Journal / Menopause

15 Signs of Perimenopause

Nancy L. Belcher

Medically reviewed by Nancy L. Belcher Ph.D, MPA

Written by Winona Editorial Team

Last updated November 25, 2021

15 Signs of Perimenopause

As we age, our body starts producing less of the sex hormones progesterone, estrogen, and testosterone. This drop in hormones can lead to major changes in your mind and body. Menopause occurs at about the age of 51 and when you have gone 12 months without a period. But there is an equally important phase before menopause - that phase is called perimenopause. You may have weird symptoms with perimenopause. The perimenopause symptoms with age are often poorly defined, and so are the signs that perimenopause is ending. 

Perimenopause has its own symptoms and signs that we should pay attention to. For many women, perimenopause symptoms are actually worse than menopause symptoms. It's best to unbuckle and get off the roller coaster of symptoms before menopause completely takes you for a ride. 

Perimenopause

Most women enter perimenopause about 7-10 years before menopause. The production of sex hormones (estrogen, progesterone, and testosterone) really starts decreasing in a woman’s 30s and 40s. During this time, women can experience sometimes obvious and sometimes not-so-obvious symptoms related to that drop in hormones. Regardless of how noticeable the symptoms are, they can negatively impact a woman’s quality of life and future health. Unfortunately, many women do not realize they are in perimenopause and there is a safe, proven treatment for the symptoms.

The years leading up to menopause aren’t a clear, straightforward path where symptoms are necessarily evident. Some women find themselves experiencing a hormonal roller coaster-like they experienced during puberty. Other women don’t notice the changes in hormone levels - but they are likely still having symptoms that they simply attribute to ‘aging.’ These symptoms can be relieved, but you have to recognize them in order to get treatment. Regardless of the severity of symptoms, all women will experience a significant reduction in their hormone levels with age.

15 Signs That You’re In Perimenopause

Whether you are a teenager or in your 40s, your hormone levels change from month to month, day to day, and even hour to hour. There are some companies that try to sell expensive hormone tests that will give a hormone level - a snapshot in time -  which really won’t tell us a whole lot. We already know you are hormone deficient because of your age and likely symptoms. So,  it doesn't make a lot of sense to use an expensive hormone test to check your hormone levels. 

Evaluating your symptoms, and the severity of those symptoms can give a much better idea of where you are in your perimenopause and menopause journey. Not every woman will experience all of the perimenopause signs listed below, and each woman will have her mix of each, but it’s good to know what to look out for so that you can seek out the treatments to help you live your best life.

  1. Irregular Periods
    As perimenopause starts you can expect your periods will start to become more erratic in timing and severity. One month you may have a heavy period and the next month just spotting. This is a telltale sign of approaching menopause. The length between menstrual cycles can shorten during perimenopause from 28 days to anywhere between 21 to 26 days. Missed periods are very common. 1,2 What’s so frustrating about this is that you really don’t know what to expect from month to month and even day-to-day.

  2. Vaginal Dryness
    Perimenopause can cause some really unexpected and uncomfortable vaginal changes.  Changes can include vaginal dryness, tenderness, and painful sex. Most women don’t associate these changes with perimenopause, which is unfortunate because these symptoms affect more than half of all peri- and menopausal women in the US. These uncomfortable symptoms are easily treatable with vaginal estrogen creams and hormone replacement therapy (HRT). 1,2

    The decrease in estrogen that happens with perimenopause makes the vaginal tissue thinner, drier, less elastic, and more fragile. If not treated the vaginal symptoms do not get better - they are chronic, progressive, and painful conditions. 1,2 Unlike hot flashes that tend to get better as you move beyond menopause, vaginal atrophy only gets worse.

  3. Difficulty Sleeping
    With perimenopause, insomnia and sleep disturbances become more common. The decrease in estrogen and especially progesterone often contribute to sleep issues that can continue for decades. Progesterone, one of the hormones in HRT, naturally makes you drowsy and is a good option to take before bed. 

