Signs and Symptoms of Perimenopause

The Importance of This Time of Life May Surprise You

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The signs and symptoms of perimenopause can begin from 2 to 10 years before actual menopause, which is the moment in time when your menstrual cycles stop.

Simple, right? Well, yes, but often no. You’ve probably heard “I’m feeling menopausal” when a woman friend was having, say, hot flashes. But most of the time, having symptoms is actually part of the perimenopausal phase, leading up to that “menopause moment.” Afterward, you’re postmenopausal.

Your symptoms may continue for a while once you’re postmenopausal, but they typically become weaker and less frequent over time.

You’re “officially” in the postmenopausal phase after you haven’t had a period for a year.

Some women don’t experience perimenopause. For example, women who have hysterectomies with both ovaries removed -- called hysterectomy with double oophorectomy -- usually experience immediate surgical menopause (induced menopause).

The age when the symptoms of perimenopause occur varies. Most women notice perimenopausal symptoms between the ages of 45 and 55; age 51 is the average age for a woman to have her final menstrual period. (Some women never experience any unpleasant symptoms; they just stop menstruating when their bodies decide it’s time.)

The Symptoms of Perimenopause

The list of common perimenopausal symptoms is long, but each woman experiences a personal “mix” that usually (and thankfully) doesn’t include all of them.


  • Period Changes. Expect to experience menstrual cycle changes during perimenopause. Your periods may be shorter, or they may be longer. You might experience heavy bleeding or less bleeding during your period. You may even miss some periods.
  • Hot Flashes and/or Night Sweats. As you probably know, these are famously common signs of perimenopause.
  • Mood Changes. These may include depression, anxiety, irritability, and mood swings.
  • Vaginal Dryness. This is common during perimenopause due to your body’s reduced production of the hormone estrogen. If vaginal dryness is a problem for you, try using an over-the-counter vaginal lubricant, or ask your doctor if a prescription medication may help.
  • Pounding heart (palpitations). Note: If you experience any heart disturbance, always consult your doctor.
  • Dry Skin and/or Hair Loss.
  • Trouble Sleeping. You may find it difficult to fall asleep or stay asleep, particularly if you’re bothered by night sweats or hormonal fluctuations.
  • An Increase in Fat Around the Waist. A classic insult-to-injury situation! Unfortunately, this is common in perimenopausal women. What can you do? Try following a healthy, low-carbohydrate diet and getting regular exercise (at least 30 minutes, three times a week, walking or doing another type of aerobic exercise).  
  • Painful Sex. Sexual intercourse may be painful during perimenopause due to vaginal dryness.
  • Reduced Sex Drive. Hormonal fluctuations that occur during perimenopause are often behind the loss of interest in sex that many perimenopausal women experience.
  • Increased Urinary Problems. These may take the form of 1) an increase in the number of urinary tract infections (UTIs) and/or 2) a higher incidence of urinary incontinence (loss of bladder control).
  • Forgetfulness. Memory and concentration problems are common during perimenopause. Don't be alarmed if you find yourself forgetting things or unable to focus on the task you have at hand. You may find that taking a B vitamin helps. Of course, if the problem is severe or gets worse, you should consult your doctor.

As long as this list is, there are still other perimenopausal symptoms you may experience. You should also be aware that symptoms of different conditions, such as thyroid disorders, can mimic those of perimenopause. As a precaution, check with your doctor whenever you experience unfamiliar symptoms.

Understanding Postmenopausal Symptoms

Studies show that some perimenopausal symptoms are especially likely to improve once you’re postmenopausal, including depression, irritability, and difficulty sleeping.

On the other hand, symptoms linked to the new lower estrogen levels in your body, such as vaginal dryness and incontinence, tend to linger on and may become more of a problem with age.

Treatment During Perimenopause

If your symptoms are annoying but don’t stop you from getting through your daily routine, you may not need treatment. On the other hand, if your perimenopausal symptoms are making you uncomfortable, your doctor can provide treatment that may help you feel better. Or, he or she may suggest treatment with both medication and lifestyle changes.

Medication for Perimenopause Symptoms. If your doctor recommends medication to relieve your perimenopausal symptoms, he or she will likely suggest 1) hormone therapy (estrogen or a combination of estrogen with progestin, the synthetic form of the hormone progesterone) and/or 2) an antidepressant to help stabilize your mood.

Lifestyle Changes That May Help.  Many women choose this “natural” route for perimenopausal symptom relief or simply decide to try it first to see if they can get relief without medication (and avoid the risk of side-effects). But whether you use medication or not, you can still benefit from making the following lifestyle changes:

  • Eat a healthy and well-balanced diet that includes a variety of fruit, vegetables, and whole grains.
  • Get at least 1,000 to 1,200 mg of calcium per day; if you aren’t getting enough calcium in your food, take a daily calcium supplement if your doctor says you should.
  • Exercise regularly.
  • Keep a food diary to find out if what you eat is making your symptoms worse (or, hopefully, better!). 


k AK, Singh R, Prasad RR. “Assessment of menopausal symptoms during perimenopause and postmenopause in tertiary care hospital.” J Basic Clin Reprod. Sci. 2015;4(1):14-19.

“Midlife transitions: Perimenopause to Menopause.” American Congress of Obstetricians and Gynecologists Education Booklet AB013 (2014).

“Menopause health program.” University of California, San Diego (2016).  

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