Perimenopause Symptoms

Last Updated on October 24, 2024

Are you experiencing perimenopause symptoms and don’t know it?  A lot of my clients in their 30s and 40s complain about a wide range of pesky symptoms and want relief.  In most cases the culprit is perimenopause and they had no idea they’re in it.

Perimenopause is the transitional period before menopause when levels of estrogen start to decrease. Perimenopause can last for years and can start in your early 30’s.

During this time it’s common to experience annoying menopause-like symptoms, such as hot flashes, stubborn weight, mood swings, or irregular periods.

I’m breaking down everything you need to know about perimenopause so you understand what it is, how it affects the body, little known perimenopause symptoms, and all the things that can make perimenopause symptoms better (and worse!) so you can find relief during your body’s natural transition.

 

What is Perimenopause?

 

Perimenopause is the phase when your body starts transitioning towards menopause. During this time, your ovaries gradually produce less estrogen and other hormones, leading to changes in your menstrual cycle, which can become irregular or unpredictable.

This natural shift marks the approach of the end of your reproductive years. While perimenopause is a normal process, it often brings both physical and emotional symptoms that can affect your daily life and well-being.

Perimenopause can start as early as your mid-30s or as late as your mid-50s, and its duration varies from person to person. Even though your hormone levels are declining and your periods are irregular, it’s still possible to get pregnant during this phase.

Perimenopause concludes with menopause, which is defined as having no menstrual periods for 12 consecutive months.

 

 

What Hormonal Changes Happen During Perimenopause?

 

The hormonal shifts during perimenopause are primarily driven by a decrease in estrogen, a hormone produced by your ovaries that’s essential for reproductive health.

As estrogen levels drop, they become imbalanced with progesterone, another key hormone. This fluctuation can cause hormonal levels to vary widely throughout perimenopause.

By the time you reach menopause, your body produces so little estrogen that your ovaries stop releasing eggs, and menstruation ceases, marking the end of your reproductive years.

 

At What Age Does Perimenopause Typically Start?

 

Perimenopause usually begins around 8 to 10 years before menopause, often starting in your mid-40s, though it can occur earlier. If menopause is completed before age 40, it’s considered premature menopause.

Certain medical conditions or procedures can trigger early menopause, but if there’s no medical or surgical cause, it’s referred to as primary ovarian insufficiency.

On average, perimenopause lasts about four years, but it can extend up to eight years. For some, this transition phase may be brief, lasting only a few months, while for others, it can span several years.

 

How Can You Tell If You’re in Perimenopause?

 

Everyone’s experience with perimenopause is unique, and symptoms can vary from person to person.

The first noticeable sign is often irregular periods. You may shift from having regular menstrual cycles to experiencing missed periods or unexpected spotting. Many people also begin to experience common menopause symptoms, such as hot flashes and vaginal dryness, early in the transition to menopause.

 

What Are the Symptoms of Perimenopause?

 

As estrogen levels start to decline, your body adjusts to the hormonal changes, and how you react can differ from others. Some people may only notice skipped periods, while others experience symptoms like hot flashes and mood swings.

Although symptoms vary widely, many people experience at least one of the following:

 

 

34 Perimenopause Symptoms

 

I’ve compiled 34 common (but little known) symptoms of perimenopause to help you recognize what to look for.

