Symptoms of Peri-menopause

What is peri-menopause?

Peri-menopause is the term used to describe the phase prior to a woman’s last menstrual period.  During this time, hormonal changes result in decreased ovarian function.  The age of onset varies for each person, it can be associated with some characteristic but bothersome symptoms.

What are the symptoms of peri-menopause?

You may have a lot or a few.

Irregular periods and hot flashes are the most common symptoms, but women may also experience mood swings and difficulty sleeping.   Whether or not you have many symptoms or only a few, they can be entirely manageable.   Twenty  percent of women, however, have symptoms that affect their ability to function well at home or at work.  We’ll discuss some solutions later.  Here are the most common peri-menopausal symptoms:

  • Menstrual Irregularity — About one in 10 women stop having menstrual periods during peri-menopause.  The remaining 90% of women experience irregular periods.  These women have either cycles that are less than 28 days, skip one or several months, have spotting instead of a normal flow, or have fewer days of bleeding.   These changes occur due to inhibition of the pituitary hormones that help stabilize estrogen levels.   As a result, during some months, the ovaries don’t release an egg.   Progesterone levels, another hormone that is important for normal menstrual cycles, also decreases.  For some women, this may cause heavier bleeding.   Although spotting can be a sign of menopause, it could also be a sign of pregnancy or something serious.  You should see your doctor if you develop  spotting.  Blood clots in menstrual blood, however, are common, and usually not a cause for concern.
  • Poor Memory and Loss of Concentration — As we get older, there is a general reduction in the ability to recall things for both men and women. This is a normal part of aging, and not specifically a symptom of peri-menopause.  However, the lower levels of estrogen have been shown to promote brain inflammation which increases the risk of Alzeihmer’s and other neurocognitive diseases in women.  “Estrogen withdrawal” may be occurring if your short-term memory seems to have gotten a lot worse, or you can’t concentrate on a simple task for any length of time.   In addition, peri-menopausal night sweats and insomnia also decrease your ability to focus. 
  • Hot Flashes — About 85% of women experience vasomotor symptoms, otherwise known as hot flashes. Studies show they occur on average seven to 10 years, but become less severe over time.  A hot flash is a sensation of heat that begins in the face, head, or chest that lasts a few seconds up to an hour.  Most resolve after a few minutes.  The decline in estrogen causes the pituitary gland to releases bursts of the hormone FSH.   The increased FSH in the bloodstream dilates blood vessels, so the blood rushes through them in a “flash.”  Hot flashes may be accompanied by headaches, dizziness, and/or nausea. For most women, hot flashes occur less than once a day, but develop in a cluster, 10 to 30 minutes apart.   They are more common during the evening and at night when your pituitary gland is most active.
  • Night Sweats and Insomnia – Sweating often follows hot flashes.  At night, our bodies are warmer under the bed covers.  When nighttime hot flashes begin, we may be sound asleep, and unable to do anything to relieve the effect of the heat (such as drinking water or removing the bedding).  We are unaware of the hot flash until we’re soaked in sweat.  Frequent night sweats can result in sleep deprivation due to frequent waking.  You may repeatedly change your clothes, sheets, etc, causing you to lose sleep in the process.  In addition to such sleep interruptions, many women have difficulty falling asleep at bedtime, or experience restless leg symptoms. 
  • Mood Swings — Many peri-menopausal women have a feeling of being “on edge,” or less able to cope with everyday things.  These symptoms are caused by fluctuations in your hormone levels.  Some women feel depressed, irritable, and have crying spells.  These mood swings could also be a reaction to experiencing so many menopausal symptoms at once.  If you are feeling more than a little depressed or anxious, talk with your healthcare provider.  There are treatment options that may provide relief.
  • Vaginal Dryness/Infections — As estrogen levels decrease, occasional or frequent vaginal dryness may become a problem.  Low levels of estrogen cause the lining of the vagina to become thinner, the vaginal walls to become dryer and less elastic, and the size of the vagina to shorten.  You may experience itching, irritation, discharge, and sometimes bleeding.  Vaginal dryness can make intercourse uncomfortable, or even painful at times.  There are easy solutions to these problems which are discussed later.  Vaginal dryness may also lead to bacterial vaginosis or yeast infections, especially if you have a history of them.
  • Urinary Incontinence/Urinary Tract Infections — During perimenopause, it is common to develop a problem controlling urine.  You may find that, when you laugh, cough, or sneeze, a small amount of urine is released.  This occurs because the muscles around the bladder and urethra become weak because of less estrogen.  Also, childbearing causes the pelvis floor muscles which support the bladder to become weak, causing the bladder to drop out of place (prolapse).  As a result, any pressure on the bladder can cause urine to be released.   It is also possible to begin to have  frequent urinary tract infections.  Symptoms include more frequent, painful, or urgent needs to urinate.  Similar to the effects on the vagina, lower estrogen levels cause the walls of the urethra to become thinner, weaker, and more likely to develop an infection.
  • Migraines — Sometimes, fluctuating estrogen levels cause migraine headaches, especially if you had them prior to the onset of menstruation.  Anything that caused them previously (i.e. certain foods, poor sleep, and stress) may trigger one during peri-menopause.  When Hormone Replacement Therapy (HRT) is recommended to manage peri-menopausal symptoms,  the fluctuations in hormone levels can temporarily cause headaches.
  • Joint Aches and Back Pains — A constant dull backache and joint pain may be an issue during perimenopause. However, this is not disabling for most women.
  • Dry Skin, Wrinkles, and Itching — Our skin dries out and wrinkles as we age because of sun damage and loss of collagen.  Collagen is the protein that gives skin its elasticity and tone, and our bodies need estrogen to produce it. When our estrogen level drops, so does our collagen level, causing our skin to easily become dry and wrinkle.  A very small percentage of women experience persistent skin itching or tingling, similar to bugs crawling on the skin.

