Symptoms of Peri-menopause

What are the symptoms of peri-menopause?

You may have a lot or a few.

Besides irregular periods and hot flashes, there are several other symptoms. You may have many of them or only a few. They may be entirely manageable. Or, you may be one of the 20 percent of women whose symptoms are severe enough that you can’t function well at home or at work without help. We’ll talk about some solutions later. Here are the most common symptoms:

  • Menstrual Irregularity — During perimenopause, periods will stop com-pletely for about one in ten women. The remaining 90% of women will have irregular periods. Their periods are irregular because some months they won’t ovulate. Their periods may become heavier, lighter, shorter, longer, closer together (14 days in between) or farther apart (56 days in between). Progesterone levels, like estrogen levels, are also decreasing. Decreasing -progesterone levels can cause heavier bleeding. Spotting is also a sign of menopause, but it could also be a sign of pregnancy or something serious. You should see your doctor if you are spotting. Blood clots in menstrual blood are common and should not be a cause for alarm.
  • Poor Memory and Loss of Concentration — As we get older, there is a general slowdown in how quickly men and women can recall information. This is normal and is not a symptom of perimenopause. But, 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, you may be having symptoms of estrogen withdrawal. In addition, if you are also having night sweats and insomnia, your ability to concentrate will be affected even more.
  • Night Sweats and Insomnia — Sweating often follows hot flashes. When it happens at night, our bodies are warmer under the covers. When the hot flash begins, we may be sound asleep and unable to do anything to relieve the effect of the heat (such as drinking water or getting out from under the covers) until we’re soaked in sweat. If you have night sweats often enough, it can lead to real sleep deprivation because you are continually changing bed clothes, sheets, etc. and losing sleep in the process.
  • Mood Swings — Many women in perimenopause have a feeling of being on edge or less able to cope with things than before. These symptoms can be a result of fluctuations in your hormone levels. A few women are depressed, irritable, and have crying spells. These mood swings may be the result of varying hormone levels. It could also be a reaction to having so many menopausal symptoms at once. If you are feeling more than a little depressed or anxious, talk with your health care team. There are treatment options that can give you relief.
  • Hot Flashes — About 85% of us will have hot flashes. They may continue for up to two years. If they last longer than that, they are usually less severe. A hot flash is a sensation of heat that begins in the face, head, or chest and can last from a few seconds to an hour — most last a few minutes. The decline in estrogen affects the pituitary gland, which releases bursts of hormones. These bursts of hormones help expand the blood vessels, so the blood rushes through them in a “flash.” Hot flashes may be accompanied by headaches, dizziness, and/or nausea. Most of the time, hot flashes happen less than once a day but they can happen one right after the other, 10 to 30 minutes apart. They occur more often in the evening and at night when your pituitary gland is most active.
  • 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 thin, the walls to become dryer and less elastic, and the vagina to possibly shorten. You may have itching, irritation, discharge, and sometimes bleeding. Vaginal dryness can cause intercourse to become uncomfortable, even painful at times. There are easy solutions to these problems, which we discuss later.  Vaginal dryness may also lead to more minor vaginal infections, especially if you are prone to having them.
  • Urinary Incontinence/Urinary Tract Infections — During perimenopause, it’s not unusual to have a problem controlling urine. You may find that when you laugh, cough, or sneeze, a small amount of urine is released. This happens because the muscles around the bladder and urethra become weak. Also, repeated childbearing or loss of estrogen causes the vaginal wall, which supports the bladder, to become weak, causing the bladder to drop out of place. Then pressure on the bladder can cause a loss of urine.A second problem is having more frequent urinary tract infections with symptoms of more frequent, painful, or urgent needs to urinate. The lower estrogen levels can cause the walls of the urethra to become thinner, weaker, and more likely to develop infection.
  • Headaches — Sometimes, fluctuating estrogen levels cause headaches, especially if you have had premenstrual migraines. Anything that may have brought on a migraine before — certain foods, alcohol, poor sleep, stress — may trigger one now. When Hormone Replacement Therapy (HRT) is first begun, hormone levels can be affected, temporarily causing headaches.
  • Joint Aches and Back Pains — A constant dull backache and some pain in your joints may be a problem during perimenopause. However, it doesn’t seem to be a big problem 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 it’s elasticity and tone. Our bodies need estrogen to produce collagen. When our estrogen level drops, so does our collagen level, and our skin begins to dry and wrinkle. Persistent itchiness or tingling, somewhat like bugs crawling on your skin, is a symptom that affects a very small percentage of women.