1.  Irregular Periods
   This is often one of the first noticeable signs. Your periods may become longer or shorter, heavier or lighter, or the time between them may change. There’s no single pattern, so the key is to notice changes from your usual cycle.
2. Weight Gain
   Many experience weight gain, especially around the abdomen, during perimenopause. As estrogen decreases, fat tends to accumulate in the midsection instead of the hips and thighs. A slower metabolism due to muscle loss with age also contributes to this weight gain.
3. Hot Flashes
   One of the most common symptoms, affecting about 80% of women. Hot flashes cause sudden feelings of heat, sweating, and redness, especially in the face and neck. This may be linked to decreased estrogen making the hypothalamus, your body’s temperature regulator, more sensitive.
4. Insomnia & Disrupted Sleep
   Around 50% of women experience sleep difficulties. Trouble falling asleep, waking up frequently, or anxiety-induced insomnia can be linked to fluctuating hormone levels. A decrease in progesterone, which helps you stay asleep, and night sweats can both contribute to disrupted sleep.
5. Night Sweats
   Similar to hot flashes, night sweats occur while you’re sleeping, often leaving you drenched in sweat and disrupting your rest. This makes it harder to get quality sleep, which can worsen symptoms like mood swings, brain fog, and hot flashes.
6. Difficulty Concentrating
   Perimenopause involves neuroendocrine changes, meaning it’s a complex interaction between your brain and hormones. Many women notice cognitive disturbances, such as trouble concentrating, earlier in perimenopause. This is often paired with other symptoms like brain fog.
7. Brain Fog
   Struggling to think clearly or find the right words? This can be unsettling, but it’s a common experience for many. Research shows that around 60% of women experience brain fog as a result of the hormonal changes that come with perimenopause.
8. Headaches
   A drop in estrogen can trigger headaches or migraines, similar to PMS-related headaches. Since hormone levels fluctuate during perimenopause, headaches can become more frequent and unpredictable. If you’ve experienced PMS headaches, you may be more prone to them during this stage.
9. Dizziness
   Dizziness can be disorienting and may lead to balance issues. As estrogen declines and affects insulin production, maintaining stable blood sugar levels can become harder, resulting in dizzy spells. One study found that about one-third of women experienced dizziness at least once a week.
10. Heart Palpitations
    These brief sensations of a fluttering or irregular heartbeat can be alarming, though they’re usually harmless. Low estrogen can overstimulate the heart, causing non-threatening arrhythmias. If you have concerns, especially with a family history of heart disease, it’s important to consult a doctor.
11. Mood Swings
    Estrogen influences neurotransmitters like serotonin, dopamine, and norepinephrine, which affect mood, memory, and focus. When estrogen and progesterone fall out of sync, emotions and cognitive function can become imbalanced, leading to mood swings.
12. Depression
    Hormonal imbalances during perimenopause can increase the risk of depression. Up to 38% of women in late perimenopause experience symptoms of depression, which may be linked to other mood disorders and emotional changes.
13. Anxiety
    Fluctuating hormones can also contribute to anxiety, with over 50% of women reporting symptoms during perimenopause. This can include panic attacks, especially if you’ve previously experienced anxiety or mental health issues. The connection between hot flashes and anxiety is also notable.
14. Panic Disorder
    Intense anxiety can sometimes trigger episodes of panic, which may include heavy breathing, sweating, trembling, and a strong sense of impending doom. These moments can be more intense and short-lived compared to general anxiety, significantly affecting your quality of life.
15. Irritability
    Irritability is one of the most common symptoms, affecting around 70% of women. Hormonal fluctuations, particularly declining estrogen and progesterone and rising testosterone, can disturb neurotransmitter systems in the brain, making mood swings and irritability more likely.
16. Low Libido
    Testosterone plays a role in libido, and as levels decrease with age, it can lead to a reduced sex drive. This may also be compounded by vaginal dryness, which can make intercourse uncomfortable and reduce interest in intimacy.
17. Vaginal Dryness
    As estrogen declines, tissues throughout the body, including the vaginal tissues, become thinner and drier, leading to discomfort, itching, and pain. This affects about 1 in 3 women during perimenopause.
18. Stress Incontinence
    Pelvic floor muscles weaken with age, and if you’ve had pregnancies or childbirth, you may experience occasional leaks when coughing, sneezing, or laughing. Pelvic floor exercises can help strengthen these muscles and improve bladder control.
19. Digestive Problems
    Fluctuating progesterone levels can lead to digestive issues like constipation and bloating. Hormonal changes can also affect the gut microbiome, meaning certain foods may not sit well anymore.
20. Bloating
    Estrogen helps your body retain water, and during perimenopause, its unpredictable fluctuations can lead to bloating. This is different from weight gain and is often temporary, with changes in your stomach appearing throughout the day.
21. Joint Pain
    Estrogen supports joint lubrication and reduces inflammation. As estrogen declines, joint pain can occur, and with less collagen production, the cushioning in joints decreases, placing more strain on them.
22. Muscle Tension
    Like joint pain, a drop in estrogen can cause muscle stiffness and tension. Stretching daily and warming up before exercise can help relieve muscle tension and keep your body flexible.
23. Body Odor & Excessive Sweating
    Hormonal shifts may lead to changes in body odor and increased sweating, especially with hot flashes and night sweats. As your skin and its microbiome adjust, these changes should stabilize over time.
24. Breast Soreness
    Similar to the tenderness experienced around menstruation, hormonal changes during perimenopause can cause fluid buildup in the breasts, leading to swelling and pain. This discomfort can range from a throbbing sensation to a dull ache or burning feeling. Breast changes are common during this time, but it’s important to monitor breast health and talk to your doctor about breast cancer screenings, especially after the age of 40.
25. Hair Loss
    As estrogen declines, testosterone’s relative increase can lead to androgenic symptoms like hair thinning or loss. Collagen, which supports hair, skin, and bone health, also decreases with age, starting around 30, with around 1% less production each year, contributing to hair changes.
26. Brittle Nails
    Keratin, a key protein in hair and nails, relies on certain amino acids found in collagen. As collagen levels drop, nails may become more brittle, reflecting the overall decline in nail and skin health.
27. Itchy Skin
    Lower estrogen levels can make your skin thinner and drier, reducing its moisture barrier and leading to itchiness. Keeping hydrated both internally and externally can help alleviate this symptom.
28. Burning Mouth
    Declining estrogen can cause increased sensitivity in the mouth, leading to burning mouth syndrome. This condition, which affects around 2% of the population, involves pain or tenderness in the mouth, tongue, cheeks, and lips, and is more common post-menopause.
29. Changes in Taste
    Perimenopause can affect your taste buds, causing food to taste stronger, metallic, or salty, even when you haven’t eaten. Estrogen influences saliva production, and as levels drop, a dry mouth can make it harder for your taste buds to function normally.
30. Bleeding Gums
    As estrogen regulates inflammation, its decline can cause your gums to become inflamed and prone to bleeding, even if you maintain good dental hygiene habits like brushing and flossing.
31. Tingling Extremities
    Hormonal changes may lead to a tingling or “pins-and-needles” sensation in the hands, feet, legs, or arms. Though rare, these feelings are typically brief and related to how hormones affect the nervous system.
32. Electric Shocks
    Some women experience electric shock sensations—short, painless zaps or tingling feelings—as hormones affect nerve function. These occur when hormonal shifts disrupt nerve signals, potentially linked to neuropathic pain.
33. Osteoporosis
    Estrogen is crucial for bone health, helping the body absorb calcium and maintain bone density. As estrogen declines during perimenopause, bones become weaker, increasing the risk of osteoporosis. Strength training can help build muscle and bone strength to reduce this risk.
34. Allergies
    Fluctuating estrogen can trigger heightened allergic reactions or even cause asthma-like symptoms for the first time. This is because estrogen receptors are present in immune cells, affecting how the body responds to allergens and inflammation, particularly in the airways. If allergies worsen during perimenopause, you may need to adjust your allergy treatment.

