10 signs you could be in perimenopause (Some may surprise you)

Decreased sex drive? Tired from waking up anxious at night? You might be in perimenopause.

If it feels like your mind is playing tricks on you, you wake up frequently or you have difficulty concentrating, these may be subtle signs you’re approaching menopause. Most women know about hot flashes, but there are many lesser-known symptoms of perimenopause that women often overlook.

What is perimenopause?

Menopause is the point in time when you haven’t had a period for one year. The years leading up to it are called the menopausal transition or perimenopause. During this time, your body transitions from a regular menstrual cycle of releasing an egg and having a monthly period to no longer menstruating.

Menopause marks the end of a woman’s reproductive years. Once you’ve experienced your final period, you can no longer get pregnant. However, it’s important to note that women can still become pregnant during perimenopause.

Perimenopause typically begins in your late 40s, but timing can vary based on your health history. Look to close family members, like a mom or sister, for a general idea of when menopause might begin. The average age for menopause is 52, but it varies for each individual.

“You can take important steps to optimize your health during the menopause transition, so that you can continue to live your best life in the future”, says Elizabeth Lunsford, M.D, an OB/GYN and certified menopause practitioner with Riverside Partners in Women’s Health.

10 signs and symptoms of perimenopause

Women spend an average of four years in the menopausal transition, says Dr. Lunsford. During this time, you may encounter a range of symptoms due to hormonal shifts from changes in your menstrual cycle. Some may be more noticeable, like hot flashes and night sweats. Other times, your body may give you subtle signs that are harder to detect.

Because menopause is identified retroactively, it’s sometimes hard to tell if you’re in the transition. Knowing the signs and symptoms of perimenopause can help you recognize it — and know what to do about it. Read more about common signs and symptoms of perimenopause below.

• Irregular or missed periods: As ovulation slows, your menstrual cycle will become irregular. This can mean shorter or longer cycle lengths, missed periods and fluctuations in menstrual bleeding. Your periods may be heavier or lighter than normal.
• Hot flashes. Changing estrogen may cause a sudden feeling of heat in your upper body. A hot flash can cause heavy sweating, blotchiness and cold shivering that lasts anywhere from 30 seconds to 10 minutes.
• Sleep disturbances. It’s common to have difficulty falling or staying asleep due to hormonal changes. Night sweats or nocturnal hot flashes can also disrupt sleep during perimenopause.
• Memory and cognition issues. Many women experience forgetfulness during perimenopause. It can also cause cognition issues, such as difficulty concentrating and brain fog. Sleep disturbances can also contribute to a lack of mental clarity.
• Vaginal atrophy. Low estrogen levels cause the vaginal tissue to lose its elasticity and become thinner. Vaginal atrophy causes dryness, pain, irritation and bleeding after sex.
• Changes in mood, anxiety or depression. Irritability and mood changes are common in the transition — but it’s often hard to know if it’s PMS or perimenopause. Talk to your doctor if you’re experiencing heightened anxiety, depression or unusual mood swings.
• Decreased sex drive. Women often lose the desire to have sex due to physical issues like vaginal dryness or pain. Hormonal mood changes can also affect your sex drive.
• Physical changes. Menopause changes your metabolism, which can result in changes to your body composition. You may gain weight more easily or find that your physical functioning is different.
• Hair, skin and nail changes. Estrogen contributes to skin elasticity, so as it drops, you may notice sagging skin. Hormonal changes can also cause dry skin, hair thinning or brittle nails.
• Bladder leak. The muscles in the vagina and urinary tract weaken during menopause. This can lead to stress incontinence or involuntary peeing during a sneeze or cough.

When to see a health care provider

Some women experience minor symptoms of perimenopause, while others endure uncomfortable side effects. When perimenopausal symptoms interfere with your everyday life, it’s time to talk to a health care provider.

Treatment options

If symptoms are disrupting your work or family life, talk to your health care provider about ways to get relief. Examples of treatment for menopausal symptoms include:

• Over-the-counter products. Creams and lubricants can treat symptoms like vaginal dryness and discomfort. Some people find relief from menopausal symptoms using herbal products like black cohosh or red clover. Consult with your provider before taking herbs or supplements.
• Medications. Prescription medications can address various challenges affecting your daily life. For instance, birth control might alleviate heavy or painful periods in perimenopause. Other prescription drugs can mitigate hot flashes, insomnia or mood swings. “Your health care provider can discuss risks and benefits of various contraceptive options to prevent pregnancy while also minimizing your menstrual bleeding and mood swings” says Dr. Lunsford.
• Hormone replacement therapy (HRT). Hormone therapy is a common treatment for hot flashes, vaginal dryness and insomnia. It comes in the form of pills, skin patches or vaginal creams or gels. Discuss with your health care provider whether HRT is suitable for you based on the severity of your symptoms and your risk factors.
• Lifestyle changes. Perimenopause is a good time to evaluate what’s working in your overall wellness routine. As your body changes, consider switching up your diet and exercise plans. Certain exercises like strength training can help regulate hormones and metabolism. Pilates can strengthen the pelvic floor and decrease urinary incontinence. You may also try cutting alcohol and caffeine to promote better sleep.

There’s no cure for menopause — it’s a natural transition in life that will eventually pass. Your healthcare provider can assist with finding treatments and lifestyle adjustments to make it more manageable.