In perimenopause and menopause, the body produces less of the sex hormones, progesterone, estrogen, and testosterone. Because hormones impact nearly every cell, this decline can lead to profound effects on the body. Women can experience strange symptoms in any stage of the menopause transition, and for many women, perimenopause symptoms are worse than menopause 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 during puberty. Other women don't notice the changes in hormone levels, but they are likely still experiencing the effects of menopause on the body and attributing them to aging.
These symptoms can be relieved, but they must first be identified. Regardless of the severity of symptoms, all women will experience a significant reduction in their hormone levels with age. This article will help identify the effects of menopause and offer solutions for treatment and relief.
What Are Perimenopause and Menopause?
Menopause occurs after a woman has gone 12 months without a period; in the US, the average age to cross this threshold is 51 years old. Perimenopause is the phase leading up to menopause, and it can begin as many as ten years prior. This means women can be suffering from symptoms long before they enter menopause. Perimenopause is brought on by the decline of estrogen, progesterone, and testosterone that begins in the mid-30s and 40s.
It is this fluctuation in hormones that creates the sometimes obvious, and sometimes not-so-obvious, symptoms. Regardless of how severe or mild, these symptoms can affect quality of life and have repercussions on long-term health. Unfortunately, many women are not aware that they are in perimenopause and therefore don’t seek treatment. However, safe, proven treatment is available.
While nothing is a cure-all, hormone replacement therapy (HRT) is a very effective option for addressing the underlying hormone deficiencies causing many symptoms. HRT is available as creams, patches, and oral tablets, and which kind is right for each person depends on their unique cocktail of symptoms.
12 Signs that You're Perimenopausal
Evaluating your symptoms and their severity can help you identify where you are in the menopause transition and open the door to options for feeling better. Each woman’s journey is different, so not everyone will experience all of the perimenopause symptoms listed below, but the following are among the most common:
Irregular Periods - As perimenopause starts, you can expect your menstrual periods to become less predictable in timing and intensity. You may have a heavy period for one month, and only experience spotting the following month. During perimenopause, the span between cycles can shorten from 28 days to as few as 21 days. Missing a period entirely is also very common1,2.
Vasomotor Symptoms (Hot Flashes & Night Sweats) - The most obvious sign of perimenopause is hot flashes. They create flushing and sweat, most notably on the face, neck, and upper body. Hot flashes can be as brief as 30 seconds or last as long as 10 minutes1. Some women rarely experience hot flashes, while others have them throughout their lives. Hot flashes in the middle of the night are called night sweats. They can destroy sleep patterns and lead to fatigue, irritability, overeating, and increased stress.
For night sweats, women can sleep with fans and consider sheets and looser-fitting sleepwear made of cooler fabric, like cotton. HRT is the most effective method to reduce night sweats and prevent hot flashes for most women.Disrupted Sleep - With perimenopause and menopause, insomnia and sleep disturbances become more common and can last for decades. Over 40% of women experience sleep problems after the age of 40.
Progesterone is considered a relaxation hormone and naturally makes you tired, so as progesterone decreases, it can make good sleep harder to achieve. Supplementing with progesterone before bed is an excellent option. HRT can treat 95% of sleep disruptions, including night sweats1,2.Vaginal Discomfort - The drop in hormones with perimenopause can cause vaginal changes including irritation, itching, dryness, tenderness, and painful sex. Most women don't associate these changes with menopause, which is unfortunate because about 50% of women in menopause will experience these symptoms.
Decreased estrogen can make 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 conditions1,2. These uncomfortable symptoms are easily treatable using vaginal estrogen creams or other forms of HRT1,2.Low Sex Drive (Libido) & Painful Sex - Libido or sex drive can plummet as women age. This is likely due to a hormonal imbalance. Libido can also suffer in response to vaginal dryness or if it is painful to have sex.
Because estrogen and testosterone levels are low at this stage, women can experience a lack of lubrication and moisture. These problems can be quickly treated with vaginal estrogen cream, estrogen body cream, an estrogen patch, or a combination of HRT taken orally. Water-based lubricants can also help.Urinary Changes - Women often experience new incontinence and more frequent UTIs when hormone production decreases with perimenopause.
As estrogen levels drop, vaginal tissues that support the bladder and urethra become thinner and weaker, making it more common to pee a bit with coughing or even lifting something heavy. Estrogen replacement can return the vaginal tissue to a more youthful state and support the bladder and urethra. This can go a long way to improving urinary incontinence.
