Table of ContentsView AllTable of ContentsSymptomsCausesDiagnosisTreatment
Table of ContentsView All
View All
Table of Contents
Symptoms
Causes
Diagnosis
Treatment
Verywell / Madelyn Goodnight
Perimenopause Symptoms
The average age of menopause is 51, and most women experience perimenopause in their 40s and early 50s. Symptoms can vary, and you may be prone to some of the effects more than others.
Even if it seems likely that your symptoms are due to perimenopause, it is important to see a healthcare provider. Medical illnesses such asthyroid disease,type 2 diabetes, andendometrial cancercan have similar effects.
Common symptoms of perimenopause include the following.
Period Changes
Changes in your usual menstrual pattern are among the most noticeable signs of perimenopause. You may have irregular bleeding, intermittent spotting, or changes in yourpremenstrual symptoms.
While it is more common to experience lighter periods or to miss periods during the perimenopausal years, increased frequency and/or bleeding can occur as well.
Is Pregnancy During Perimenopause Possible?
Hot Flashes and Night Sweats
Hot flashescan occur at any time, regardless of the environmental temperature. Some women also frequently feel warm and are prone to sweating during perimenopause.
Night sweatsusually occur at night and can leave you and your blankets soaked.
Mood Changes
Vaginal Dryness
Sleep Problems
In addition to hot flashes, night sweats and anxiety can contribute to sleeping problems during perimenopause. Sleeping difficulties, in turn, can worsen mood changes.
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Weight Changes
During perimenopause, women often have slight to moderate weight gain and are prone to increasing fat around the waist area.
Urinary Problems
Urinary problems common in perimenopause includeurinary tract infections(UTIs) and decreasedbladder control or urinary incontinence. You may “leak” when laughing, exercising, or holding urine for long.
Lower Sex Drive
Many women have less interest in sex during the perimenopausal years, which can be distressing for women and their partners.
Skin Changes
You may notice skin dryness or a change in skin elasticity, which can make skin appear “saggy” or older.
Hair Problems
You may lose hair, resulting in thinning on your head. You may also get more hair on your face due to the shift in hormones.
As estrogen helps maintain bone health and heart health in women, thinning bones, a predisposition to osteoporosis, and an increased risk of heart disease can slowly develop during the perimenopausal period. These physical effects are typically without symptoms.
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Throughout the reproductive years, you produce several different estrogen hormones. These hormones help regulate the menstrual cycle and facilitate pregnancy through the action of complex feedback mechanisms.
During perimenopause, your body’s production ofestrogen hormonesgradually declines.This is a normal part of a life and is what causes related symptoms.
Ovulation (ovaries releasing an egg) declines. The processes that accompany this, such as monthly production of the uterine lining, also decline during perimenopause. Menstruation, the release of the uterine lining when there is no pregnancy, gradually ceases as well.
Who Doesn’t Experience Natural Perimenopause
If you have a total abdominalhysterectomy, with both of your fallopian tubes and ovaries removed, you can expect to experience surgical menopause (also called induced menopause).
There are also other causes for induced menopause, including pelvic radiation or chemotherapy.
Low Estrogen: Symptoms, Causes, and Treatments
Typically, perimenopause is diagnosed based on your medical history, physical examination, and possibly diagnostic testing as well.
Often, women seek medical attention for the more distressing effects of perimenopause. For example, irregular periods are usually a cause of concern. Similarly, mood changes, hot flashes, and UTIs often prompt a visit to the healthcare provider.
To complicate matters, decreased estrogen in perimenopause can exacerbate many of the symptoms related to such conditions.
Given this, your healthcare provider will consider all possible causes of your symptoms—not just perimenopause, even if it seems likely.
Examination and Testing
There is no diagnostic test or imaging study to confirm perimenopause. However, certain types of testing and imaging may be used to exclude other causes of symptoms if they are suspected.
Your healthcare provider may use any of the following to help form a diagnosis:
Even if you don’t have symptoms, your healthcare provider may also run tests to assess for osteoporosis and hypertension.
Most women do not need to take medication to relieve perimenopausal effects. Often, lifestyle strategies can have a big impact on symptoms.