 

How is Perimenopause Diagnosed?

 

A healthcare provider can often determine if you’re entering perimenopause based on your symptoms, age, and medical history, along with a physical exam. However, an official diagnosis isn’t always necessary. Many people recognize the changes in their bodies and manage mild symptoms on their own, while others seek medical attention when symptoms become severe or disruptive.

 

What Functional Labs Can Diagnose Perimenopause?

 

There are no imaging tests to confirm perimenopause, but your healthcare provider may order tests to rule out other conditions with similar symptoms.

Hormone testing isn’t essential for diagnosing perimenopause because hormone levels fluctuate significantly, making the tests unreliable.

However, certain functional lab tests can help assess hormone imbalances and offer insight into perimenopause, though diagnosing perimenopause itself is primarily based on symptoms and age. Here’s how functional lab tests work in evaluating hormone levels:

1. Follicle-Stimulating Hormone (FSH): FSH levels typically rise during perimenopause as your ovaries produce fewer eggs. A consistently elevated FSH level can indicate the beginning of the perimenopausal transition.
2. Estrogen (Estradiol): Estrogen fluctuates greatly during perimenopause. Low or inconsistent levels of estradiol (the main form of estrogen) may suggest that you’re nearing menopause, especially if paired with other symptoms like irregular periods and hot flashes.
3. Progesterone: Progesterone is another key hormone that declines during perimenopause. Testing its levels can highlight imbalances, particularly if you’re experiencing mood swings, anxiety, or sleep disturbances.
4. Testosterone: While typically considered a male hormone, testosterone levels in women can also fluctuate with age. Low testosterone can impact libido, energy, and muscle mass, while relatively higher levels (due to estrogen decline) can cause hair loss and other androgenic symptoms.
5. Thyroid Function Tests (TSH, Free T3, Free T4): Thyroid dysfunction can mimic or exacerbate perimenopausal symptoms, like fatigue, mood changes, and weight gain. Testing thyroid function can help rule out or diagnose thyroid issues alongside hormonal shifts.
6. Adrenal Hormones (Cortisol, DHEA): The stress hormone cortisol and the adrenal hormone DHEA can become imbalanced during perimenopause due to stress and hormonal changes. These imbalances can exacerbate symptoms like anxiety, fatigue, and sleep disturbances.
7. Sex Hormone Binding Globulin (SHBG): SHBG binds to sex hormones, including estrogen and testosterone, regulating their availability in the body. Low SHBG levels can lead to more “free” testosterone, resulting in symptoms like acne, hair loss, or increased body hair.