    When women are in their 20s and early 30s only about 12% report sleep problems, but that number changes to 40% of women experiencing sleep problems in their 40s and 50s. Women have the most sleep issues during their menopause years, ie.,  during perimenopause and all the way through postmenopause (often 20 years) due to the drop in hormones.

    Hormone Replacement Therapy (HRT) can help improve sleep problems. Peri- and menopausal women can enjoy better sleep when taking estrogen and progesterone (HRT) than when using traditional sleep medications. If your sleep problems are caused by hot flashes or night sweats, 95- 98% of these disruptions can be cured with HRT. HRT is the most proven method for decreasing hot flashes and night sweats. 1,2

  4. Skin & Hair Changes
    When estrogen levels drop during perimenopause, it shows (sometimes first) in your skin, hair, and even your fingernails. Most women report the biggest change in their skin. It is common for women to notice their skin getting thinner, drier, less youthful-looking, and small wrinkles deepening in perimenopause. 

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    Collagen is what helps keep skin toned, fresh-looking, and resilient. As estrogen drops, so does collagen production.  These changes start to happen in your 30s and are not necessarily a losing battle. HRT and specific skincare products can make all the difference in the appearance of your skin and hair if started early enough. 

  5. Irritability & Mood Problems
    As women, we have lived with hormonal fluctuations for most of our lives. The fluctuations start at puberty and follow us every month thereafter. We have seen how women vary in their response to these hormone changes and how the changes directly correlate with mood and mental health. Sadly, the medical profession often discounts the reality of mental health and hormone levels, especially during peri- and menopause. 

    During peri- and menopause irritability and mood symptoms often arise due to dropping hormones. But there are also other causes for these changes including the lack of sleep, life transitions (kids moving away, aging parents, and other issues) that arise in your 40s and 50s. 

    Fixing the underlying hormonal imbalance is one of the most effective ways of reducing peri- and menopausal mood swings. When a woman’s estrogen level drops, so do levels of a mood-regulating neurotransmitter chemical in her brain, called ‘serotonin.’ This drop can alter your mood and even lead to depression, and fatigue.  It is important to take these mood changes seriously and mitigate them.

  6. Decreased Libido & Painful Intercourse
    In peri- and menopausal women, the main cause of low sex drive is hormonal imbalance. Libido is impacted by low hormones that can cause symptoms such as vaginal dryness, pain during intercourse, and/or depression. 

    When estrogen levels drop with menopause, the vaginal tissue becomes drier, thinner, less elastic and the vagina can become smaller. The vagina is frequently itchy and easily irritated.

    Increasing pain with intercourse is often due to peri - and menopause. The lack of estrogen and testosterone can impact lubrication and moisture that is so common with peri- and menopause. This can lead to uncomfortable and often painful sex but it can be treated with topical vaginal estrogen, body creams, patches, or oral HRT. Water-based lubrication can be helpful too.

  7. Weight Gain & Slowed Metabolism
    Hormonal changes during peri- and menopause can lead to weight gain, especially around your middle. With perimenopause, as the hormones estrogen, progesterone, and testosterone decrease you can start to gain weight around the midsection. Maybe you start to look more like an ‘apple’ shape than a ‘pear’ or even ‘hour-glass.’ 

    Many people call this increase in belly fat “menopausal weight gain.” Studies show that by normalizing estrogen levels during menopause, we can protect against belly weight gain. Gaining weight in the belly area is particularly unhealthy because it increases the risk of developing type 2 diabetes, heart disease, and some forms of cancer, particularly colon cancer. 3

    Hormones control metabolism, where fat is deposited (stored), overall appetite, and weight balance. The most effective way to get hormones back on track, stop the scale creep, and return to a healthy weight is to correct hormonal imbalances with HRT. Winona’s HRT is made from yams and is identical to the hormones our body naturally makes. Once hormones are back in balance, weight loss can begin.

