Perimenopause: What You Need to Know

By WV Marshall

For some women, perimenopause is a breeze.

For others, physical and mental changes hit with the force of a hurricane.

Most women experience something in between—discomfort, inconvenience, annoyance but not severe enough to interfere with everyday life.

My mom and her friends experienced “the change” and took what were resignedly called “pumpkin seeds,” because the blaze-orange HRT pills were the size of a pumpkin seed and, to put it delicately, altered the color of urine to a more orange-y hue.

But we now live in a more informed age, where “the change” is now menopause and its precursor is perimenopause, and we are mistresses of our fate when determining courses of action to address symptoms and conditions typically associated with we stop menstruating.

But really, what is perimenopause? See Menopause By Many Other Names

More importantly, when can we expect symptoms to typically manifest or do they just sort of sneak up on us?

The answers, according to a Main Line Health blog, aren’t what doctors or their patients were expecting.

Many women in their 40s and the years leading up to menopause – AKA perimenopause – discovered that symptoms typically associated with menopause can show up much sooner, creating a triple whammy of physical, mental and emotional mayhem on women’s lives.

Unfortunately, many women having perimenopausal symptoms – sleepless nights, lack of interest in sex or that feeling of “losing it” – didn’t know what was going on with their suddenly out-of-control bodies, Main Line Health said.

The likely reason?

We’ve traditionally been told that after the childbearing years comes menopause, generally defined as 12 months since a woman’s last period.

Yet, for maybe five to 10 years before a woman actually stop menstruating, the ovaries start producing less of the sex hormones estrogen, progesterone and testosterone, wreaking all kinds of havoc including hot flashes, vaginal dryness, irregular or heavy bleeding, brain fog and lost sex drive.

These symptoms are familiar to most women, yet one in four women experiences no perimenopausal symptoms at all.

And just as there is a range of symptoms, the presence of symptoms runs the gamut as well – for some only a few months, and for others, more than five to 10 years.

“I’ve been practicing for 30 years and there are women who never seem to perceive anything, never have moodiness in pregnancy, never a hint of depression or baby blues, and they go through menopause without a single hot flash,” said Dr. Jocelyn Craparo, an OB/GYN at Bryn Mawr Hospital, part of Main Line Health. “I’m not kidding—nothing!”

Craparo says the doctor in her wants to make her patients better, “but people don’t always want it to be fixed.”

Educating her patients about this phase of their lives is vital.

She said she finds many patients benefit from validation and education – because they understand what’s going on, they know they aren’t crazy, and they recognize there are legitimate reasons why they aren’t feeling so hot.

Common Symptoms of Perimenopause

Here are some of the most common symptoms of Perimenopause. However, there are dozens more.

Hot flashes

Hot flashes are a primary and widely experienced perimenopause symptom.

That sudden feeling of heat gradually moving up your body, your face and neck turning red, sweating and feeling flushed?

You guessed it, all are symptoms of hot flashes, which can last between 30 seconds and 10 minutes. See Hot Flashes and the Risk of Heart Disease

Night sweats

Night sweats and hot flashes are very common among women around the time of menopause – but menopause isn’t the only reason for night sweats.

If you are pre-menopausal or are in menopause, and have no other symptoms, this is likely the cause of your symptoms. However, check with your healthcare provider if possible as there are other issues that can cause this.


The doctor-recommended seven or eight hours of sleep at night can be a struggle for perimenopausal women who find themselves waking up earlier than they want and having trouble falling back asleep.

Countermeasures include relaxation and breathing techniques, avoiding spicy or caffeine-containing foods and drinks, and trying to go to bed at the same time every night. See Resigning from The Insomnia Club

Breast tenderness

Breast pain, a common symptom, can develop during perimenopause because of variable estrogen and progesterone levels. Although postmenopausal women can experience breast pain, it is more common in premenopausal and perimenopausal women.

Breast pain affects as many as 70 percent of women at some point in their lives.

Muscle cramps

The hormonal imbalance associated with perimenopause typically is responsible for muscle tension.

Hormone levels of estrogen and progesterone (primarily) begin to fluctuate as the body prepares to cease menstruation altogether.

Joint pain

Joint pain is common in women approaching menopause, so much so that the term “menopausal arthritis” has been used to describe this symptom that can be unpleasant and make simple tasks and movements agonizing. See Pains, Strains and Lower Back Sprains

Hormones play a major role in a woman’s bone and joint health and when hormones are imbalanced during perimenopause, joint pain can occur.


Hormonal imbalance is the main cause of headaches for women going through perimenopause, but there are other factors that can set off or aggravate headaches, such as

  • bright lights;
  • stress, anxiety, or relaxation after stress;
  • changes in weather;
  • alcohol;
  • caffeine (too much or too little);
  • too little or too much sleep;
  • skipping meals or fasting; and
  • certain foods.