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 when you are in your thirties. From that point on, you may begin having some symptoms of estrogen withdrawal (for example, irregular periods, insomnia, headaches, etc.), even though full menopause may be more than ten years away. Hot flashes may continue for up to five years for less than a quarter of women. However, most women experience the major symptoms for only a year or two.

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 menopause and may make a significant difference in the quality of your life for the 20+ years following 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 up at night. And it’s known to increase and intensify hot flashes.
  • Avoid alcohol — The effects of alcohol increase with age. Alcohol not only is filled with empty calories (no nutrition) 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. Stress can sometimes make hot flashes worse. Caffeine can cause sleep problems. Your doctor may recommend taking Vitamin B6 once or twice a day as a preventative measure.
  • Eat right — Eating right means different things at different ages. It’s always good to eat less fat and more low-cholesterol and high-fiber foods. As you age, you may have to eat less food to maintain your ideal weight because your metabolism rate is slowing down.
  • Keep your skin moist — Drink 6-8 glasses of water a day and avoid the sun.
  • Increase your calcium — A major concern during menopause is preventing osteoporosis. If you are not getting enough calcium in your diet, your doctor will probably recommend a calcium supplement.
  • Exercise — Regular exercise is always good for you. During perimenopause, it can help you in several ways — exercise may help:
    • reduce hot flashes
    • you get to sleep and stay asleep (if you don’t exercise close to bedtime)
    • improve your general health which helps your mental outlook
    • reduce the incidence of 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 health tips we’ve already mentioned, here are some additional suggestions that may help with the symptoms of perimenopause.

Hot Flashes

  • Watch your diet — Too much sugar, hot soups and drinks, 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 house (especially when you go to sleep at night), sleep with light covers, wear cotton or other natural fabrics that “breathe,” splash/spray cool water on your face and neck when you start feeling warm.
  • Reduce stress — Find ways to relax more and lower your stress levels.


  • Keep a regular 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 in you), listen to music or relaxation tapes, read, meditate, 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 medicines which affect your sleep such as nasal decongestants, antihistamines, and diet aids.

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 growth, and infection. To help prevent vaginal infections — wear cotton panties, sleep without underwear, and avoid prolonged use of tampons.

Urinary Incontinence/Urinary Tract Infections

  • Kegel Exercises — These exercises, described after this section, are often suggested for new mothers to restore muscle tone following childbirth. “Doing Kegels” also work for women in perimenopause. Kegel exercises strengthen the pubococcygeal muscle, which helps control the flow of urine and prevents -urinary incontinence.
  • Medications — Your doctor may prescribe medications to help with bladder control.
  • Collagen injections — These injections around the urethra can build support.
  • 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 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.


  1. Tiffany says:

    I wonder if it is too early for me to have the beginning symptoms of peri-menopause. I am 33. My cycle has been super regular since I had my youngest child almost 10 years ago, before that I would have periods just whenever my body wanted, some times 2 times a month. Recently my periods are so heavy that the first few days I have to wear overnights because I bleed through them in just over an hour, my cramps are unbearable even when I am not on my period. My DR wants to do a Novasure procedure. But recently I have been noticing changes, for the past 7 months I am unbearably hot, 60* outside and I am sweating. For the past couple months I have have been having insomnia to the point that unless I take a pill to make me go to sleep I will be up until 2 or 3 am and I have to be up at 6am. I am exhausted all the time. Sex with my husband is becoming painful, but not from dryness.. its like I wont open up to him even though I want to. My ankles are always sore. I tried to bring this up with my OB/GYN but he told me that I was too young.

  2. I am 51 and every month, every day, is a weird experience. Despite being celibate for 8 years, I began getting UTI’s a few years ago if I used a vibrator, even if I bathed and disinfected everything beforehand, it was as if stimulation itself was causing it. Then, the UTI’s started to occur if I worked out, same thing, did not matter if I washed before and after and changed clothes. The UTI’s have become harder to treat. I am starting to notice hot flashes, but, had hot flashes when several UTI’s quikly (within two hours of onset of symptoms) turned into a kidney infection, so, when I have several things going on at once, like UTI symptoms, close to period (because it has not stopped) taking antibiotics a few days, and I still feel off and urgency to pee, and hot flashes, its almost impossible to figure out. And as if thats not all, my urine seems to test negative UNTIL it spreads to kidneys. My skin is so dry it itches at night and I scratch and scratch until it hurts, then I have to treat the damaged skin 🙁 I seem terribly thirsty at all times, and water doesnt seem to combat my thirst, I drink it all day and night. I have arthritis and so many aches and pains….including migraines of many rare varieties.. put it all together and its absolutely crazy making.

