What are the symptoms of perimenopause?

There is a very broad spectrum of perimenopausal symptoms that can vary in both intensity and in frequency. While some women breeze through perimenopause, and others have only a few bothersome symptoms, some may find their symptoms disrupt their daily life. Decreased oestrogen production during perimenopause can cause both physical and mental symptoms. You may experience none, some, or all of the following symptoms.

Physical symptoms

Changes to your menstrual cycle: The first sign of perimenopause is usually a change in the pattern of your periods. As ovulation slows, your menstrual cycle will become irregular. You may start having unusually light or heavy periods. The frequency of your periods may also be affected. You may have one every two or three weeks, or you may not have one for months at a time. Eventually you’ll stop having periods altogether.

Hot flashes Hot flashes, also known as hot flushes and scientifically called vasomotor symptoms, are the hallmark signs of perimenopause. A hot flash is a short, sudden feeling of intense heat, usually in the face, neck and chest. Your face, neck, and chest may also turn red, you may have heart palpitations, and perspire heavily. When the hot flash is over, you might feel chilly and shivery. Some women experience a couple of hot flashes over a week while others may have 10 or more intense hot flashes a day. They can also occur at any time, causing discomfort, and sometimes embarrassment in social situations.

Interesting fact

According to research, over 80% of women experience hot flashes during perimenopause. The cause of hot flashes and night sweats is not fully understood, but it’s thought to be related to changes in the hypothalamus, which regulates body temperature.

Vaginal atrophy: Low oestrogen levels cause the vaginal tissue to lose its elasticity and become thinner. Vaginal atrophy causes dryness, pain, irritation, and bleeding after sex.

Urinary incontinence: Changes during perimenopause cause the muscles in the vagina and urinary tract to weaken. This can lead to stress incontinence or involuntary peeing while sneezing, laughing, coughing, exercising, or carrying heavy objects.

Recurrent UTIs: You’re at an increased risk of urinary tract infections because perimenopause can cause your urethra to become dry, irritated, or inflamed. Vaginal infections can also occur more frequently because your vagina has become dryer and thinner.

Joint pain: More than 70 per cent of women experience joint and muscle aches and pain during perimenopause, and for 25 per cent of them, it’s debilitating, according to recent research. Low levels of oestrogen can lead to many of your joints feeling stiff and aching.

Bone density loss: As oestrogen levels decrease during perimenopause, women are at an increased risk of osteoporosis, a condition where bones become fragile and more susceptible to fractures. 

Hair, skin and nail changes: As your levels of oestrogen drop, you may notice your skin sagging. Hormonal changes can also cause your skin to become dry, your hair to thin, and brittle nails.

Weight gain: Fluctuating oestrogen levels may be partly to blame for weight gain during perimenopause, particularly around the abdomen area. According to the Mayo Clinic, menopausal women gain on average 1.5 pounds per year in their 50’s.

Mental symptoms

Mood swings: Perimenopause can cause mood swings, irritability, anger, depression, and anxiety. Hormonal changes and trouble sleeping can contribute to these issues. Also, how you feel about menopause may come into play. For example, distress about low libido or the end of fertility can contribute to depression during this time.

Memory and cognitive changes: Many women notice they have difficulty concentrating during the perimenopause. This is often called 'brain fog'. Sleep disturbances can also contribute to forgetfulness and a lack of mental clarity.

Sleep disturbances: It’s common to have difficulty falling or staying asleep due to hormonal changes, making you feel tired and irritable during the day. Night sweats or nocturnal hot flashes can also disturb your sleep during perimenopause.