By evaluating these hormone levels, functional lab tests can help identify hormone imbalances related to perimenopause, guiding targeted treatments like lifestyle changes, supplements, or hormone therapy to alleviate symptoms.

If you’re interested in Functional Labs & a personalized treatment plan you can learn more about working with me here.

 

Management and Treatment of Perimenopause Symptoms

 

While there’s no way to stop perimenopause, which is a natural phase leading to menopause, there are options to help manage its symptoms. Perimenopause itself doesn’t require treatment, but if the symptoms are uncomfortable, there are ways to ease them.

Many people find relief through lifestyle changes or medications. For mild symptoms, lifestyle adjustments like changes in diet, exercise, and stress management can make a significant difference. For others with more severe symptoms, healthcare providers may suggest medications, such as hormone therapy or other treatments, to help improve quality of life.

Each approach can be tailored to your specific symptoms and needs.

 

What Lifestyle Changes Can Help Manage Perimenopause Symptoms?

 

You can often manage perimenopause symptoms at home without medication. Here are some effective strategies:

• Eat a Balanced Diet: Focus on consuming plenty of fruits, vegetables, whole grains, lean proteins, and healthy fats.  I recommend eating for your unique metabolic needs as different metabolic types digest & absorb nutrients differently.  Take my Metabolic Type Quiz & Training to discover your metabolic type and the best diet you.
• Engage in Weight-Bearing Exercises: Activities like walking, hiking, or strength training can be beneficial.  Take my Program Style Quiz to discover the right workout program for your skill level & goals.
• Practice Stress Management: Techniques such as meditation can be effective. Somatic exercises are particularly effective in balancing the nervous system and balance hormones in the process. Stress is a root cause of ALL hormone issues.  Luckily, somatic exercise stop stress, balance the nervous system, and make it significantly easier to balance hormones, feel great, and lose weight.  If you feel stressed, struggled with hormone imbalance, and stubborn weight my ​Somatic Exercise Program​ will get you feeling better and losing weight quickly and naturally.
• Maintain a Healthy Weight: Focus on achieving and maintaining a weight that’s healthy for you. The more excess body fat you have typically means you’ll experience more challenging symptoms.  Reducing body fat can help minimize symptoms.
• Enhance Sleep Hygiene:  Improve sleep quality and get a minimum of 7-8 hours of deep sleep a day to keep hormones balanced.  Use these 12 Tips for Better Sleep to get the quality sleep you need.
• Quality Supplementation:  Some supplements help balance hormones better than others.  Check out supplements for hormones to learn more and see what I recommend most for hormone balance.
• Limit Alcohol and Caffeine: Reducing these can help alleviate some symptoms.
• Quit Smoking: Avoid tobacco products, as they can exacerbate symptoms.
• Dress in Layers: This allows you to easily remove clothing if you experience sweating or hot flashes.
• Control Your Environment: Use fans or keep your living space cooler to manage temperature fluctuations.

 

What Factors Can Worsen Perimenopause Symptoms?

 

There’s no single factor that universally makes perimenopause worse; it varies from person to person. However, certain factors can exacerbate symptoms:

• Unhealthy Eating Habits: Consuming sugary drinks, desserts, or foods high in saturated fat can worsen symptoms. A nutritious diet can help manage weight changes and hot flashes.
• Sedentary Lifestyle: Lack of exercise can lead to increased fatigue, mood swings, and sleep issues. Regular physical activity has numerous benefits during this phase.
• Tobacco Use: Smoking is linked to early menopause and decreased bone density, and it can also intensify vaginal dryness.

If you’re experiencing symptoms, it’s important to address your lifestyle and use a tailored treatment plan to enhance your overall well-being.

Take my Program Style Quiz to find the meal plan and/or workout plan I recommend for you.

Your Coach & Biggest Cheerleader,