Written By: Cate Boyd

Cate Boyd

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Perimenopause is a pivotal stage of life which can start several years before menopause, and brings with it a range of physical and emotional changes that every woman should be prepared for. Speaking from first hand experience of being under prepared, understanding the signs and symptoms of perimenopause is essential. From unpredictable menstrual cycles to extreme fatigue, joint pain and sudden emotions and mood swings, the signs can vary widely from one individual to another. This stage of life often feels daunting, and it can feel like your body is taking over control but arming yourself with knowledge can help demystify the experience and help you take back control. In this article, we’ll explore 10 key signs and symptoms perimenopause brings, to ensure you feel informed as you navigate this significant transition.

What is Perimenopause?

Perimenopause marks the period during which a woman’s body begins to undergo the natural transition toward permanent infertility. Typically, perimenopause can start as early as a woman’s late 30s or as late as her mid-40s, lasting for several years. This transitional phase is characterized by fluctuations in hormone levels, particularly estrogen and progesterone, which can lead to a variety of physical and emotional changes.

Understanding perimenopause and the 10 key signs and symptoms perimenopause brings is crucial because it equips women with the knowledge to manage symptoms effectively and make informed decisions regarding their health.

During perimenopause, the ovaries gradually produce less estrogen, leading to various physiological changes. These changes can affect the menstrual cycle, making periods irregular and sometimes more painful.

As estrogen levels fluctuate, women may experience a range of symptoms, from mild to severe. Whilst perimenopause is a normal part of aging and not a medical condition symptoms can sometimes be severe enough to disrupt daily life.

Recognizing the onset of perimenopause can be challenging, as its symptoms often overlap with other conditions. Many women find themselves unsure whether the changes they are experiencing are related to perimenopause or other factors. This uncertainty underscores the importance of being aware of the 10 key signs and symptoms perimenopause brings.

By learning to identify these changes, women can take proactive steps to manage their health and well-being during perimenopause. In this article we’ll share:

The Hormonal Changes During Perimenopause

Hormonal changes are the hallmark of perimenopause, primarily involving fluctuations in estrogen and progesterone levels. Estrogen, a hormone produced by the ovaries, plays a vital role in regulating the menstrual cycle and maintaining various bodily functions.

During perimenopause, the production of estrogen becomes erratic, leading to many of the symptoms associated with this transition. These hormonal fluctuations can affect everything from the menstrual cycle to mood and energy levels and even shifts where your body stores fat.

Progesterone, another hormone produced by the ovaries, also plays a significant role in the menstrual cycle. It prepares the lining of the uterus for a potential pregnancy each month.

As perimenopause progresses, progesterone levels may decline, leading to changes in the menstrual cycle, such as heavier or lighter periods, and increased frequency of cycles. These hormonal changes can also lead to symptoms such as mood swings, sleep disturbances, and hot flushes.

The interaction between estrogen and progesterone is complex, and their fluctuating levels during perimenopause can affect each woman differently. Some women may experience severe symptoms, while others may have a relatively smooth transition with mild discomfort.

I can’t stress enough how important understanding these hormonal changes are for managing symptoms effectively and seeking appropriate treatments, such as hormone therapy, (HRT) if necessary.

It took me months of knowing something significant was happening in my body, I wasn’t just tired, I wasn’t just low or sad, I wasn’t just out of sorts, I knew something was very different – something felt wrong. I had become a totally different person and over a very short period of time, but I couldn’t for the life of me put my finger on why or what to do.

At 39 perimenopause was not on my radar. How wrong was I.

By staying informed about the hormonal dynamics of perimenopause, women can better navigate this transition.

10 Key Signs and Symptoms Perimenopause Brings

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1. Irregular Periods

One of the first signs of 10 key signs and symptoms perimenopause brings is changes in menstrual cycle frequency or flow. Periods may come closer together, further apart, or skip months and also become heavier, or lighter. These changes are due to the fluctuating hormone levels that affect the ovaries’ ability to release eggs consistently.

