What are the symptoms of perimenopause?

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

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.

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.