The term "perimenopause" means around menopause, referring to the time a woman's body undergoes the natural transition to menopause, hence its other name, the menopausal transition. Menopause denotes the end of the reproductive years, and women go through perimenopause at different ages. They may experience signs of advancement toward menopause, such as menstrual irregularity, around the age of 40s, which may also happen as early as their mid-30s. 

As your body undergoes the perimenopausal period, it experiences fluctuations in the level of oestrogen, a primary hormone in women. Your menstrual cycles may come longer or shorter, and you may start to have menstrual cycles where your ovaries don't release an egg (ovulate). You may also experience symptoms that characterise menopause, such as vaginal dryness, sleep issues, and hot flashes. There are treatments available to help ease these symptoms. You may also take a perimenopause test to measure your hormone levels.

The perimenopause period is over once you do not experience menstruation for 12 consecutive months, which means you've officially arrived at menopause.

What are the symptoms of perimenopause?

These hormonal changes result in a wide range of symptoms. Below is a list to help you identify and track your symptoms of perimenopause and menopause.

Physical symptoms

• Allergies. Hormones are associated with your immune system, allowing some allergies to develop despite not having a history of previous allergies. Common allergies may include hay fever, eczema, asthma, and food allergies.

• Bloating. While bloating is a shared experience, especially around menstruation, constant bloating also occurs during perimenopause as one of the initial signs that you are entering this period.

• Body odour. There may be a significant increase in sweat due to hot flashes and a change in your body odour due to hormonal changes.

• Bone fractures. People with weaker bones due to age are prone to osteoporosis, commonly diagnosed through a bone density scan. Osteoporosis is a condition where bones decrease their density, a change directly associated with a loss of oestrogen. There are no symptoms unless bones break.

• Breast soreness. Breast soreness during menopause is similar to that experienced during a menstrual period or pregnancy when hormone levels also fluctuate. 

• Brittle nails. Your nails begin to snap, break, or flake more often than usual.

• Burning mouth. Burning mouth syndrome is characterised by sensations of hotness, burning, tingling and pain with other strange sensations with no apparent signs of damage or injury.

• Decrease in libido. Your desire for sexual activities gradually declines. Sex during this time may be less pleasurable with fewer orgasms and may sometimes be painful due to vaginal symptoms like vaginal dryness. Loss of sexual desire is extremely common, but not many people talk about it. It is also linked to other menopausal symptoms such as anxiety, low mood, and mood swings.

• Dry, itchy skin. The protein collagen keeps our skin healthy. Its decrease during age for perimenopausal may lead to drier, itchier skin.

• Dizziness. Changes to the cardiovascular system or nervous system, low oestrogen, increased anxiety, swings in blood sugar, and other factors can cause dizziness and light-headedness.

• Gum and dental problems. Bone health can impact your jawbone, resulting in tooth movement and even tooth loss. Less severe oral issues include receding gums, bleeding gums, and bad breath.

• Joint pain. This is a broad symptom resulting from loss of oestrogen. Low oestrogen levels can impact joints and the connective tissue that 'glues' the skeleton together, resulting in muscle aches, pains and stiffness. The pain may vary from mild aching in your joints to severe joint pain, signalling the beginnings of arthritis in some cases.

• Hair changes. Your hair can thin out all over or from the sides or crown. The condition can also trigger hair to become brittle and make new hairs finer. Stress, diet, and lifestyle are all factors of hair loss in midlife and hormonal changes. 

• Headaches. Hormone fluctuations and other symptoms like lack of sleep, stress, and mood changes can trigger headaches. Beware of the changes in the intensity and frequency of headaches and (or) migraines.

• Heart palpitations. During menopause, it's common to notice heart palpitations or irregular heartbeats, which can feel like a pounding or fluttering in the chest. This is normal, but it's always worth consulting a doctor. Heart palpitations may occur from a few seconds to a minute, often coinciding with a hot flash.

