Is Menopause on the Horizon?

Embarking on the journey of perimenopause is unique for every woman

Woman who can not sleep
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Many women start to notice symptoms they suspect could be indicative of menopause in their 40s. This period of time is called perimenopause, which is the phase leading up to your final menstrual period.

During perimenopause, a woman's ovarian function begins to wane, so estrogen levels in the body start decreasing. With declining estrogen levels and other hormone changes in the body, many women begin to experience symptoms like hot flashes and mood problems, as well as a change in their menstrual cycles.

We'll explore these (and other) common signs and symptoms that women experience as menopause approaches. To clarify, menopause is a point in time where a woman has not had a menstrual cycle for 12 consecutive months. 

Changes in Menstrual Cycle

For many women, the first sign of perimenopause is a change in the length of menstrual cycles. Often, at first, the time between a woman's periods will lengthen, as compared her normal menstrual cycles. Then, a woman will often experience skipped periods that may occur once in awhile or even for several cycles. This is normal, and a sign that a woman's ovaries are not releasing eggs (called ovulating) monthly anymore. 

Of course, if you have been regular (in terms of your monthly periods) as clockwork since you were 13, you are more likely to notice any change. But, if you have had irregular periods, this may not hit your radar until later, and that's OK.

Everyone woman experiences perimenopause differently; some have more obvious signs and symptoms, and others with more subtle ones.

Finally, it's important to note that you can still get pregnant during perimenopause, as your ovaries can still release an egg, just not reliably. So be sure to consider pregnancy as a possibility if you miss a period.

Hot Flashes

Hot flashes are the most common symptom experienced by women in perimenopause and just after menopause. A hot flash is commonly described as a warm flush or feeling that begins in the face or neck and moves down the body, although the description of it can vary. The severity can also vary, meaning for some women their hot flashes are debilitating whereas, for others, they are a minor nuisance.

The good news is that hot flashes do tend to get better with time, as they usually go away within five years of onset. However, a small number of women may continue to have hot flashes well after menopause.

It's also worthy to note that women who undergo surgical menopause, meaning they had their ovaries surgically removed, tend to experience more severe and frequent hot flashes. 

If hot flashes affect your daily functioning and/or quality of life, speak with your doctor. There are a number of behavioral techniques (for example, wearing loose clothing and using a fan at night), as well as medications (for example, an antidepressant or hormone therapy) that can help you feel better. 

Vaginal Symptoms

For some women, vaginal dryness is their first inkling that menopause is on the way. This can come in the form of painful intercourse, as the vaginal walls become thinner and less elastic from the loss of estrogen in the body.

In addition to vaginal itching and dryness, a woman may experience more frequent urinary tract infections or urinary incontinence, as the lining of the urinary tract also thins in response to the estrogen decline.

While the vast majority of symptoms in perimenopause get better with time, vaginal dryness, unfortunately, tends to worsen as a woman gets older. In fact, some women do not even begin to experience this symptom until late postmenopause.

The good news is that there is a range of therapies available to treat this uncomfortable symptom ranging from over-the-counter vaginal lubricants and moisturizers to nonhormonal and hormonal medical therapies.

Finally, it's important to mention that even without vaginal dryness, women can notice a lower interest in sex as menopause approaches. Changes in libido may go unnoticed in the chaos of a stressful life, but eventually, you may realize that you don’t seem as interested in sex anymore, or that your orgasms are not as intense.

Remember, libido is an amalgam of physiological processes and psychological and emotional elements. Finding a solution will probably involve talking to both your doctor and your partner.

Changes in Mood

During perimenopause, some women experience mood changes and may describe feeling irritable, sad, anxious, discontented, and/or angry. Since mood problems affect relationships and work performance, women understandably worry about this symptom.

Experts are not entirely sure why some women experience mood changes during perimenopause and others do not. It's likely that hormone shifts, like a drop in estrogen levels, during this time play a role for some women. That said, other factors are probably involved besides hormones, such as the natural process of aging.

For instance, women may mourn the loss of their regular cycle, and the fact that they cannot bear children anymore, or they may be vulnerable to anxiety or sadness as their children leave for college.

Likewise, perimenopause may occur at a time in a woman's life when her own parents are becoming ill or dying, or when she herself is experiencing a change in partnership (for example, divorce). Other health issues may begin arising around the time of perimenopause which can make a woman even more sensitive to emotional hurdles.

If you are concerned about your mood, especially if you are experiencing sadness that is affecting your relationships and/or your functioning on an everyday basis, be sure to see your doctor or a mental health professional.

Besides pervasive sadness, other symptoms of depression may include a loss of pleasure in activities you once enjoyed (called anhedonia), feelings of guilt and worthlessness, a change in your appetite or sleep patterns, and/or thoughts of death or suicide.

Changes in Sleep Patterns

Losing sleep is frustrating, and yet, this is a fairly common complaint of women as they approach menopause. There are many reasons your sleep pattern might be changing at this time in your life. For example, it could be due to nighttime hot flashes, mood problems like feeling anxious or depressed, or simply the stresses of a busy work or life schedule.

Furthermore, frequent nighttime awakenings due to primary sleep disorders like restless leg syndrome or sleep apnea may begin occurring at this time. 

Of course, there are many possible remedies, including behavioral therapies, as well as a short-term use of medications that may help you get your sleep pattern back to normal. 

Change in Appearance

There are many other potential signs and symptoms that may occur as a woman nears menopause, and they very well likely stem (at least partially) from the hormone changes associated with the loss of ovarian function. 

Some of these changes to be aware of include:

  • Hair loss
  • Aging skin (for example, loss of skin moisture and more wrinkles)
  • Expanding waistline due to the redistribution of fat in the body
  • Acne

A Word From Verywell

The journey to menopause is unique for every woman, and it's hard to predict what symptoms any individual woman will experience and when exactly she will encounter them. Be reassured though that most symptoms like hot flashes and mood problems do get better.

Even so, there are ways to manage them along the way, so discuss them with your doctor—you deserve to feel well. That said, try to embrace this natural transition as best as you can, knowing you are not alone. 

Sources:

Boston’s Women’s Health Book Collective, Our Bodies, Ourselves. New York, NY: Simon & Schuster Trade; 2011.

The North American Menopause Society. (2014). The Menopause Practice: A Clinician’s Guide, 5th Mayfield Heights, OH: The North American Menopause Society.

Simon JA et al. Low-dose paroxetine 7.5mg for menopausal vasomotor symptoms: two randomized controlled trials.Menopause. 2013 Oct;20(10):1027-35.

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