How long do symptoms of peri-menopause last?

Most women have symptoms for a year or two.

Your ovaries begin producing less consistent levels of estrogen once you are in your thirties.   Most women, however, develop peri-menopausal symptoms in their 40s.  From that point on, symptoms of estrogen withdrawal such as irregular periods, insomnia, and headaches may occur, even though full menopause may be more than ten years away.  Hot flashes may occur for two to 11 years.

What can I do about symptoms of menopause?

Start with the basics.

The general health tips listed below can have a positive effect on many of the symptoms of perimenopause.  You’ve probably heard them all before, but they are even more important now.  Following these tips can help relieve some of the bothersome symptoms of, and may make a significant difference in the quality of your life for the 20+ years after menopause.

  • Stop smoking — Smoking weakens your bones, dries out your skin, speeds up the aging process, and increases your risk for heart disease.  Also, it acts as a stimulant, so it may keep you awake at night.  It’s also known to increase and intensify hot flashes.
  • Avoid alcohol — The effects of alcohol increase with age, including an increased risk of breast cancer.  Alcohol not only is filled with empty calories (no nutritional value,) but can also cause sleep problems, headaches, and mood swings.
  • Consume less caffeine, salt, and concentrated carbohydrates — This will reduce the effects of stress on your body.  Caffeine is known to worsen hot flashes, and it can cause sleep problems and more frequent urination.  
  • Vitamin B6 or B12 –  Certain B vitamins have been found to help perimenopausal mood changes and cognitive functioning.  Your doctor may recommend taking Vitamin B6 or B12 as a preventative measure.
  • Eat right — Eating “right” has different meanings for peri-menopausal women.  It’s always good to eat less fat and more low-cholesterol, high-fiber foods.  As you age, you may need eat less food to maintain your ideal weight because your metabolic rate is slowing down.
  • Keep your skin moist — Drink 6-8 glasses of water a day, and avoid excessive sun exposure.
  • Increase your calcium intake — A major concern during menopause is preventing osteoporosis.  Lower estrogen levels promote bone loss.  If you are not getting enough calcium in your diet, your doctor will recommend a calcium supplement.
  • Exercise — Regular exercise is always good for you.  During perimenopause, xercise may help:
    • reduce hot flashes
    • you get better quality sleep (if you don’t exercise close to bedtime)
    • improve your overall health which boosts your mental outlook
    • reduce headaches
    • improve flexibility which can reduce joint aches and pains

Are there other things I can do to help?

