Perimenopause Symptoms and Other Changes

Perimenopause - What is it and what to expect

Hot Flashes in Perimenopause.

For many women, perimenopause and menopause are synonymous with getting old. Just saying it carries a negative burden. The good news is, the more you understand your estrogen window, which is the title of my new book, the more you will be able to put things in perspective and gain control over your symptoms. That will make you feel both healthier and happier. Another good thing is that most women only get some of the symptoms -  almost no one gets them all.

Common Perimenopause Symptoms

  1. Acne
  2. Anxiety
  3. Bloating
  4. Breast tenderness
  5. Crying
  6. Decreased libido
  7. Facial hair
  8. Forgetfulness
  9. Frequent need to urinate
  10. Hair loss or thinning
  11. Headaches
  12. Hot flashes
  13. Interrupted sleep
  14. Irregular periods
  15. Mood swings
  16. Night sweats
  17. Urinary incontinence
  18. Vaginal dryness
  19. Weight gain, especially around the middle

What is happening to my body and my brain?

Are you a woman who is used to juggling work, social, and family obligations and who once managed your days and slept through the night? Now, do you suddenly find yourself waking up at 4:00 a.m. with heart palpitations or feeling sleepy, anxious, or teary during the day? Do you sometimes lose focus and have a shorter fuse than you used to? Throw in a few mood swings, headaches, and forgetting where the car is parked and you begin to wonder if something is physically or mentally wrong with you.

What's Happening To My Hormones?

Hormonally, perimenopause looks like going through puberty backwards, and it brings with it some of the same experiences.

During perimenopause, shifting production levels of the hormones estrogen and progesterone cause periods to become irregular and vary in the amount of flow. A woman may have regular periods for 3 months, then none for 6, then periods that arrive regularly for several months, or periods for 6 months, none for 4, then heavy flow or light spotting in-between and so on.

The variables all depend on the individual woman. For the majority of women, perimenopause occurs during their forties, but like everything else on this journey, it may occur earlier or later.

How Long Does it Last?

The average length of perimenopause is 4 years, but again, since everyone is different, that too can vary. Some women have symptoms for 10 years. Occasionally, symptoms will last longer. Over time, estrogen levels will drop to prepuberty levels, periods stop entirely, and it is no longer possible to become pregnant. During perimenopause, estrogen levels plunge and soar like a wild hormonal roller-coaster ride. Instead of estrogen and progesterone levels working together with precision, they work somewhat independently. Progesterone levels don’t typically rise unless the ovary ovulates an egg. Progesterone’s primary role is to stabilize the uterine lining so an embryo can implant (the word progesterone stems from “pro-gestation”), but progesterone also plays a role in a woman’s moods by attaching to the same sites in the brain as the neurochemical GABA, a hormone that helps reduce anxiety.

Lower progesterone levels affect women differently, but persistently low levels are believed to play a major role in the mood changes and swings so often experienced by women during perimenopause and menopause. Hysterectomy can speed up the time of menopause even if the ovaries are left in.

Onset of Menopause


Before age 20

1 out of 10,000 women

Before age 30

1 out of 1,000 women

Before age 40

1 out of 100 women

Before age 45

1 out of 10 - 20 women

Compiled by Mache Seibel, MD

Since it starts as early as 10 years before menopause, you could start having symptoms in your 20s or 30s. As uncomfortable and as aggravating as perimenopause can be, know that like puberty, it is only temporary and will end. The menopausal transition symptoms typically decline significantly 2 years after your last menstrual period, which is 1 year after menopause begins.

Can I Still Get Pregnant?

For women who wait to have a child, perimenopause is a challenge. It's not easy to get pregnant, but is still possible to get pregnant. So although it is a time of lower fertility, unless you want to get pregnant, use contraception - as Yogi Berra said, "It ain't over till it's over."

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