For some women, symptoms are especially bothersome andhormonal birth controlcan be helpful. Not only does it provide supplemental hormones, but it also protects against pregnancy—which is still possible in perimenopause.Hormone replacement therapy (HRT)may also be used in some cases.
In other instances, symptomatic treatment aimed at controlling specific effects, such as depression, anxiety, or hair loss, are the best fit.
Lifestyle
Taking practical steps to ease your comfort may be all you need. This is especially true if your symptoms are mild and intermittent. You might not want to take a daily medication for a problem that only bothers you once every few weeks.
Some strategies to try:
While not a treatment, absorbent liners can help catch bladder leaks and irregular vaginal bleeding, so they are worth having handy.
Symptomatic Treatment
Often, women opt to take treatment to help control the most bothersome symptoms of perimenopause. Treatments can range from simple over-the-counter (OTC) medication to prescription therapies.
For example, OTCvaginal lubricantscan help relieve vaginal dryness.
Prescription medications may also be helpful: An antidepressant or antianxiety medication for mood, an anticholinergic for bladder control, or a sleep aid for insomnia, to name a few.
Hormone Replacement
Because a decline in estrogen is the main cause of perimenopausal symptoms, taking estrogen or a combination of estrogen with progestin (the synthetic form of the hormone progesterone) is often used to manage the effects.
HRT can be taken systemically (a skin patch or a pill) or locally (vaginal estrogen to treat dryness).
Keep in mind that some women can’t use HRT and it does carry some health risks, even for healthy women.
Should You Use Hormone Replacement Therapy?
A Word From Verywell
To many, entering this new phase of life represents getting older, which may carry emotional challenges for some. Many of the symptoms of perimenopause are temporary and do not continue after menopause. However, some of the health effects of decreased estrogen, including the predisposition to heart disease and fragile bones, remain throughout a woman’s life after menopause.
Be sure to get regular preventative health check-ups so that you can avoid health problems in the years to come.
7 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Johns Hopkins Medicine.Perimenopause.Canadian Cancer Society.Treatment-induced menopause.National Institute of Child Health and Human Development.Uterine fibroids.Cho MK.Use of combined oral contraceptives in perimenopausal women.Chonnam Med J. 2018;54(3):153. doi:10.4068/cmj.2018.54.3.153The American College of Obstetricians and Gynecologists.Hormone therapy for menopause.The North American Menopause Society.The experts do agree about hormone therapy.Kaunitz AM, Manson JE.Management of menopausal symptoms.Obstet Gynecol. 2015;126(4):859–876. doi:10.1097/AOG.0000000000001058Additional ReadingColl-Risco I, Borges-Cosic M, Acosta-Manzano P, Camiletti-Moirón D, Aranda P, Aparicio VA.Effects of concurrent exercise on cardiometabolic status during perimenopause: the FLAMENCO Project.Climacteric.2018 Dec;21(6):559-565. doi: 10.1080/13697137.2018.1526892.Kulkarni J, Gavrilidis E, Hudaib AR, Bleeker C, Worsley R, Gurvich C.Development and validation of a new rating scale for perimenopausal depression-the Meno-D.Transl Psychiatry.2018 Jun 28;8(1):123. doi: 10.1038/s41398-018-0172-0.Lizneva D, Yuen T, Sun L, Kim SM, Atabiekov I, Munshi LB, et al.Emerging concepts in the epidemiology, pathophysiology, and clinical care of osteoporosis across the menopausal transition.Matrix Biol.2018 Oct;71-72:70-81. doi: 10.1016/j.matbio.2018.05.001.