• Hot flashes. It is the most popular menopausal symptom. A hot flash can abruptly start and is often described as a sudden feeling of heat and redness that escalate quickly throughout the body, which can be apparent on the face and neck.

• Irregular periods. Irregular periods are those that are either heavier, lighter, more frequent, or less frequent than your usual period. Periods can become irregular in perimenopause, completely stopping during menopause.

• Muscle tension and restless leg. Muscle tension makes your muscles feel tight and sore from the tension, commonly occurring in the neck, back or shoulders. Increased stress levels can worsen the tension. Achy, restless legs are most commonly experienced at night, making it difficult to fall asleep.

• Nausea and digestive issues. These noticeable symptoms of hormonal changes can make you feel like you have sickness, diarrhoea, bloating, indigestion, and cramping.

• Night sweats. Night sweats refer to the hot flashes that you experience during the night. They can occur without daytime flashes. Waking up in heavy sweat, with soaking night clothes and sheets, can negatively affect sleep, contributing to stress and anxiety.

• Tingling extremities. You commonly feel this symptom in your legs, arms, feet, and hands, possibly signifying perimenopause and menopause.

• Urinary symptoms. When your pelvic floor muscles weaken, your bladder can also lose strength. Bladder issues often include leaking, getting up at night, and more frequent passing of urine.

• Vaginal atrophy. This painful and debilitating symptom can make you feel sore or itchy due to reduced vaginal discharge and lubrication, ranging from mild to moderate. As its severity increases, you may have a burning sensation, which makes having sex, wearing tight clothes, or being as active as you usually would impossible.

• Weight gain. Our individual lifestyles and genetics cause us to gain weight as we age. You gain weight around your abdomen during perimenopause and menopause when women are prone to comfortable eating and decreased activity associated with other menopausal symptoms such as low mood, fatigue, and anxiety.

Emotional and mental symptoms

• Anxiety and low self-esteem. It is a common symptom that makes you feel tense, stressed, or fearful. It can trigger physical symptoms, like palpitations, and can worsen symptoms, like hot flashes. Anxiety can involve panic and consistent overthinking of situations. Sometimes, anxiety, accompanied by some of the other menopausal symptoms, can also lead to a feeling of low confidence.

• Depression. Depression can refer to feeling sad and low and generally losing interest in your usual hobbies or interests. It's a common and under-recognised symptom of perimenopause and menopause. Affected women can experience it to varying degrees of intensity and duration. You may cry more often than usual and prefer to stay at home rather than socialising with friends and family. 

• Difficulty sleeping. Sleep issues are common and are often due to ageing. Poor sleep may be associated with hormone changes, but physical symptoms, like hot flashes, mood changes, and stress, can contribute too. It may be more challenging to get to sleep at night or make you wake up more frequently through the night, too, leading to disturbed sleep patterns. 

• Forgetfulness. Many women experience feelings of 'brain fuzziness' during perimenopause and menopause. Finding the right words during a conversation or remembering seemingly simple things can become more challenging. Memory lapses are a common source of stress, worry, and frustration, which low oestrogen levels in the brain trigger. Mood changes, poor sleep, and stress can also contribute.

• Irritability. Menopausal irritability causes you to become more impatient and more easily annoyed than usual. Increased irritability is also closely associated with other menopausal symptoms, such as stress and difficulty sleeping.

• Mood swings. Hormone swings, along with the mental and physical symptoms of menopause, can all bring about changes in mood. Women who still have periods may notice premenstrual syndrome gets worse.

• Poor concentration. Difficulty concentrating is common and can arise due to the direct influence of low oestrogen on the function of the brain. It can be related to low mood, anxiety, stress and fatigue. This symptom makes it harder for you to regain concentration or focus on the task.  

• Tired or lack of energy. Hormonal changes of menopause can cause extreme tiredness and fatigue. It can be harder to sleep at night, even without hot flashes and night sweats. It can be aggravated by other menopausal symptoms such as low mood, night sweats, and difficulty sleeping.