  8. Changes in Appetite
    Studies suggest that HRT may help reduce this sudden upswing in appetite with peri- and menopause. Hormones control pretty much everything in our bodies, so of course, there are hormones that make us feel full or hungry. There are hormones called the "hunger hormones," also known as leptin and ghrelin.

    Leptin is a hormone that is made by fat cells that can decrease your appetite or act as an ‘appetite suppressor.’ Levels of leptin -- the appetite suppressor -- are lower in thin people and higher in overweight people. But many obese people have built up a resistance to leptin so the appetite-suppressing effects of leptin aren’t working.

    Ghrelin does the opposite - it is a hormone that is released by your stomach and signals the brain that you need to eat. Ghrelin increases appetite, and also plays a role in body weight. Not only does ghrelin tell your brain if you are done eating, but it also times how quickly you feel hungry. After eating, ghrelin levels go down for about 3 hours and then they spike making you hungry all over again. 

    HRT can counteract the effects of cortisol and help balance the levels of ghrelin and leptin. During menopause, your estrogen levels start to decline. This may also allow cortisol levels to rise and trigger stress responses. 

    One of the main concerns women have with peri- and menopause is weight gain. Cortisol impacts our appetite hormones (ghrelin and leptin), how your body uses (metabolizes) carbohydrates, fats, and proteins, and controls your sleep-wake cycle. We know without enough sleep people have an elevated appetite, eat more and gain weight. By balancing estrogen and progesterone you can start to normalize the other hormones that impact how much you eat. 

    Our hormones have to work together and balance one another to maintain balance. If one hormone is too high, it can throw off the whole system. During menopause our bodies are doing their best to adapt however, our hormones aren’t always able to keep up with the changes.

    The most effective way to get hormones back on track, stop the scale creep, and return to a healthy weight is to correct hormonal imbalances with HRT. Once hormones are back in balance, appetite can be normalized and weight loss can begin.  

  9. Brain Fog
    If you are like most women experiencing peri- and menopause, you might notice forgetfulness,  brain fog, confusion, or memory problems. You are likely wondering if the memory loss may be due to early dementia, but it is likely due to the significant drop in hormones.

    Whether you have difficulty remembering appointments, a person's name, or searching for your sunglasses on your head, dropping hormones can be the culprit. It doesn’t come as any surprise that researchers have confirmed that the “brain fog” often rolls in with perimenopause. 4 

    As estrogen levels decrease, so do the protective functions it provides in brain function.  That might look like feeling a step behind in the conversation. It can be very disconcerting, but estrogen can benefit mental function because it reduces hot flashes and so many other menopause symptoms. 5

    "The more hot flashes a woman has, the worse her memory performance. And when we intervene to address those hot flashes (with HRT), her memory performance bounces back." 5

    Research indicates that it may be possible to use HRT at peri- and menopause to prevent brain fog and even Alzheimer's and other forms of dementia later on. 5

  10. Hot Flashes
    Hot flashes are often the most obvious sign of menopause, but what many people don’t know is that they are also a sign of perimenopause. Hot flashes can begin 10 years before true menopause begins. Hot flashes are caused by a decreased production of the hormone estrogen.  

    Hot flashes can create flushing and sweating especially on the face and upper body. The experience of hot flashes can range from mild/light flashes to severe heat that lasts from 30 seconds to 10 minutes. 1 Some women rarely experience hot flashes, while others have them throughout their lives. 

    The good news is that there are specific things that a woman can do to help with hot flashes. HRT  is one of the most effective methods to reduce hot flashes and night sweats for most women. 

  11. Night Sweats
    When hot flashes happen during sleep and are accompanied by sweating we call them ‘night sweats.’ Many women experience night sweats, which cause disruptions to sleep, and can lead to increased irritability, depression, overeating, and stress. 

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    The changes in hormones with perimenopausal can cause women to wake up many times during the night, tossing, turning, and suffering from insomnia. For night sweats, women can consider sheets and looser-fitting sleepwear that are cool, such as cotton, and blankets that are easy to remove, but an old favorite is a fan or multiple fans. HRT is the most effective method to reduce night sweats for most women. 

