Perimenopause can bring more than hot flashes and irregular periods. From brain fog to heart palpitations, here are symptoms to know about and what may help.
The years leading up to menopause can bring a range of changes as your body’s hormone levels begin to drop. This period, known as perimenopause, can affect your sleep, mood, heart health and more.
Many women experience symptoms without realizing they’re in perimenopause. In fact, a recent study found that about 1 in 3 women 35 and older are unsure of their reproductive stage.1
Understanding the signs can be the first step toward getting relief. Here are 17 surprising perimenopause symptoms, plus treatment options that may help.
What is perimenopause?
Perimenopause is the stage before menopause. Menopause is a single point in time: It’s officially reached after 12 months in a row without a period.2 The average age this happens is 52.3
Perimenopause looks different for everyone, but there’s a general pattern:1,4
- Perimenopause usually begins in your mid-40s, though the age it starts can vary.
- The transition typically lasts 4 to 8 years.
- Women experience irregular periods as levels of hormones, including estrogen and progesterone, begin to decline.
- Fertility declines too, though pregnancy is still possible until you reach menopause.
The specific symptoms women experience can vary widely, however.1 The severity of these symptoms can vary, too: Some may interfere with your quality of life, while others may be mild. Many have treatment options that can help, so it’s important to share how you’re feeling with your healthcare provider.
How perimenopause can affect sleep
More than half of women experience sleep issues during perimenopause.5
1. Hot flashes and night sweats
A hot flash is a sudden feeling of heat in your face, neck and chest. It often lasts 1 to 5 minutes and can happen during the day or night.
When it happens while you sleep, it’s called a night sweat, and it can come with chills or shivering. Up to 80% of women have hot flashes at some point during this life stage.6 For some women, hot flashes may come and go for several years, even decades. 7
2. Insomnia
Hormone shifts can throw off your internal clock. That can make it hard to fall asleep, even when you’re tired.8
3. Disrupted sleep
Beyond night sweats, sleep can feel less restful during this stage. Falling asleep and staying asleep may both be difficult.2 Poor sleep can be linked to other symptoms, such as fatigue, brain fog and low mood.
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Perimenopause mood changes
Mood symptoms during perimenopause are often mistaken for stress or burnout, but hormone shifts can play a role.3 Symptoms can include:
4. Anxiety or depression
Changing hormone levels can bring on anxiety or depression, even in women who’ve never dealt with it before.6,9 For some women, this can include panic attacks.9
5. Brain fog
Perimenopause brain fog is common. Between 40% and 60% of midlife women report trouble with memory, focus or finding the right word.6
6. Irritability and mood swings
Irritability is one of the most common perimenopausal symptoms.8 Mood swings are also common.2 They’re often mistaken for everyday stress instead of a hormone-related shift.
Physical changes: Heart, metabolism and more
Perimenopause affects many parts of the body, from your heart to your joints.
7. Heart palpitations
Your heart may pound, flutter or skip a beat.8 While it’s usually not cause for concern, it’s worth mentioning to your healthcare provider.
8. Fatigue
Low estrogen can bring on fatigue that makes it hard to get through the day. Having sleep issues at night can make it worse.9
9. Weight gain
It’s common to gain weight or notice a shift in where you carry weight during this transition.8 Eating a healthy diet and exercising regularly can help. For women who are overweight, weight loss can reduce the risk of diabetes and help lower cholesterol.6
10. Digestive issues
You may experience GI issues, such as constipation or diarrhea, during perimenopause. Bloating can also become more noticeable.9
11. Joint pain
As many as half of all perimenopausal women experience joint pain.8 Estrogen helps protect your joints, so as levels drop, you may notice more aches or stiffness throughout your body.8
12. Headaches
Shifting hormone levels can trigger headaches, and if you’re already prone to migraines, they may get worse during this time.6,9
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How perimenopause affects your skin and hair
Declining hormones affect more than your reproductive system. It can also show up in your skin, hair and nails.9
13. Thinning hair and hair loss
Estrogen helps hair grow. As levels drop, hair can shed more, thin out or grow more slowly than before.