Tips for special problems of perimenopause.

In addition to the health tips discussed above, here are some additional suggestions that may help reduce the symptoms of peri-menopause.

Hot Flashes

  • Watch your diet — Too much sugar, hot soups and beverages, and large meals can trigger hot flashes.
  • Keep cool — Find ways to keep cool:  drink cold beverages, take cold showers, lower the temperature in your home. Especially when you go to sleep at night, use lightweight bedding, wear cotton or other natural fabrics that “breathe,” and splash/spray cool water on your face and neck when you start feeling warm.
  • Reduce stress — Find ways to relax, and lower your stress levels.
  • Hormone Replacement Therapy (HRT) – If your hot flashes are particularly bothersome and there are no medical contraindications, you doctor may recommend estrogen or progesterone supplements.   This treatment is not recommended for women who have a history of breast cancer or blood clots.


  • Keep a regular sleep schedule — Wake up and go to bed at around the same time every day.
  • Having a soothing ritual — Take a warm bath (if it doesn’t trigger hot flashes), listen to music or relaxing sounds, read, meditate, or drink warm milk or herbal teas.  Find ways to make yourself drowsy, and ready for sleep.
  • Avoid certain types of over-the-counter medicines — Avoid medications that can affect your sleep such as nasal decongestants, antihistamines, and dietary aids that contain caffeine.
  • Melatonin supplements – Melatonin is released within the brain to help with sleep onset, but its levels are lower in perimenopausal women.  Speak to your doctor about whether or not a melatonin supplement may be helpful.

Vaginal Dryness/Infections

  • Lubricate — Ask your pharmacist or clinician to recommend an over-the-counter lubricant such as Astroglide, K-Y Jelly, or Replens.  Your doctor may prescribe an estrogen cream.
  • Prevent infections — Vaginal dryness can lead to itching, bacterial overgrowth, and yeast infections.  To help prevent these complications, wear cotton underwear, sleep without underwear, and avoid prolonged use of tampons.

Urinary Incontinence/Urinary Tract Infections

  • Kegel Exercises — These exercises, described below, are often suggested for new mothers to restore muscle tone following childbirth. “Doing Kegels” are equally helpful for women in peri-menopause.  Kegel exercises strengthen the pubococcygeal muscle which helps control the flow of urine and prevent urinary incontinence.
  • Medications — Your doctor may prescribe medications to help with bladder control.
  • Estrogen vaginal cream — Applying this cream into the vagina will improve the condition of the vaginal walls and the urethra.  This may help with problems of incontinence and infection.
  • Surgery — As a last resort, your doctor may suggest corrective surgery.

The Kegel Exercise

  1. While urinating, try to start and stop of the flow of urine by tightening your pelvic floor muscles, then release.
  2. Tighten (stop the flow) for 10 seconds, then release.  Repeat 10 times.
  3. Repeat 5 to 10 times a day, and when each time you urinate.

Make this a daily habit.  You can do Kegels anywhere.  Do them in the car at a stoplight, watching TV, or when you’re on the phone.  It may take a few months of Kegel exercises before the incontinence stops.  If you stop doing Kegels, your incontinence will probably return.

Leah Alexander, MD, FAAP

Dr. Alexander began her pediatric career at Elizabeth Pediatric Group of New Jersey in 2000, and has practiced at Pediatricare Associates of New Jersey since 2005. After graduating from Kalamazoo College and Michigan State University College of Human Medicine, she completed her pediatric training at Overlook and Morristown Memorial Hospitals. She is board certified in General Pediatrics. In addition to pediatrics, Dr. Alexander pursued her interest the culinary arts with study at the French Culinary
Institute. In 2007, she opened Global Palate, LLC, catering small group events for six years. Dr. Alexander has also been a professional writer and editor since 2018, engaging in a variety of medical editing and writing projects.