First Signs Of Perimenopause In Women

If you thought hormonal ups and downs ended in your teenage years, think again! Perimenopause, the time leading up to your final menstrual cycle and the start of menopause, can also be a hormonal roller coaster.

But don’t despair. While it’s true perimenopause symptoms can be unpleasant, it doesn’t have to control your life. There are steps you can take to feel your best during this time in your life.

What Is Perimenopause?

During and around menopause, the production of the female hormone estrogen declines. Perimenopause is the time immediately before menopause. 

“Perimenopause is the transition that occurs between a woman’s reproductive years and menopause, usually starting seven to ten years before the final period,” explained Jean Miller, NP, at Franciscan Physician Network Winfield Health Center. “It’s important to remember that while this is a natural process, it’s also one that varies for each woman, with some noticing little change and others experiencing more significant symptoms.”

In the last one or two years of perimenopause, the drop in estrogen speeds up, and women experience menopause symptoms while still having a period. 

What Are The Stages Of Menopause?

After puberty, there are three other phases of female fertility:

• Pre-menopause: Women have full ovarian function and regularly produce estrogen and ovulate.
• Perimenopause: The ovaries begin to fluctuate in their ovulation and production of estrogen, which can result in unpredictable menstrual cycles and symptoms.
• Menopause: The ovaries have shut down. You are in menopause after 12 months without a period.

When Does Perimenopause Start?

The average age of menopause is 51, and perimenopausal symptoms typically begin about four years before your final period. Most women start to notice perimenopause symptoms in their 40s, but some notice changes as early as their mid-30s. For others, it can happen later.

You may experience subtle changes in menstrual cycle length, duration and flow even before perimenopause. This is when your fertility begins to decline and hormone patterns start to fluctuate.

For some women, perimenopausal symptoms may start earlier, especially if they’ve had cancer treatment (chemotherapy or pelvic radiation) or smoke. Smokers generally reach menopause two or three years earlier than nonsmokers.

What’s The First Sign Of Perimenopause?

The first sign of perimenopause typically is a disruption of your menstrual cycle.

“The first symptom that women usually experience is changes in their monthly periods,” said Miller. “So, their periods become more irregular, meaning that the number of days between their periods either becomes shorter or longer by seven days or more. The bleeding with their periods may become heavier or lighter, last longer or stop earlier than expected. And this can vary from month to month.”

But once that starts to change, you begin to experience some of the other more common perimenopause symptoms.

Perimenopausal symptoms are a natural part of the aging process. But some medications, cancer treatments and ovary surgery can speed up the process or cause menopause sooner. Kourtney Morris, MD, a Franciscan Physician Network Obstetrics & Gynecology in Lafayette, Indiana, said, “For some women, perimenopause is barely noticeable, but for others, the symptoms make them miserable.”

What Are Perimenopause Symptoms?

Perimenopause comes with a wide variety of symptoms. According to Miller, “Perimenopause is a time of hormonal turbulence, with estrogen levels fluctuating greatly.”

Less estrogen leads to symptoms that can affect physical and emotional health.

“We also know estrogen receptors exist in all different organ systems in the body. So, the symptoms not only vary but also affect different areas of the body.”

About 80 percent of women will experience some form of a hot flash. Hot flashes happen when your brain has trouble regulating your internal temperature, which is a common response to having less estrogen. The shift in temperature may not be noticeable. Or, it may feel like someone cranked up the thermostat on your core body temperature. You suddenly feel uncomfortably hot and sweaty or may wake up drenched in sweat (night sweats).

Other symptoms of perimenopause include: 

• Bladder incontinence
• Fatigue
• Lower libido
• Memory struggles or brain fog
• Mood swings, including irritability, panic attacks and anxiety
• Night sweats
• Thinning hair
• Trouble sleeping
• Urinary tract infections (UTIs) or frequent vaginal infections
• Vaginal dryness

You may also experience symptoms like increased joint pain, muscle aches, changes in skin elasticity, dryness and weight gain. Miller said that changes in body composition, including weight gain and muscle mass loss, are common complaints during perimenopause.

