What are the symptoms of perimenopause?

Diana Meeks
Diana Meeks on behalf of Sigma Nursing
Family Practitioner

Perimenopause is the transitional period that begins 8 to 10 years before menopause, when fertility ends. Most women start perimenopause in their 40s, but it can start in your 30s.

Perimenopause usually lasts about four years and ends when menopause begins. Symptoms of perimenopause include:

  • Fatigue
  • Hot flashes
  • Irregular periods
  • Vaginal dryness or sexual discomfort
  • Frequent urination
  • Breast tenderness or sensitivity
  • Worse premenstrual syndrome
  • Sleep problems
  • Mood swings
Dr. Julia Schlam Edelman
OBGYN (Obstetrician & Gynecologist)

Women usually spend anywhere from 2 to 10 years in perimenopause. For some women this is a trying time. The erratic hormone shifts may produce debilitating hot flashes and night sweats, irregular menstrual periods, disturbing mood changes, and poor sleep quality. For other women, these changes are mild and barely noticeable. For a fortunate minority the transition is invisible. Twenty percent of women do not experience any hot flashes or night sweats.

During perimenopause, levels of progesterone, the other female hormone made in the ovaries, are erratic and often too low. They may be too low to effectively counterbalance high estrogen levels. Bloating, irritability, and breast tenderness may result. Imbalances of estrogen, progesterone, or both are characteristic of the perimenopausal years. When there is no ovulation for a cycle, little or no progesterone is released and the monthly shedding of the lining does not take place, often resulting in a missed period.

The primary symptoms of perimenopause is an increase in the length of the menstrual cycle, an increase in heaviness bleeding, a decrease in fertility, and greater irregularity in the frequency of periods. However, because estrogen levels can sometimes fluctuate during this time, we may see menopausal symptoms of varying intensity such as hot flashes, night sweats, vaginal dryness, painful intercourse, urinary leakage, and osteoporosis.
In this clip from Discovery Health's "Women's Health Tips," learn the symptoms and how to cope with peri-menopause which affects women in there late 40s.
Paula Greer
Midwifery Nursing Specialist
Perimenopause is the period 8-10 years before actual menopause. Your body will start to change gradually over time. Your hormone production and egg releases will change. Menopause is defined as no menstrual cycle for one year. Many things may change prior to actual menopause occurring. Many women will start to have vasomotor symptoms like night sweats and hot flashes. Some will complain of decreased sex drive, vaginal dryness and things like those stubborn stubbly chin hairs. Most of these symptoms are related to decreasing estrogen. Eating a healthy diet may help. If you have questions and think you are in perimenopause talk with your OB/GYN or Midwife.
Dr. Dawn Marcus
The perimenopause is a time of marked hormonal change, usually beginning 6 or more months before menopause. Hormone levels fluctuate during perimenopause, resulting in menstrual irregularities, hot flashes, sweating, and other unpleasant symptoms. Menopause is officially diagnosed after a woman has gone 1 year without a menstrual period.
The Woman's Migraine Toolkit: Managing Your Headaches from Puberty to Menopause (A DiaMedica Guide to Optimum Wellness)

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Dr. Lisa Rogo-Gupta
OBGYN (Obstetrician & Gynecologist)
'Menopause' is not a single day, is a gradual process that can take many years for some patients. We typically think of menopause as 12 months since the last menstrual period. For years before this some women experience changes in their periods, vaginal symptoms such as dryness, discomfort or bleeding, changes in their urinary and bowel habits, hot flashes, and even more skin wrinkles. The perimenopausal period can also cause difficulty with memory, changes in sleep patterns, and even depressive episodes. These are important symptoms!
Perimenopause is the time surrounding menopause, typically defined as one year without a period. During perimenopause you may experience many symptoms such as irregular bleeding, abdominal cramping, vaginal dryness, joint pain or abdominal bloating. 
Mrs. Marjorie Nolan Cohn
Nutrition & Dietetics Specialist

Some of the symptoms of perimenopause:

  • Irregular periods/change in menstrual cycle - You may notice your period coming more or less often, and perhaps it’s heavier or lighter than it’s been. Maybe you’re even skipping periods when you never have before.
  • Hot Flashes - About 65-75 percent of women experience hot flashes. They come on quickly and can feel like a burst of warmth, leaving you flushed, sweaty, and confused. They don’t last long but are hard to miss.
  • Insomnia and night sweats - Now that your hormones have begun to shift, drifting off to sleep and staying asleep isn’t as easy as it once was.
  • Vaginal and bladder problems - Lower estrogen levels lead to less elasticity and lubrication in the vagina over time. You may find sexual intercourse uncomfortable and less estrogen may mean more vaginal or urinary infections for some women. During perimenopause, some women also experience a degree of urinary incontinence.
  • Decreased interest in sex - The combination of physical and emotional changes can make sex less appealing for many women during perimenopause.
  • Bone loss - Osteoporosis risk rises during menopause because with less estrogen, you begin to lose bone faster than you replace it. The risk of osteoporosis is greater for Caucasian and Asian women.
  • Rising cholesterol levels - Your blood cholesterol levels may have always been within normal ranges, but perimenopause and menopause can cause shifts that affect those levels and put you at greater risk for heart disease. In some cases, your “bad” cholesterol (LDL) can increase just as the “good” cholesterol (HDL) starts to drop. The double whammy can leave you vulnerable to diseases of aging.

During perimenopause, a woman's body changes in many ways. The most common symptom is menstrual irregularity. Your periods might become shorter or longer, more spread apart or closer together, and may sometimes be heavier or lighter. During this time many women also begin to experience hot flashes or sweating during the night. Vaginal dryness is another common symptom. Some women also experience sleep problems.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.