When to see a doctor

Perimenopausal symptoms may demand medical attention for some women, while symptoms are either tolerable or mild enough not to need much attention for others. Because symptoms may be subtle and appear gradually, it may not be obvious at first that they're all related to hormone fluctuations as part of the menopausal transition.

If you experience bothersome symptoms that affect your daily life or well-being negatively, such as hot flashes or changes in mood and sexual function that trouble you, it may help to consult your doctor.

Why does perimenopause occur?

As you go through perimenopause, the level of oestrogen and progesterone in your body fluctuates. Decreasing oestrogen is the primary cause of the many changes you experience during this period.

Risk factors for earlier perimenopause

Although menopause is a normal phase in a woman's life, some may have it earlier than others. According to several journals, certain factors may make you start perimenopause earlier, including:

• Cancer treatment. Early menopause can be due to pelvic radiation therapy or chemotherapy as treatments for cancer.

• Family history. If you have a family member or history of having an early menopause, you may also experience early menopause.

• Hysterectomy. A hysterectomy is a surgical procedure of removing your uterus for specific reasons. It does not remove your ovaries and doesn't cause menopause. Although periods no longer occur, your ovaries still produce oestrogen. However, such surgery may cause menopause to occur earlier than average. And if you have one ovary removed, the intact ovary might stop working sooner than expected.

• Smoking. Compared to non-smoker women, those who smoke are most likely to have the onset of their menopause occur 1 to 2 years earlier.

Complications

Irregular periods strongly indicate perimenopause. This is normal for women and is usually not a cause of concern. However, consult your doctor if you experience:

• Extremely heavy bleeding, whereby you're changing pads or tampons every hour or two

• Bleeding that lasts longer than seven days

• Bleeding that occurs between periods

• Periods that regularly occur less than 21 days apart

Signs like these may denote a reproductive system issue requiring medical diagnosis and treatment.

What can I do with perimenopausal symptoms?

As a woman, you will experience symptoms related to perimenopause at some point. As it is a normal phase, you cannot dictate your body to go through or not go through these changes. However, you can find ways to manage the symptoms, such as by:

• Moving your body. Staying active and eating healthy foods seem not to be absent for making a lot of things easier, such as during the phase of perimenopause. Aim for 30-60 minutes each day of aerobic and strength training exercises five days a week. This will also help decrease the raised risk of osteoporosis that accompanies menopause.

• Into a healthy diet. Nutrition in the form of whole foods will help keep blood sugars level. Quality protein, fruits, vegetables, complex carbohydrates, and good fats can help you attain a healthy diet and its benefits. Eliminating or reducing intake of caffeine, alcohol, and sugar may also help alleviate symptoms. This can help fight fatigue, belly bloat, and weight gain and stabilise moods. 

• Resorting to medications. Some doctors will recommend drug therapy to treat symptoms, including antidepressants, hormone replacement therapy, and vaginal oestrogen.

Furthermore, the following tips can help manage specific symptoms:

• Alleviating hot flushes. Hot flushes are generally managed conservatively by dressing in layers, using personal fans, and avoiding irritants like spicy foods. But when symptoms get moderate to severe, consider seeking medication.

• Sleeping better. Treating hot flushes can help relieve some of these sleep disturbances and offer you sweet dreams.

• Using lube. Using personal lubricants may help, although these issues often require oestrogen therapy which is usually limited to vaginal oestrogen replacement.

Final words

The perimenopausal period occurs just before menopause when the ovaries begin to produce fewer eggs. Symptoms of this natural process manifest in the body and the mind. Treatment is not required but may help manage symptoms. Hormone replacement, perimenopause test, antidepressants, and behavioural modification are all part of the treatment plan.

There is a good chance that many women who have lesser symptoms may be able to manage any pain without the involvement of a medical professional. But if you cannot get relief, it may be time to visit your doctor to discuss other options. To learn more about perimenopause symptoms, click this link.

Learn more about the signs of perimenopause ending or the signs, symptoms and treatments of menopause here at Welzo!