• A longitudinal study found that over 90% of women experienced menstrual changes during perimenopause.¹
• Irregular ovulation is caused by fluctuating levels of estrogen and follicle-stimulating hormone (FSH).

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2. Hot Flushes and Night Sweats

These sudden feelings of intense heat, often accompanied by sweating and flushed skin can occur at any time of day or night. Hot flushes are caused by changes in the body’s temperature regulation, which are linked to fluctuating estrogen levels. A common sign of perimenopause, they can be uncomfortable and disruptive, especially if they occur frequently.

• Up to 75% of women experience hot flushes in perimenopause.²
• Caused by disrupted thermoregulation in the brain due to estrogen withdrawal.

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3. Mood Swings and Anxiety

Women may find themselves experiencing sudden and intense emotions, ranging from irritability and anxiety to sadness and even depression. These mood changes are thought to be related to hormonal fluctuations which can affect neurotransmitters like serotonin and dopamine, leading to emotional instability, as well as the stress of dealing with other perimenopausal symptoms.

• A 2021 study in JAMA Psychiatry found a 60% increased risk of depression in perimenopausal women.³
• Anxiety and irritability are also common, even in women with no prior mental health history.

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4. Sleep Disturbances

Sleep disturbances, including difficulty falling asleep or staying asleep, are frequently reported and make it into the 10 key signs and symptoms perimenopause brings. These issues may be exacerbated by night sweats, another key perimenopause symptom, which can disrupt sleep and lead to fatigue and irritability during the day.

• According to the Study of Women’s Health Across the Nation (SWAN), 40–60% of perimenopausal women report sleep issues.⁴

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5. Dryness and Discomfort

Lower estrogen levels lead to thinning and drying of delicate tissues, reduced lubrication, and discomfort during intercourse with increased susceptibility to infections.

This symptom can impact a woman’s quality of life, making it important to address with appropriate treatments such as estrogen therapy.

• This symptom affects up to 50% of women during perimenopause, yet many do not seek help.⁵

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6. Low Libido

A decline in desire can be related to hormonal changes, discomfort, fatigue, and emotional shifts.

• A large UK study reported that over 30% of women aged 40–55 experienced reduced sexual desire.⁶

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7. Weight Gain and Metabolism Changes

Weight gain is also up there in the 10 key signs and symptoms perimenopause brings. Many women report gaining weight — especially around the abdomen — despite no changes in diet or activity.

Many women notice an increase in abdominal fat, which can be attributed to hormonal changes as well as aging and lifestyle factors. These changes can affect a woman’s self-esteem and overall health, highlighting the importance of a balanced diet and regular exercise to maintain a healthy weight during this transition.

• This is due to declining estrogen, insulin sensitivity, and loss of lean muscle mass.⁷
• A 2020 review found perimenopausal women experience a decrease in resting metabolic rate.⁸

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8. Brain Fog and Memory Issues

Cognitive changes such as forgetfulness, reduced concentration, and mental fatigue are widely reported.

• A 2016 study from Harvard showed that women in perimenopause scored lower on memory and attention tasks.⁹

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9. Breast Tenderness

Fluctuating oestrogen and progesterone levels can cause soreness, swelling, or lumpiness in the breasts.

• Similar to PMS symptoms, but may be more prolonged or unpredictable.¹⁰

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10. Joint and Muscle Aches

Joint stiffness, muscle pain, or general achiness is a lesser known symptom but common enough to make it into the 10 key signs and symptoms perimenopause brings.

• Thought to be linked to inflammation, ageing, and declining estrogen.
• Over 50% of perimenopausal women in a UK survey reported new or worsened musculoskeletal pain.¹¹

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The Emotional Impact of Perimenopause

The emotional impact of perimenopause can be significant, as hormonal fluctuations can lead to mood swings, anxiety, and depression.

These emotional changes can be challenging to cope with, especially when combined with physical symptoms such as hot flushes and sleep disturbances. Women may find themselves feeling overwhelmed, stressed, or even disconnected from themselves and others.