7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Johns Hopkins Medicine.Perimenopause.Canadian Cancer Society.Treatment-induced menopause.National Institute of Child Health and Human Development.Uterine fibroids.Cho MK.Use of combined oral contraceptives in perimenopausal women.Chonnam Med J. 2018;54(3):153. doi:10.4068/cmj.2018.54.3.153The American College of Obstetricians and Gynecologists.Hormone therapy for menopause.The North American Menopause Society.The experts do agree about hormone therapy.Kaunitz AM, Manson JE.Management of menopausal symptoms.Obstet Gynecol. 2015;126(4):859–876. doi:10.1097/AOG.0000000000001058Additional ReadingColl-Risco I, Borges-Cosic M, Acosta-Manzano P, Camiletti-Moirón D, Aranda P, Aparicio VA.Effects of concurrent exercise on cardiometabolic status during perimenopause: the FLAMENCO Project.Climacteric.2018 Dec;21(6):559-565. doi: 10.1080/13697137.2018.1526892.Kulkarni J, Gavrilidis E, Hudaib AR, Bleeker C, Worsley R, Gurvich C.Development and validation of a new rating scale for perimenopausal depression-the Meno-D.Transl Psychiatry.2018 Jun 28;8(1):123. doi: 10.1038/s41398-018-0172-0.Lizneva D, Yuen T, Sun L, Kim SM, Atabiekov I, Munshi LB, et al.Emerging concepts in the epidemiology, pathophysiology, and clinical care of osteoporosis across the menopausal transition.Matrix Biol.2018 Oct;71-72:70-81. doi: 10.1016/j.matbio.2018.05.001.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Johns Hopkins Medicine.Perimenopause.Canadian Cancer Society.Treatment-induced menopause.National Institute of Child Health and Human Development.Uterine fibroids.Cho MK.Use of combined oral contraceptives in perimenopausal women.Chonnam Med J. 2018;54(3):153. doi:10.4068/cmj.2018.54.3.153The American College of Obstetricians and Gynecologists.Hormone therapy for menopause.The North American Menopause Society.The experts do agree about hormone therapy.Kaunitz AM, Manson JE.Management of menopausal symptoms.Obstet Gynecol. 2015;126(4):859–876. doi:10.1097/AOG.0000000000001058
Johns Hopkins Medicine.Perimenopause.
Canadian Cancer Society.Treatment-induced menopause.
National Institute of Child Health and Human Development.Uterine fibroids.
Cho MK.Use of combined oral contraceptives in perimenopausal women.Chonnam Med J. 2018;54(3):153. doi:10.4068/cmj.2018.54.3.153
The American College of Obstetricians and Gynecologists.Hormone therapy for menopause.
The North American Menopause Society.The experts do agree about hormone therapy.
Kaunitz AM, Manson JE.Management of menopausal symptoms.Obstet Gynecol. 2015;126(4):859–876. doi:10.1097/AOG.0000000000001058
Coll-Risco I, Borges-Cosic M, Acosta-Manzano P, Camiletti-Moirón D, Aranda P, Aparicio VA.Effects of concurrent exercise on cardiometabolic status during perimenopause: the FLAMENCO Project.Climacteric.2018 Dec;21(6):559-565. doi: 10.1080/13697137.2018.1526892.Kulkarni J, Gavrilidis E, Hudaib AR, Bleeker C, Worsley R, Gurvich C.Development and validation of a new rating scale for perimenopausal depression-the Meno-D.Transl Psychiatry.2018 Jun 28;8(1):123. doi: 10.1038/s41398-018-0172-0.Lizneva D, Yuen T, Sun L, Kim SM, Atabiekov I, Munshi LB, et al.Emerging concepts in the epidemiology, pathophysiology, and clinical care of osteoporosis across the menopausal transition.Matrix Biol.2018 Oct;71-72:70-81. doi: 10.1016/j.matbio.2018.05.001.
Coll-Risco I, Borges-Cosic M, Acosta-Manzano P, Camiletti-Moirón D, Aranda P, Aparicio VA.Effects of concurrent exercise on cardiometabolic status during perimenopause: the FLAMENCO Project.Climacteric.2018 Dec;21(6):559-565. doi: 10.1080/13697137.2018.1526892.
Kulkarni J, Gavrilidis E, Hudaib AR, Bleeker C, Worsley R, Gurvich C.Development and validation of a new rating scale for perimenopausal depression-the Meno-D.Transl Psychiatry.2018 Jun 28;8(1):123. doi: 10.1038/s41398-018-0172-0.
Lizneva D, Yuen T, Sun L, Kim SM, Atabiekov I, Munshi LB, et al.Emerging concepts in the epidemiology, pathophysiology, and clinical care of osteoporosis across the menopausal transition.Matrix Biol.2018 Oct;71-72:70-81. doi: 10.1016/j.matbio.2018.05.001.
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