Some women in perimenopause complain they just don’t feel like themselves.

“We know that hormone fluctuations cause mood changes,” said Miller. “We see it with PMS, in pregnancy, in the postpartum period, and those are all times of extreme hormonal change. We also know that there can be dysregulations in the mood because of hormones, so things like premenstrual dysphoric disorder, postpartum anxiety and depression.”

During perimenopause, you may lose pleasure in activities that you’ve enjoyed in the past. You may have a tough time feeling motivated to do things and have difficulty functioning because of your symptoms.

“It’s important for women to monitor these symptoms and understand how it’s affecting their quality of life,” said Miller. “If it’s making their life unmanageable, it’s really important for them to talk to their women’s healthcare provider about the treatment options .”

What Causes Perimenopause Symptoms?

Your ovaries have been making estrogen since your first period. During perimenopause, the ovaries’ production of estrogen decreases substantially, though not in a steady manner.

“Instead, it’s a turbulent time for hormones, with spikes and fluctuations that contribute to the symptoms women experience,” Miller explained.

Perimenopausal symptoms are entirely normal, but it’s a good idea to see a doctor at this point to rule out other causes for these changes. Heavy or unexpected bleeding can be a sign of fibroids or uterine cancer. Night sweats and a racing heartbeat may signify a thyroid disorder.

Can A Blood Test Diagnose Perimenopause?

The most reliable blood test for perimenopause looks for high levels of follicle-stimulating hormone (FSH) released by the pituitary gland in response to declining estrogen stores. However, if you take birth control pills, you’ll need to stop taking them temporarily to get accurate results.

Typically, perimenopause is a gradual transition, and no particular test indicates what is happening to the body. Identify what symptoms bother you most, then work with your provider to address them. There are steps you can take to feel better.

How Can I Treat Perimenopause Symptoms?

For some women, perimenopausal symptoms are manageable without treatment, but others seek help to address specific health concerns. The treatments are not a one-size-fits-all approach.

Your gynecologist can help develop a treatment plan to tackle perimenopause symptoms, like:

• Erratic bleeding: Hormonal medications can create a predictable menstrual cycle.
• Depression: A low-dose antidepressant can improve a mood disorder.
• Irritability: An exercise plan can improve mood.

Medications

Hormone therapy, vaginal estrogen treatments and antidepressants are common treatments for perimenopausal symptoms.

“The most effective treatment we have is hormone therapy (HT),” explained Miller. “HT helps address declining hormone levels with a combination of estrogen, progesterone and sometimes testosterone.” 

She said that HRT does have risks, particularly for women after menopause. However, newer studies suggest that the risks are lower than previously thought, especially when hormone therapy is given during perimenopause.

“Non-hormonal options, such as medications typically used for anxiety and depression, have proven effective for hot flashes and mood changes,” Miller said. “Another option targets hot flashes by regulating temperature control in the brain.”

Talk to your provider about which options may be right for you.

Lifestyle Changes

In addition to medications, lifestyle changes can make a significant impact on easing perimenopausal symptoms and improving overall health. Miller recommended:

• Yoga: Helps reduce stress, improve flexibility and promote better sleep.
• Regular exercise: Increased activity levels can reduce stress, manage weight and improve mood.
• Meditation: Mindfulness practices like meditation help reduce anxiety and promote relaxation.
• Lose weight if needed: A healthy weight can help reduce the risk of perimenopausal symptoms and improve overall wellbeing.
• Develop a sleep routine: Wake up at the same time every morning, avoid naps and decrease caffeine to help optimize sleep patterns.
• Dietary changes: Reduce caffeine and processed sugars to help balance hormones and avoid unwanted weight gain.
• Stress reduction techniques: Grounding, which involves using your hands and feet to touch natural surfaces, can help lower stress levels. Therapy and counseling are valuable tools for managing emotional challenges during perimenopause.

But sometimes, what comforts you most is knowing that you’re not alone — and that your perimenopausal symptoms don’t take away your vitality. Your body is moving toward not having babies anymore. It’s completely normal and natural. You’re just preparing for the next stage in life.