Managing the emotional impact of perimenopause requires a combination of self-care, support, and sometimes professional help.

Engaging in regular physical activity, maintaining a healthy diet, and practicing stress-reduction techniques such as meditation or yoga can help alleviate some of the emotional symptoms.

Hormone therapy or antidepressants may also be considered to help balance mood and alleviate symptoms. It is important for women to remember that they are not alone in their experiences and that help is available to navigate the emotional challenges of perimenopause.

Physical Changes to Expect in Perimenopause

During perimenopause, women may notice a variety of physical changes, some of which can be surprising or distressing.

Changes in skin and hair are common, as decreased estrogen levels can lead to drier, thinner skin and increased hair shedding.

Some women may also notice increased facial hair or changes in hair texture.

Breast tenderness and changes in breast size are also common during perimenopause. These changes can be attributed to hormonal fluctuations and may cause discomfort or concern for some women. It is important to continue regular breast self-examinations and mammograms during this time to monitor any changes and ensure breast health.

Bone health is another important consideration during perimenopause, as decreased estrogen levels can lead to decreased bone density and an increased risk of osteoporosis.

Women should ensure they are getting enough calcium and vitamin D in their diet, as well as engaging in weight-bearing exercises to maintain bone strength. Regular bone density screenings may also be recommended to monitor changes and prevent bone loss.

How Long Does Perimenopause Last?

The duration of perimenopause can vary widely among women, with some experiencing symptoms for only a few years and others for a decade or more.

On average, perimenopause lasts about four years, but it can range from a few months to as long as ten years. The length of perimenopause can be influenced by factors such as genetics, lifestyle, and overall health.

During perimenopause, women may experience periods of stability where symptoms are mild or manageable, followed by periods of more intense symptoms. This variability can make it difficult to predict how long perimenopause will last for any individual woman.

While perimenopause is a natural part of aging, it is important for women to be proactive about their health during this time. Regular check-ups with a healthcare provider, as well as discussions about symptoms and treatment options, can help women navigate the perimenopausal transition more comfortably.

Lifestyle Changes to Manage Perimenopause Symptoms

Making lifestyle changes can be an effective way to manage perimenopause symptoms and improve overall well-being. A balanced diet rich in fruits, vegetables, whole grains, and lean proteins can provide essential nutrients and support hormonal balance. Limiting caffeine, alcohol, and processed foods can also help reduce symptoms such as hot flushes and mood swings.

Regular physical activity is another important aspect of managing perimenopause symptoms. Exercise can help regulate mood, improve sleep, and maintain a healthy weight. Activities such as walking, swimming, yoga, and strength training can be beneficial for both physical and mental health. Finding an enjoyable form of exercise can make it easier to incorporate into daily life.

Stress management is also crucial during perimenopause, as stress can exacerbate symptoms and impact overall health. Techniques such as deep breathing, meditation, or mindfulness can help reduce stress and promote relaxation.

When to Seek Medical Advice

While perimenopause is a natural process, it is important for women to seek medical advice if symptoms become severe or interfere with daily life. Heavy or prolonged bleeding, severe mood swings, or debilitating hot flushes may require medical intervention. A healthcare provider can offer guidance on treatment options, such as hormone therapy or other medications, to help manage symptoms.

Women should also seek medical advice if they experience symptoms that are unusual or concerning, such as unexplained weight loss, persistent fatigue, or changes in breast health. These symptoms may indicate other health issues that require evaluation and treatment. Regular check-ups and open communication with a healthcare provider can help ensure that any potential health concerns are addressed promptly.

It is also important for women to discuss their family history and any risk factors for conditions such as osteoporosis or heart disease with their healthcare provider. Preventive measures and screenings can be tailored to each woman’s individual needs, helping to maintain optimal health during perimenopause and beyond.

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References – 10 Key Signs and Symptoms Perimenopause Brings

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