How to Recognize and Manage Perimenopausal Symptoms

What is Perimenopause?

Perimenopause literally translates to “around menopause.” It refers to the period of menopausal transition when your body starts to move towards menopause. Menopause marks the end of your reproductive years. It is officially diagnosed when you’ve gone a full year (12 months) without having a menstrual period. Once you reach menopause, the perimenopause period is over.

Common Perimenopause Symptoms

Common symptoms of perimenopause include irregular periods, hot flashes, sleep problems, mood changes, vaginal dryness, bladder problems, decreased fertility, weight gain, changes in sexual function and sexual desire, bone loss, and increased blood cholesterol levels.

The Biological Changes Behind Perimenopause

During the childbearing years of a woman’s life, the ovaries produce estrogen. In women nearing menopause, symptoms of perimenopause happen due to fluctuating levels of estrogen. 

Declining estrogen levels cause the length of the menstrual cycles to become longer or shorter. In addition, anovulatory cycles can occur, where the ovaries don’t release an egg. 

A decrease in estrogen also throws off the balance with progesterone, the other female hormone produced by the ovaries. Together, these two hormones regulate ovulation and menstruation. Hormonal fluctuations during perimenopause can be erratic and cause these hormones to go up and down like a rollercoaster.

These changes happen because the ovaries start making less estrogen in preparation to completely stop releasing eggs. It is the body’s way of preparing for the menopause transition. Once menopause is complete, your periods stop, and you cannot become pregnant.

Identifying Peri-Menopausal Symptoms

How Do I Know If I’m Perimenopausal?

You can tell you are in perimenopause if you have changes in your menstrual cycle length or flow and symptoms such as hot flashes and sleep difficulties. If you experience these symptoms at an age less than 30, talk to your healthcare provider.

Can FSH Be Used to Diagnose Menopause?

Follicle-stimulating hormone (FSH) levels are sometimes measured to confirm menopause. FSH is a hormone made by the pituitary gland in the brain. It triggers the ovaries to release eggs. 

If the FSH level is consistently high at 30 mIU/mL or above and a woman has not had a menstrual period for a full year, she is said to have reached menopause. 

However, gynecologists and women’s health experts warn that FSH levels can be misleading if you’re having perimenopause diagnosed because hormone levels are erratic during this time. In addition, certain health conditions, such as overactive thyroid and high prolactin levels, and certain medications, like hormone therapy and birth control pills, can interfere with FSH results.

What is the Typical Age for Perimenopause?

The typical age for beginning menopause symptoms is 40 to 44 years. However, some women can start experiencing symptoms of perimenopause in their early to late 30s. Late stages of perimenopause or early menopause usually occur in the late 40s and early 50s. 

Note: If you start experiencing symptoms of perimenopause in your early 40s or younger, talk to your healthcare provider. This can be a sign of premature menopause or primary ovarian insufficiency. 

Early vs. Late Perimenopausal Symptoms: Menstrual Cycle Changes

Persistent changes in the length of your menstrual cycle (shorter or longer cycles by 7 days or more) or changes in menstrual flow are signs of early perimenopause. Not having a menstrual period for 60 days or longer is a sign of late perimenopause. Additionally, hot flashes and sleep difficulties are common symptoms in all stages of perimenopause.

How Long Does Perimenopause Last?

The average length of perimenopause is 4 years. However, this can vary from person to person. Some people might be in perimenopause for only a few months, while others may experience perimenopause symptoms for a decade.

What Are The 3 Stages of Menopause?

• Perimenopause or early menopause is a transitional period in which you have menopause-like symptoms like irregular periods and hot flashes.

• Menopause is the stage when you have not had a menstrual period for a full year (12 months). This means your ovaries have mostly stopped producing estrogen and are no longer releasing eggs. 

• Post-menopause is the stage after you’ve completed menopause (stopped getting your menstrual periods). Menopause symptoms decrease and eventually go away during this time. However, the risk of osteoporosis, heart disease, breast cancer, and blood clotting problems remains high.

Check out our blog, “How Long Does Menopause Last? Symptoms & Treatments.”

What Are The Stages of Perimenopause?

Early Perimenopause

This is the beginning of perimenopause, when hormonal fluctuations start. You may still have regular menstrual cycles, but you start experiencing symptoms of perimenopause, such as:

• Hot flashes, which are a feeling of intense heat rising up from your core to your head and neck and limbs. Hot flashes are especially common just before or during your period when estrogen levels are low.

• Sleep problems such as insomnia, especially if you are having night sweats (hot flashes at night).

• Weight gain is a common symptom in early menopause transition.

Symptoms of early menopause can usually be managed by modifying lifestyle factors, such as practicing good sleep hygiene and increasing physical activity. However, treatments are available if perimenopausal women find the symptoms bothersome. 