The thinning of the tissues allows more E. coli bacteria to move up the urethra and cause infection, resulting in more frequent UTIs. This can also be treated with topical vaginal estrogen.Changes to Skin, Nails, & Hair - Aging often shows first in your face, and when estrogen drops with perimenopause, it is evident in skin, hair, and even your fingernails. It is common for women to notice small wrinkles deepening and their skin getting thinner, drier, and less youthful-looking in perimenopause.
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 but are not a losing battle. HRT and specific skin care products can improve the appearance of your skin and hair if implemented early enough.Changes in Appetite - Hormones are involved in almost every system in the body, including hunger and digestion. The "hunger hormones" that make us feel either hungry or full are called ghrelin and leptin.
Ghrelin is released by the stomach and signals to the brain that you need to eat. Ghrelin can increase appetite and play a role in body weight too. Not only does ghrelin tell your brain when you’re hungry, but it also controls how quickly after a meal you feel hungry again. After eating, ghrelin levels decrease for about 3 hours, and then they spike, making you hungry all over again.
Leptin is a hormone that is made by fat cells that can decrease your appetite or act as an appetite suppressor. Leptin is what signals to your brain that you are satiated and full after eating. As estrogen declines, cortisol can rise, triggering a stress response. This in turn can dysregulate ghrelin and leptin levels. HRT can help regulate these hormones and normalize your hungry/full cycle.Menopausal Weight Gain & Decreased Metabolic Rate - As hormones drop, women may notice that they’re gaining weight, especially around the middle. This belly fat is called "menopausal weight gain" or "meno-belly." Weight gain in the midsection is unhealthy because it increases the risk of developing heart disease, type 2 diabetes, and even cancer3.
Hormones control our appetite, metabolism, and where fat cells are stored. HRT and a healthy diet are the most effective ways to manage hormonal weight gain. Studies show that by normalizing estrogen levels during menopause, this type of weight gain can be avoided.The Brain, Headaches, & Memory - During perimenopause and menopause, some women experience forgetfulness or what they call brain fog. Many women fear it may be a sign of oncoming dementia, but it is likely due to the significant drop in hormones. As estrogen decreases, it can't protect the brain like it used to. Supplementing estrogen can help mental function in part because it reduces disruptive hot flashes and many other menopause symptoms that can contribute to others5.
"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."3
While occasional headaches aren’t unusual, as perimenopause starts, some women suffer from severe headaches with flu-like symptoms. Contrarily, some women that previously suffered severe headaches may find relief with the declining hormones. Most scientists agree that the headaches associated with perimenopause are due to hormone fluctuation6.
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, and they 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 and prevent future headaches.Irritability & Mood Problems - Irritability, anxiety, and mood symptoms are not foreign, since as women we deal with hormonal fluctuations for most of our lives. Perimenopause and menopause are no different in that the hormone deficiencies at this time can also produce these symptoms.
Serotonin levels can drop correspondingly with estrogen. Serotonin works to help regulate mood, and when there isn’t enough, your mood can become low, leading to fatigue and depression. Fixing the underlying hormonal imbalance is one of the most effective ways of reducing menopausal mood swings.Fatigue & 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 fluctuating hormone levels impacting the immune system. Appropriate levels of estrogen help prevent inflammation, so low levels of estrogen during perimenopause can lead to increased inflammation and joint pain. Balancing hormone levels can help manage inflammation and aching.
People often attribute an ongoing, persistent feeling of weakness, tiredness, and low energy to aging. What occurs is as estrogen, progesterone, and testosterone drop, so do your energy levels. The same hormonal changes that cause the other perimenopausal symptoms mentioned above can lead to chronic fatigue. Additionally, if you aren't getting enough sleep because of night sweats or are chronically anxious because cortisol levels are out of whack, fatigue is likely to follow.
Conclusion
When hormones begin to decline in your late 30s and 40s, your body can go through a whole host of hormonal changes that lead to a wide variety of uncomfortable perimenopause and menopause symptoms. If you are suffering from the effects of menopause on the body, please know that you are not alone and help is available.
Any single symptom or a combination of these signs may be how your body is trying to tell you that your hormones are off balance and you need some help. To remedy these symptoms and promote long-term health benefits, we suggest visiting Winona’s anti-aging and wellness center to find out more about how you can improve your experience.