  12. Achy joints
    Joint pain is one of the most commonly under-acknowledged symptoms of perimenopause.  Aches and pains in your muscles and joints are often related to the effects that fluctuating hormone levels have on the immune system.

    Appropriate levels of estrogen help prevent inflammation in the joints, so low levels of estrogen during perimenopause can lead to increased inflammation, and increased joint pain. Yes, you are getting older but joint pain doesn’t have to coincide with it. Try getting your hormone levels back to normal with HRT.

  13. Headaches
    While we all suffer from headaches occasionally, as perimenopause starts some women can suffer from incredible headaches that include flu-like symptoms. Some women that previously suffered serious headaches before perimenopause may find relief with the drop in hormones with menopause. It depends on the woman, but most scientists agree that the headaches associated with perimenopause are due to the change in the hormone. The improvements after perimenopause are likely due to the decrease in the fluctuations of hormones. 6

    Hormone replacement therapy (HRT) can help reduce the incidence and severity of headaches. Like many symptoms of perimenopause, women don’t realize headaches are a part of an underlying problem (low hormones) and they simply try to work through it with aspirin and painkillers. By taking HRT you can normalize the levels of hormones possibly for the first time since puberty. Balancing hormones is key to preventing future headaches.

  14. Chronic Fatigue
    An ongoing, persistent feeling of weakness, tiredness, and low energy is often attributed to age. As we age,  estrogen, progesterone, and testosterone all drop and play a critical role in energy levels. As their levels drop, so do your energy levels. 

    The same hormonal changes that cause the other perimenopausal symptoms mentioned above,  can also affect your energy levels and lead to fatigue. If you aren’t getting enough sleep because of night sweats, or if you are chronically anxious because cortisol levels are out of wack, fatigue will follow. 

  15. Increased Incontinence & UTIs
    Who would have thought that decreased hormones can lead to peeing when you laugh, or urinary tract infections? Well, when hormones drop with perimenopause women often experience new incontinence and more frequent UTIs. 

    As estrogen levels drop with perimenopause your vaginal tissues that support the bladder and urethra become thinner and weaker making it more common to pee a bit when you cough or even lift something heavy. Estrogen replacement can return the vaginal tissue to a more youthful state and give better support to the bladder and urethra. This can go a long way to improve urinary incontinence. 

    With perimenopause, urinary tract infections (UTIs) can increase. As the hormones estrogen and testosterone drop, vaginal dryness increases, and the vaginal tissues become thinner. This thinning of the tissues creates a potential for more E. coli bacteria to move up the urethra and cause an infection. This may also be treated with topical vaginal estrogen.

Conclusion

When your hormones drop in your late 30s and 40s, your body can go through a whole host of hormonal changes that can lead to weird symptoms with perimenopause. If you are suffering, please know that you are not alone and there is help available. Perimenopause symptoms with age typically start around the time when you may be experiencing other changes and stresses that also contribute to your symptoms. 

All women have different signs of perimenopause and signs that perimenopause is ending. However, any one or a combination of these signs may be the way that your body is trying to tell you that your hormones are off balance and you need some help. To help remedy these symptoms and promote long-term health benefits, we suggest visiting bywinona.com to find out more about how you can improve your perimenopause and ultimately your menopause experience.

"This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment."

References

  1. https://www.nuffieldhealth.com/article/5-signs-youre-in-the-grip-of-perimenopause

  2. https://www.besthealthmag.ca/list/perimenopause-symptoms/

  3. https://www.mayoclinic.org/healthy-lifestyle/womens-health/in-depth/menopause-weight-gain/art-20046058

  4. https://www.considerable.com/health/dementia/menopause-alzheimers-dementia/

  5. https://www.npr.org/sections/health-shots/2018/07/23/630688342/might-sex-hormones-help-protect-women-from-alzheimer-s-after-all-maybe

  6. https://www.healthline.com/health/menopause-headaches#menopause