Late Perimenopause

This is the stage of perimenopause when you’re getting close to menopause. In addition to the above, symptoms of late perimenopause include irregular periods, including longer or shorter menstrual cycles, skipped periods, and lighter or heavier bleeding than usual. As you get closer to menopause, you may skip periods for several months at a time. 

Timeline and Progression of Symptoms

Symptoms and signs of perimenopause and menopause last for 7 to 10 years on average. This timeframe can vary from person to person. The symptoms can range from mild to severe, depending on how quickly estrogen decreases. The average length of perimenopause is about four years. Symptoms of perimenopause begin about 8 to 10 years prior to menopause.

What Perimenopause Really Feels Like

Decreased estrogen production during perimenopause can cause both physical and mental symptoms.

Physical Symptoms

• Irregular periods due to declining estrogen levels

• Vasomotor symptoms (hot flashes and night sweats)

• Vaginal dryness and thinning of vaginal tissues

• Urinary incontinence (leaking of urine)

• Reduced sexual desire

• Trouble sleeping

• Weight gain

Cognitive and Emotional Symptoms

• Mood swings such as irritability

• Anxiety and depression

• Memory problems

• Difficulty concentrating

• Brain fog

Management and Relief

Lifestyle Changes and Home Remedies for Perimenopause

The following lifestyle changes can help most women in managing the symptoms of perimenopause:

• Eat a healthy diet (low-fat, high-fiber, calcium-rich diet) to promote overall health and make the transition easier.

• Engage in regular exercise to help control weight gain and improve sleep and mood. 

• Practice good sleep hygiene to minimize sleep disruptions due to hot flashes at night.

• Avoid foods and activities that trigger hot flashes, such as alcohol, caffeine, smoking, spicy food, hot weather, and tight clothes.

• Practice stress reduction techniques such as meditation, deep breathing, and yoga.    

Prescription Perimenopause Treatments

Perimenopausal women who are experiencing severe symptoms due to declining estrogen levels should seek care from their healthcare provider. A health care provider can make sure the symptoms are not due to some other medical or surgical cause. They can also recommend over-the-counter and prescription perimenopause treatment (these medications stabilize estrogen levels and treat premenopausal symptoms). 

Treatment options include:

• Birth control pills to stabilize hormone levels.

• Hormone replacement therapy. This treatment stabilizes estrogen levels in the body. Estrogen therapy is available in the form of pills, creams, gels, and patches. 

• Antidepressants such as selective serotonin reuptake inhibitors (SSRIs) to relieve symptoms like depression, mood swings, and sleep disturbances.

• Anti-seizure medications such as gabapentin (Neurontin) which can help with hot flashes and migraine symptoms in some women.

• Over-the-counter vaginal creams and lubricants to relieve vaginal dryness and pain during sex that occurs due to thinning of vaginal tissue.

• Hormone-free options such as fezolinetant (Veozah) which blocks temperature regulation pathways in the brain and relieves hot flashes.

Alternative Remedies

Some of the complementary and alternative approaches to treating perimenopause include:

• Black cohosh, a herbal extract available in supplement form

• Phytoestrogens or plant estrogens that are found in soy, legumes, flaxseed, whole grains, and certain vegetables and fruits, as well as dietary supplements.

• Bioidentical hormones (lab-made hormones that are chemically identical to natural hormones in the body)

• Dehydroepiandrosterone (DHEA), a natural steroid, which can decrease pain related to sexual intercourse

Keep in mind that there isn’t enough scientific evidence to support the safety or efficacy of these alternative treatments. Also, dietary supplements are not regulated by the U.S. Food and Drug Administration (FDA). Therefore, their quality and safety profiles can vary. 

When to Seek Medical Advice for Symptoms of Perimenopause

Perimenopause symptoms are a natural transition and not something to worry about if they are manageable. However, you should seek medical advice if you have the following serious or bothersome symptoms:

• Very heavy periods or menstrual bleeding that contains blood clots.

• Irregular bleeding (periods lasting several days longer than usual or periods occurring closer together).

• Abnormal bleeding or spotting between periods.

• Spotting or bleeding after sex. 

• Symptoms that are severe enough to interfere with daily life

Supporting Loved Ones Through Perimenopause

Perimenopause and menopausal transition can be an overwhelming and uncomfortable experience for many women. If a loved one is going through this stage of life, here are some tips to support them:

• Inform and educate yourself about the signs of perimenopause.

• Use positive language in conversations about menopause and its symptoms.

• Listen to the person and make them feel supported.

• Encourage them to adopt a healthy lifestyle to manage perimenopausal and menopausal symptoms.

• Consider making changes to your relationship, such as showing love and intimacy in other ways if sex is uncomfortable.

• Encourage them to seek perimenopause treatments such as hormone replacement therapy.