Brain fog

Several factors can contribute to memory lapses in perimenopausal women, but chief among them is hormonal imbalance.

Memory lapses also could result from other perimenopause symptoms that affect a woman’s concentration level and mental retention.

Mood swings

Estrogen – and the shifting and reduction of estrogen during perimenopause –helps regulate several hormones that may have mood-boosting properties. A common sign of perimenopause is a swing in mood.

While it may not be clear what’s behind mood swings and the typically accompanying irritability, mood swings differ from depression.

Sudden fatigue

Many perimenopausal women experience “crashing fatigue,” a sudden and extreme feeling distinguished by exhaustion, weakness, and a marked drop in energy levels.

Because these episodes can strike willy-nilly, carrying out daily tasks can be difficult.


Erratic periods during perimenopause are common, with perimenopausal women sometimes missing a month or several months, and then noting their periods resume their monthly cycles for a few months.

That monthly cycle also could shorten, meaning periods are closer together.

Despite irregular periods, pregnancy is possible.

Vaginal dryness

Another side effect of perimenopause is vaginal dryness, caused by diminished moisture production and the vagina losing its elasticity.

The problem with vaginal dryness is it can be uncomfortable during sexual intercourse, sometimes to the point of bleeding, the Mayo Clinic said.

Painful intercourse

Experiencing pain during a sexual encounter sometimes could be traced to vaginal dryness.

Sometimes moisturizers specifically developed for vaginal use may help, or some women could benefit from using am estrogen treatment, available as a cream, tablet or ring.

Sex drive

A lower libido is perimenopause because of the changes brought about by reduced estrogen.

These changes can include a diminished clitoral sensitivity and slow-to-no orgasm.

Bladder pain

Changes in urinary function typically accompany perimenopause.

A chief cause is urogenital atrophy, or deterioration of the urinary tract and vagina.

Two reasons why these changes happen:

Perimenopause lowers the amount of estrogen, the lack of which reduces the urinary tract’s ability to control urination;

and advanced age, which usually coincides with perimenopause, has debilitating effects on organs and tissues in the pelvic region.

Symptoms include the need to urinate more often, the inability to control urination, dryness and itching in the vaginal area and increased urinary tract infections.

Urinary incontinence

Vaginas aren’t as stretchy or supple as they once were, which can lead to several issues, including urinary incontinence.

This condition can manifest itself in two ways: urge incontinence, a strong urge to urinate followed by an accidental loss of urine, or stress incontinence, the loss of urine with coughing, laughing or lifting.

Also, women may contract urinary tract infections more often.

Fecal incontinence

Fecal incontinence could be another consequence of perimenopause, which can cause bladder/bowel problems in several ways, including weak pelvic floor muscles, a less elastic bladder, vaginal dryness or weight gain.

Incontinence shouldn’t be ignored because it seldom reverses course and usually worsens over time, interfering with work, social activities, and sexual and personal relationships.

Intestinal issues

As hormones change during perimenopause, women may experience digestive health changes, including gas, bloating, and shifts in bowel movements.

Post-menopause women also may have trouble absorbing certain nutrients because of medications prescribed and because of changes associated with age.

Hair loss

Perimenopausal women may experience changes in skin and hair. See When Hair Loss Makes You Blue

Loss of fatty tissue and collagen makes skin drier and thinner.

A lower estrogen level also may contribute to hair loss or result in hair feeling brittle and dry.

Body odor

Many typical perimenopause symptoms can increase sweat production, which can lead to changes in body odor.

However, when discussing body odor with a healthcare provider, it is important to be specific with descriptions and definitions to find the proper treatment method because different smells mean different things:

The most common perimenopausal body smell is an intensification of the natural scent of sweat, often caused by hormonal imbalance.

Trimethylaminuria, a thyroid-related metabolic condition, is thought to be the reason behind a fish-like smell and menopausal women are especially susceptible.

If there is a fruity smell, a perimenopausal woman should discuss this with her healthcare provider to check for insulin resistance or diabetes.

The fourth odor is that of urine, which is expelled through weakened muscles by pressure created from coughing, laughing or sneezing.

Weight gain

Up to 90 percent of perimenopausal women will gain weight to some degree.

Weight gain is a natural and common in the aging process. See Meno Belly Why? WHY

On average, women gain between 12 and 15 pounds when perimenopause occurs. The extra pounds typically accumulate around the abdomen.

mySysters is an app for women in perimenopause and menopause. Good Housekeeping and Woman’s Day named mySysters the Best App for Women in Perimenopause and a Must Have App for Women.

Sources: Main Line Health: Our Bodies, Ourselves: Mayo Clinic: Healthline: