Understanding the Symptoms of Perimenopause: What to Expect and When to Seek Treatment

Jacquelyn Stone
Jun 13
4 min read

Updated: Jul 19

If you're in your late 30s to mid-40s and notice changes in your body, you might be entering perimenopause. This stage leads up to menopause, and it can feel unfamiliar. You may experience shifts in your menstrual cycle, sleep, mood, or energy.

Experiencing hot flashes, a woman questions if she is entering perimenopause while working from home.

Perimenopause is a natural phase that can last from a few months to over a decade. It results from gradual hormonal changes, particularly in estrogen and progesterone. These changes can cause a variety of physical and emotional symptoms.

Menopause typically occurs at age 51, though it can happen between 45 and 55. Symptoms of perimenopause can begin as early as 10 years before menopause, meaning you might start experiencing these changes in your mid-30s!

Common Symptoms of Perimenopause

Marking the dates of her period on a calendar, a woman notices that her periods have become irregular due to perimenopause.

1. Irregular Periods

This symptom is often the first and most noticeable. You may find that your cycle lengths become shorter before turning irregular. Many women skip months, and then periods can stop altogether. Some women, however, may experience heavy bleeding. If you have frequent or heavy bleeding, check with your doctor to rule out other causes.

2. Hot Flashes and Night Sweats

Hot flashes and night sweats are common symptoms caused by hormonal fluctuations. These can occur during the day (hot flashes) or at night (night sweats), disrupting sleep and leaving you fatigued. Typically, hot flashes start in your face and can last up to 15 minutes. Night sweats often wake women, causing drenched sheets. Don’t hesitate to consult your doctor; treatments are available!

A woman lies in bed struggling with insomnia, a common challenge faced during perimenopause.

3. Sleep Disturbances

You may find it difficult to fall asleep or stay asleep, even without experiencing night sweats. Hormonal changes can disrupt your sleep cycles, leaving you feeling exhausted, even after a full night’s rest.

4. Mood Changes

During perimenopause, mood swings, anxiety, irritability, and even depressive symptoms are quite common. This isn’t just psychological; it’s connected to changes in estrogen, which affects neurotransmitters like serotonin.

5. Vaginal Dryness and Urinary Symptoms

Lower estrogen levels can thin and dry vaginal tissues, leading to discomfort during sex and daily irritation. Symptoms such as urinary urgency, an overactive bladder, and frequent UTIs may also occur. This is called genitourinary syndrome of menopause and can often be treated effectively with vaginal estrogen.

6. Brain Fog and Memory Lapses

Many women report difficulty concentrating or experiencing forgetfulness during perimenopause. This can be distressing, especially if you are balancing work and family commitments. Some women with ADHD find their medication becomes less effective.

Managing weight changes during menopause: Embracing body positivity and self-care throughout transitional phases.

7. Weight Gain and Body Composition Changes

Maintaining your usual weight can become challenging. Hormonal shifts can lead to fat storage, especially around the abdomen. You might notice weight gain starting 4-5 years before menopause. This typically amounts to just 1-2 pounds annually, but for some, it can be significantly more.

8. Breast Tenderness

Fluctuations in estrogen can lead to sore or swollen breasts, similar to premenstrual syndrome (PMS).

9. Headaches or Migraines

If you’ve experienced hormone-related headaches before, they may become more common or intense during perimenopause. Conversely, some women find that hormonal migraines improve as estrogen levels decline.

10. Changes in Hair and Skin

You might notice changes such as thinning hair, dry skin, or reduced skin elasticity. These shifts are primarily related to lower estrogen and slower collagen production.

11. Decreased Libido

As estrogen and other hormone levels drop, you may also notice a decline in libido. This can be compounded by pain during sex or mood issues.

12. Joint Pain

Low estrogen levels can affect your joints and muscles, leading to discomfort. Joint pain is among the lesser-known symptoms of perimenopause and menopause.

Treatment Options for Perimenopause

You don't have to suffer alone. Many women feel brushed off during this phase, led to believe that they are too young or that this is just "part of life." However, many safe and effective treatment options are available!

Low Dose Birth Control Pills: If you don’t have medical conditions that make combination birth control pills unsafe (like migraines with aura or high blood pressure), these can help manage symptoms and prevent pregnancy. They typically contain a higher dose of estrogen than menopausal hormone therapy.
Menopausal Hormone Therapy (MHT): MHT can be safely initiated during perimenopause. It involves a lower dose of estrogen and is an option even for women who cannot take combination birth control. While MHT won’t prevent pregnancy, it can alleviate several symptoms.
Vaginal Estrogen: This treatment does not increase blood levels of estrogen but can effectively treat urinary and vaginal symptoms. Most women with a history of breast cancer can safely use this option.
Non-hormonal Medications for Vasomotor Symptoms: Many non-hormonal options can help with hot flashes and night sweats. However, these may not address other perimenopausal symptoms like brain fog or joint pain.
Testosterone: Transdermal testosterone might assist with low libido. It is safe if levels remain within normal premenopausal limits. Avoid injections and pellets as they can result in dangerously high levels, causing serious side effects.

When to Talk to Your Doctor

Perimenopause is a natural part of aging, but that doesn’t mean you should suffer. If your symptoms disrupt your quality of life, discuss this with your healthcare provider. Effective treatments, including hormone therapies, non-hormonal medications, and lifestyle changes, can significantly improve your well-being.

You should also consult your doctor if:

Your periods become unusually heavy or prolonged.
You bleed between your periods.
You feel persistently sad or anxious.
Sleep issues or concentration challenges impact daily functioning.

Want to discuss symptoms and treatment options? I would love to help you. If you reside in a state where I am licensed, you can visit my telemedicine clinic for perimenopause consultation. Feel free to contact me or schedule an appointment!

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