14. Dry and itchy skin
As estrogen declines, skin can become dry, flaky or more prone to itching.
15. Brittle nails
Nails may become more fragile and prone to breaking.
Perimenopause urinary and bladder issues
Declining estrogen levels cause vaginal tissues to thin. This can lead to dryness that can cause vaginal, sexual and urinary symptoms.4,8
16. Vaginal dryness
Estrogen helps keep vaginal tissue lubricated and flexible. As levels drop, dryness may make sex uncomfortable.
17. Urinary issues
Vaginal dryness is part of a broader shift called genitourinary syndrome of menopause, or GSM. As estrogen drops, it can also affect your bladder and urethra. That can mean more frequent urination or a higher risk of urinary tract infections.
How to get help
If perimenopause symptoms are affecting your quality of life, talk to a healthcare provider. Ideally, choose one trained in menopause care.10 A provider can rule out other causes and walk you through options that fit your symptoms and health history.
Common approaches include:
Hormone therapy
Hormone therapy is FDA-approved to treat hot flashes and related symptoms. It’s the most effective option for many women.11 It also carries some risks. Your healthcare provider can help you decide if it’s the right treatment for you.
Topical hormone treatment
Estrogen-based creams can help with symptoms of GSM and are one of the most commonly used methods of delivering menopause hormone therapy.12
Non-hormonal treatments
Depending on your symptoms, there are a range of options.13
Lifestyle changes. Diet, exercise and healthy sleep habits may help ease symptoms such as fatigue and weight changes.2
Mental health support. Mood symptoms are common during this stage. Speaking with a mental health professional can help you manage anxiety, irritability or low mood tied to this transition. Medications such as antidepressants may help, too.3
Targeted treatments
There are a range of methods commonly used to treat perimenopause symptoms. These include:2
- Non-hormonal medication for hot flashes
- Therapy for sleep issues
- Water-based lubricants for vaginal dryness
- Medicines to treat or help prevent osteoporosis
- Medicines for urinary incontinence
Bottom line: Perimenopause looks different for every woman, and no symptom is too small to mention. Talk to a healthcare provider about what you’re feeling so you can find relief that fits your needs.
Interested in health support that fits your life stage? Connect with a licensed insurance agent at 844-537-0707 to learn about your telehealth subscription (non-insurance) options.
Frequently asked questions
What’s the difference between perimenopause and menopause?
Perimenopause is the stage before menopause. During this time, hormone levels shift and periods become irregular.2 Menopause is a single point in time. You reach menopause once you’ve gone 12 months in a row without a period.2
How is perimenopause diagnosed?
Your doctor looks at your age, symptoms and changes in your period. They may also run bloodwork to rule out other conditions, like thyroid issues, that can cause similar symptoms.
Can you still get pregnant during perimenopause?
Yes. Ovulation can still happen during perimenopause, even if it’s irregular. That means pregnancy is possible until you reach menopause.14 If you don’t want to get pregnant, keep using birth control until your doctor confirms you’ve reached menopause.
At what age does perimenopause usually start, and how long does it last?
Perimenopause typically starts in your 40s.1 It usually lasts 4 to 8 years before you reach menopause.1 The exact timing varies from person to person.
Does perimenopause affect sex drive or cause vaginal dryness?
Yes. As estrogen drops, vaginal tissue can become thinner and drier.4 That can cause discomfort during sex or cause urinary issues. Some women also notice a lower sex drive.8 Vaginal moisturizers, lubricants or vaginal estrogen therapy are common treatment options.3
For informational purposes only. This information is compiled by HealthMarkets Insurance Agency and does not diagnose problems or recommend specific treatment. Services and medical technologies referenced herein may not be covered under your plan. Please consult directly with your primary care physician if you need medical advice.
