As part of WHA’s new menopause series, we’re taking a closer look at this critical part of women’s lives. Read more about knowing and coping with the earliest signs of perimenopause, hormone replacement therapy and more.

Despite the significance and commonality of the transitional period of perimenopause, in terms of medical research and societal understanding, it’s really more of a gaping hole.

For most of our lives, female sex hormones (and their fluctuations) are linked to childbearing. But women are more than their ability to get pregnant, and hormones affect more than just our monthly cycles. For those with ovaries, hormonal changes mark life’s major transitions. During these times our bodies and brains shift in preparation for the next phase–and that shift can come with varying degrees of disruption and discomfort.

Beginning typically in the early- to mid-40s, perimenopause is the transitional period leading up to menopause when sex hormone production begins to decline, while menopause is marked by one year without a period. The symptoms of perimenopause are vast, can be disruptive, individual, and can affect the whole body, including our brains.

The medical community relates a whopping 34 symptoms to perimenopause. So it’s no wonder so many people are confused about whether what they’re experiencing is actually perimenopause or a sign of something else–including simply aging and the normal stressors of life (fatigue, anyone?), which can be more justifiably put off or dismissed altogether. There’s a lack of awareness among patients and large parts of the medical community alike.

What causes perimenopause symptoms?

Hormones and how they interact with various bodily systems are the underlying cause of all perimenopause and menopause symptoms. These potent, powerful chemical messengers affect just about every process in our body, from development and reproduction to metabolism and mood—and many other critical functions.

For people with ovaries, the sex hormones estrogen and progesterone do a lot of the heavy lifting. Yes, they control ovulation. But their balance (or imbalance) also plays the most major role in perimenopause symptoms; estrogen, in particular, plummets during this stage.

Because of the impact declining levels of these hormones can have, hormone replacement therapy (HRT) is a known option to help treat the symptoms of perimenopause and menopause. HRT works by replenishing estrogen and progesterone, which typically reduces the severity of several of the most common and disruptive symptoms.

For many, HRT can make life much more bearable. But that doesn’t mean everyone wants to do it or is a candidate for it. It can depend on which symptoms are most bothersome to you, and where you are in the years leading up to or following menopause.

You can read more about HRT in our article here, but let’s take a closer look at what’s happening in terms of symptoms.

Stages of perimenopause and menopause symptoms

The first signs of perimenopause are typically changes in your menstrual cycle. That might mean they become shorter or longer, or the flow is heavier or lighter. Super easy to distinguish, right? Yeah, not so much. This is why keeping track of your cycles can be helpful. When a pattern of chaos emerges, speak with your provider.

Also, with that initial drop in estrogen, hot flashes and night sweats are common first signs of perimenopause, often occurring right before periods. Mood changes, sleep disturbances and vaginal dryness may soon follow. There is no linear process, which adds to the confusion. All of these occur because the body is working to adjust to the hormonal shifts and recalibrate to a new normal.

Imagine the body as operating one way since puberty. It has the same tools and knows exactly what to do with them. Then, a few tools disappear (or in this case, drop in potency) and it needs to figure out how to operate without them.

How one person’s body reacts compared to another is also notably different. So while we think we know the gamut of perimenopause symptoms, we can’t predict which ones each person will experience exactly when or to what degree. But we do know which are commonly associated with this time.

The 34 symptoms of perimenopause/menopause

Perimenopause symptoms fall across three categories: neuroendocrine (nerve and brain function), physical and vulvovaginal.

Neuroendocrine symptoms of perimenopause

  • Changes in mood
  • Irritability
  • Insomnia
  • Difficulty concentrating
  • Brain fog
  • Anxiety
  • Depression
  • Panic attacks
  • Decreased libido (sex drive)

Physical symptoms of perimenopause

  • Night sweats
  • Hot flashes
  • Irregular periods
  • Breast tenderness
  • Headaches
  • Weight gain
  • Bloating
  • Digestive problems
  • Joint pain
  • Muscle tension
  • Decreased muscle strength/mass
  • Dizziness
  • Changes in taste
  • Burning mouth sensation
  • Heart palpitations
  • Body odor
  • Hair loss
  • Brittle nails
  • Itchy skin
  • Tinnitus
  • Bleeding gums
  • Tingling extremities
  • Electric shocks

Vulvovaginal symptoms of perimenopause

Outside of HRT, similar management approaches, whether with medical assistance or natural remedies, can help relieve multiple symptoms. For instance:

  • Regular movement and a nutritious diet can mitigate (to a degree) both neuroendocrine and physical symptoms.
  • Alcohol intake can specifically make night sweats, insomnia, anxiety, and weight gain worse.
  • Cognitive-behavioral therapy and selective serotonin reuptake inhibitors (SSRIs) can help with mood changes.
  • Meditation, deep breathing and even hypnosis can reduce stress and the severity of symptoms.

Simply having a positive mindset and being curious about the transition has actually been shown to help reduce symptoms. This is easier said than done!

In terms of how long symptoms last, there’s really no way of knowing. Some people have perimenopause for four years and some for 10. But every person deserves to know the options available to help relieve their perimenopause symptoms, no matter which you experience or how “bad” someone else deems them to be. You are the sole judge of that.

When to see a doctor for menopause symptoms

Because of the individual variations in perimenopause, confirming a “diagnosis” in the medical sense can be difficult–and to be honest, not all that important. The moment you feel your symptoms warrant a discussion—which is probably sooner than your self-doubt will let you act on them—is when you should make an appointment to speak with a provider. This could be your regular OBGYN or nurse-midwife, or another clinician with knowledge and experience helping people through the menopause transition.

When you find the right provider, this discussion should help validate your experience and provide you with options. In addition to sharing everything you’re experiencing, providers especially want to know about hot flashes, night sweats and sleep disturbances. The first two have potential links to worsened cardiovascular outcomes long-term, whereas lack of sleep can make our daily routine that much harder because it’s so crucial to our overall health and happiness.

Knowing these symptoms may empower you with knowledge; or, it may overwhelm you with dread. There’s no “right” approach or “right” answer. For all of us with ovaries, there is no escaping the reality of perimenopause; it’s part of life. And since the world is just now beginning to acknowledge the historical absence of women in medical research, it’s even more important to find a provider who will be with you on this journey.