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.