where you have to change your tampon or pad every one to two hours
- Periods that are longer than usual or last more than seven days
- Periods that occur more frequently or happen closer together
- Spotting between periods or after sex
Abnormal bleeding can occur for various reasons, including hormone problems, pregnancy, birth control pills, blood clotting problems, fibroids, or, rarely, cancer. It’s best to speak with your doctor and have regular well-woman care visits to monitor irregular perimenopause symptoms.
Your medical provider may also recommend hormone replacement therapy options to manage symptoms of perimenopause, even while you are still menstruating. Hormone therapy is known to be a helpful treatment for women in menopause, but it is most beneficial when used in women during perimenopause.
Because of this, we recommend that women begin hormone therapy during perimenopause instead of waiting until menopause. Perimenopause symptoms can be significant and should be addressed sooner rather than later, meaning you don’t have to wait until you’ve missed a year of periods to seek help. Hormone therapy options like bio-identical hormone replacement therapy (BHRT) for women can help to ease the transition to menopause from a symptomatic perspective.
What Is the Difference Between Menopause and Perimenopause?
Some may confuse perimenopause with menopause, but the two are very different. Perimenopause is the transitional phase between regular reproductive years and menopause. Menopause occurs at the end of a woman’s reproductive life when they no longer have menstrual cycles, and therefore do not get their monthly period.
Because Perimenopause is the time leading up to menopause, women will experience a myriad of symptoms due to hormonal changes in the body. Once menopause happens, these symptoms usually go away. If the negative effects of perimenopause continue into menopause, it may be time to seek relief through treatments like hormone replacement therapy or lifestyle changes.
How Can Perimenopause be Treated?
Because perimenopause is a naturally occurring phase for every woman, there’s no way to fully prevent it or its symptoms. However, some treatments are available to lessen the severity of perimenopausal symptoms. If you are experiencing symptoms that have greatly interfered with your life or overall well-being, your doctor can provide information for treating certain symptoms that have become bothersome.
Treatments your doctor may recommend to ease symptoms of perimenopause could be:
- Birth control, including the pill, skin patch, vaginal ring, and progesterone injections, can help to stabilize your hormone levels and relieve some symptoms of perimenopause
- Hormone therapy that uses estrogen, progesterone, and testosterone to stabilize hormone levels and help with mood swings or other mood disorders like depression. There are many forms of hormone replacement therapy that can be considered to best fit your lifestyle, including pills, creams, troches, injections, and pellet therapy.
- Vaginal creams that can be prescribed and used to ease pain related to sex or vaginal dryness
In addition to these treatment options, your provider may also recommend making certain lifestyle changes to help with symptoms:
- Eat a healthy diet including vegetables, fruits, and whole grains
- Exercise regularly
- Stop smoking and limit the use of alcohol
- Take vitamins, such as a multivitamin or a calcium supplement
- Sleep more and retain a regular sleep schedule
- Maintain a healthy weight for your body
- Avoid what may trigger your hot flashes, such as certain foods or activities
Perimenopause is a normal phase in every woman’s life, so don’t be embarrassed to seek help for severe symptoms, pain, or discomfort. It’s also important to stay on top of having regular screenings during this time, including colonoscopies and annual pelvic exams, pap smears, and mammograms.