  3. I had an Endometrial Ablation done when I turned 40 and have not had a period just the odd spotting but very rare and phantom cramps. I am 46 now and have been night sweats for about the last 2 years to the point where my clothes are soaked sometimes. I get the odd sweating during the day but no where as I do at night. Is this premenopausal for me

  4. It’s very frustrating for me to consider periods and menopause. My mother had a partial historectomy because she had cysts and my sister had her tubes tied after 2 children, so neither can tell me anything about our family’s periods at the age of late 20’s to early 30’s. I’m 33 and my periods started when I was about 12-13. In my teens, my period lasted 2-3 weeks at a time. It came and went as it pleased in my 20’s. It didn’t start to gain any predictability until I was about 28-29.

    About 2-3 days before a period, I routinely work harder on my cardio because I feel bloated and cut back on strength/resistance training because I start to feel sore. It’s like a subconscious calendar. Occasionally, I’ll get an odorless egg white discharge before a period that irritates me when it dries externally. My GYN has determined that this is normal and reassuring, but it doesn’t feel that great. The first 2-3 days of my cycle are spotty and usually brown/oxidized. A liner is enough to cover me because I only spot right before I have to pee during that time. Then the heavy comes. I know that it will be a heavy night for me because I start feeling itchy when I get ready to go to bed. I get sweaty flashes and feel physically depressed. My flow gets so heavy for 3-4 days that I have to wear a Super tampon and overnight pad just to go outside of my home for no more than 2 hours max before I will ruin my clothes. I don’t leave the house during this time. I just stay in bed watching movies, feeling sweaty and faint, crossing my legs with an overnight pad on. After the haul, I have about 2-3 more days of bright red spotting that comes and goes at the most inconvenient times, like when I least expect it or don’t have a backup liner.

    I do wonder if I’m going through the early stages of pre-menopause and how taking a PRN of 0.5-1mg of Xanax could affect my period. I worry about polyps, cysts, and estrogen/progesterone levels. I wonder if Id need Xanax for anxiety if those levels were being monitored. I don’t feel like I’ve ever had a “regular” period. I feel like there are a lot of period things that others don’t have to suffer with, abnormal things that could be fixed by a doctor if they examined my symptoms more closely. I also know that there are people that have it much worse than me with their period. It’s just something we live with until they become a huge problem.

  5. Andrea O'Loughlin says:

    I’m almost 45. Over the last year my periods come anywhere between 25 to 30 days. Sometimes they start light then go heavy then may stop for a day or so. Normally last 7 days. Normally about 7 to 10 days before my breasts would be tender. Now each month is different for eg my period is due any day but my breasts are hardly sore. I’m finding just randomly I’ll become hot and clammy

  6. Kim Spraggins says:

    I am 52 and was using the Nuva Ring as a form of birth control. My periods completely stopped about a year after using the ring other than a little spotting every 6 months. My doctor took me off the ring and now that I’m in the menopause range I don’t know how to tell if I can still get pregnant. I experienced hot flashes for 6-7 months and now I started spotting. What’s up?

  7. Melissa. I’m 41 years old and for the past three months I’ve experienced headaches. Insomnia. Bad mood swings. My poor boyfriend and severe hot flashes. February 11 I started a 5 day period. Feb 27 I started again a 1 week period. Didn’t have a period again til may 2. Ugh!

  8. milissa says:

    I am at a loss…..I’m 39 yrs old I had a mid cycle April 6-10 and then started a normal period April 21-26 . I had sex on April 30 ,May 8 I started spotting not even enough to need a pad but it didn’t last all day. Now I’ve been spotting like that for 12 days straight for only a couple hours each day not enough to fill a panty liner it’s off and on. I can go 8 hours with nothing and then I go to the bathroom and whipe and there is a small amount of red blood. No clots the whole time. But again I don’t bleed the whole time. What do you think it is??

Speak Your Mind