What Are the 32 Symptoms of Perimenopause?

How do I know if my symptoms are indicating perimenopause?

Perimenopause is the transitional phase leading up to menopause. This phase typically starts in a woman’s 40s but can start as early as the mid-30s. It can last anywhere from a few months to over a decade, but understanding the range of symptoms associated with perimenopause can help you navigate this life stage with more ease and preparedness.

Underneath, we outline 32 perimenopause symptoms commonly experienced during the perimenopause period.

These symptoms are: 

1. Irregular PeriodsOne of the first signs of perimenopause is changes in menstrual cycle length and flow as ovulation becomes unpredictable. Periods may become lighter or heavier, and cycles may become shorter or longer.
2. Decreased FertilityAs ovulation is irregular, your ability to conceive decreases but mainly does not diminish completely until you are 12 months post your last period. .. As long as periods continue, you can possibly conceive however, if you wish to avoid pregnancy, take birth control until you have not had periods for a year.
3. Changes in LibidoSex drive may fluctuate, with most women experiencing a decrease or, less commonly, an increase.
4. Hot Flashes-Dysregulated temperature control Sudden temperature increases, often accompanied by sweating and a flushed face, are common during perimenopause. Some women feel that they can not tolerate any extremes of temperature, hot or cold, as well as before.
5. Night SweatsNight sweats occurring during the night can disrupt sleep independently from an inability to fall asleep or wake during the night. 
6. Sleep ProblemsMost women find that sleep is lighter and unstable during this transition. If women are stressed, that can make sleep even worse.
7. FatigueFeeling unusually tired or experiencing a lack of energy is a common symptom.
8. DizzinessFeeling lightheaded or dizzy can be a symptom.
9. Mood SwingsHormonal fluctuations and various other symptoms and factors of perimenopause can cause mood changes, including irritability, anxiety, and depression.
10. Weight ChangeShifts in hormone levels can contribute to weight gain, especially around the abdomen. A small percentage of women can lose weight during this transition, but unfortunately, this weight loss is usually attributed to muscle loss, which is unhealthy. Being a smoker is a big risk for muscle loss. 
11. Thinning HairHair may become thinner and less full during perimenopause due to hormonal changes.
12. Dry SkinLower oestrogen levels can lead to drier, less elastic skin.
13. Breast TendernessSome women may experience tenderness or pain in their breasts.
14. HeadachesHormonal fluctuations can trigger headaches or exacerbate existing headache conditions, such as migraines, especially menstrual migraines.
15. Tingling ExtremitiesSome women may experience a tingling sensation in their hands and feet.
16. Joint and Muscle AchesAnother common symptom is increased joint and muscle pain during perimenopause.
17. Memory Lapses
    Memory difficulties, particularly recalling or remembering words and names, often called “brain fog,” can occur.
18. Concentration ProblemsTrouble focusing or concentrating on tasks.
19. BloatingHormonal changes can lead to an increased bloating feeling and water retention.
20. Digestive IssuesSome women may experience changes in digestion and experience issues such as constipation or diarrhoea. Some women can develop transitory food intolerances.
21. Changes in TasteSome women report changes in their sense of taste during perimenopause.
22. AllergiesIncreased sensitivity to allergies or the development of new allergies can cause skin rashes.
23. Gum ProblemsDecreased oestrogen levels can lead to gum sensitivity. Oral hygiene is important at any age but should be reviewed at perimenopause. 
24. Muscle TensionIncreased muscle tension and soreness are common complaints of perimenopause.
25. Changing Cholesterol levels
    As oestrogen levels decline, blood cholesterol levels may also undergo unfavourable changes, which might increase the risk of heart disease. It should not be looked at in isolation. The other cardiovascular risks must be taken into consideration when commenting on increased cholesterol during perimenopause. 
26. Loss of Bone Mass As estrogen decreases, bone mass decreases. In different women, the speed of bone loss is different, depending on many other factors ( exercise, muscle mass, family history, smoking status, etc)
    

27. Heart PalpitationsHeart palpitations or a rapid heartbeat can occur.
28. Panic AttacksSome women experience panic attacks or increased anxiety during this transition.
29. Increased Urinary FrequencyMore frequent urination or urgency can occur due to changes in pelvic floor muscles, hormone levels, sexual activity, bowel opening patterns, exercise regimen, weight changes, anxiety, etc. 
30. Bladder Control IssuesSome women experience bladder control problems, including incontinence.
31. Increased Risk of UTIsHormonal changes can make urinary tract infections more likely.
32. Vaginal DrynessDecreased oestrogen levels can lead to vaginal dryness, making intercourse uncomfortable and increasing the risk of vaginal infections.

Managing Perimenopause Symptoms

While perimenopause is a natural part of ageing, managing its symptoms can improve your quality of life. Regardless of your decision to take HRT, lifestyle habits must be reviewed and often adjusted. Here are a few tips:

• A Healthy Diet: Eating a balanced diet rich in fruits, vegetables, and whole grains can help manage weight and provide essential nutrients. The Mediterranean diet is a good example of a healthy diet. Unfortunately, there is no one size fits all diet advice. It has to be tailored individually.
• Regular Exercise: Physical activity can alleviate many symptoms, including weight gain, mood swings, and joint pain. Three types of exercise are generally recommended during the perimenopause transition: aerobic, strength, and restorative. Ninety minutes of exercise a week is another general recommendation. 
• Hydration: Staying hydrated helps combat dry skin, vaginal dryness, brain clarity, kidney health, and overall wellbeing
• Stress Management: Practices like yoga, meditation, and deep breathing can help manage stress and improve sleep. Reviewing your relationships and boundaries is essential. Some women benefit from CBT (cognitive behavioural therapy), hypnotherapy, coaching or counselling.
• Medical Consultation: Your healthcare provider may recommend hormone replacement therapy (HRT) and/or other treatments to better manage perimenopause. There are many treatment options. It is not only a decision between HRT and nothing. The decision of what treatment option to try should always be tailored to your needs after thoroughly and carefully considering your current health and future health risks.  

If you are experiencing these symptoms and they are impacting your daily life, it’s important to consult a menopause-informed healthcare provider. They can offer guidance and treatment options tailored to your specific needs. Remember, you don’t have to navigate perimenopause alone—professional help is available.

About the author

Dr Ivana Matic-Stancin is a Melbourne-based medical doctor (GP) with over 25 years of clinical medical experience working with people of all ages, from various socio-economic, ethnic, and cultural backgrounds, and suffering from different medical conditions.

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