What Are the First Signs of Perimenopause? Early Symptoms & What to Expect

What Are the First Signs of Perimenopause?

Perimenopause is a natural phase of life – understanding it and recognising the symptoms makes the transition smoother and helps in effectively managing them.

1. Irregular Periods

Irregular periods are a common and expected sign of perimenopause. Menstrual changes happen due to varying hormone levels, which can result in your periods being shorter or longer than normal, cause the flow to be heavier or lighter, or even result in missed periods.

What to Expect:

• You may get your periods more frequently, or they may take longer than usual.
• You may experience changes in the blood flow – sometimes just spotting, or at other times, heavier and longer periods of bleeding.

Why It Happens:

• In perimenopause, your ovaries produce reduced amounts of oestrogen and progesterone, the hormones that control your menstrual cycles. 
• Ovulation (the egg’s release from the ovary) can become irregular and occasionally may not occur, resulting in missed periods.

2. Hot Flashes and Night Sweats

Hot flashes: Who needs a fireplace when your body turns into a furnace at random moments? 

Hot flashes are abrupt feelings of warmth spreading over your face, neck, and chest, usually accompanied by perspiration and brief flushing of your skin. 

Hot flashes can happen during the day (hot flashes) or night (night sweats), disrupting your sleep and causing you to awaken in a cold sweat.

What to Expect:

• A feeling of intense warmth that spreads through your chest, neck, and face.
• Sweating and rapid heartbeat.
• Reddish skin or a flushed face.
• Night sweats can interfere with sleep and cause you to wake up drenched in sweat.

Why It Happens:

Oestrogen levels drop during perimenopause. This makes the hypothalamus (the brain area that controls temperature) react more vigorously to minor temperature changes. Your body responds in an exaggerated way to lower your body temperature, which causes you to experience hot flashes.

3. Sleep Problems

Did you know? As many as 47% of women encounter sleep issues during perimenopause! Many women struggle to get a good night’s sleep during this transitional phase.

What to Expect:

• Difficulty falling asleep, which leads to insomnia.
• Frequent awakenings at night as a result of feeling hot or sweating.
• Shorter sleep cycles.
• Not feeling refreshed, anxious, or restless as a result of poor sleep quality.

Why It Happens:

Hormonal fluctuations (decrease in oestrogen and progesterone) lead to the disruption of the natural sleep-wake cycles, which can result in sleep disturbances. Declining hormone levels also lead to lower levels of melatonin, which adds to sleep problems during perimenopause.

4. Mood Swings and Irritability

Hormonal fluctuations during perimenopause can lead to mood instability, resulting in a range of emotions from irritability and anxiety to even depression. Suddenly, things that have previously not bothered you can easily become irritating or even overwhelming.

What to Expect:

• Feeling irritable for minor reasons.
• Feeling anxious and on edge, making it harder to relax.
• Sudden changes in emotions – feeling happy at one moment and frustrated or angry the next.
• Feeling tired, drained, and more sensitive than usual.

Why It Happens:

Your body starts producing less oestrogen during perimenopause. This affects areas of the brain that regulate mood and also influences the production of mood-regulating chemicals like serotonin and noradrenaline. This makes you feel irritable and experience mood swings during this period.

5. Decreased Libido

Perimenopause can lead to shifts in libido, influenced by elements such as hormonal fluctuations, physical concerns like vaginal dryness, or emotional aspects like mood swings that can impact relationships.

What to Expect:

• Less interest in sex.
• Trouble getting aroused.
• Vaginal dryness, which makes sex uncomfortable or painful.

Why It Happens:

The decreasing levels of oestrogen, progesterone, and testosterone in women during perimenopause can influence libido and lead to vaginal dryness, making sexual activity uncomfortable. Shifts in mood and sleep issues experienced by women also influence their sexual desire and arousal.

6. Weight Gain and Changes in Body Shape

Due to hormonal changes in the body, it is common for women to experience weight gain in the years prior to menopause. Women typically gain weight around their abdomen rather than from their hips or thighs, which changes a woman’s body shape during these years. 

What to Expect: 

• Increased fat accumulation around your abdomen. 
• Increased food cravings. 
• Your body appears softer due to the decreased muscle mass and increased fat. 
• Your clothes do not fit like they did before. 

Why It Happens: 

• The decrease in oestrogen levels slows metabolism, which makes it easier to gain weight.
• The fat deposition pattern in your body changes – more fat accumulates around your abdomen.
• In addition, hormonal changes increase appetite and cravings, which may increase the tendency to overeat.

7. Breast Tenderness

Hormonal fluctuations that may occur during perimenopause also lead to sensitivity in your breast tissue, resulting in pain, tenderness, and swelling. Some women report that their breasts feel sore and lumpy, similar to how they feel before a menstrual period.

What to Expect:

• Breasts may feel achy and uncomfortable.
• Breasts feel heavier, fuller, or swollen.
• Pain feels like a throbbing, shooting, or burning sensation.
• A change in breast texture makes it feel denser or lumpier.

Why It Happens:

Hormonal changes during perimenopause make the breast tissue more sensitive and also increase water retention, which causes the breasts to become swollen and heavier.

8. Dry Skin and Hair

Another sign of perimenopause that leaves many women worried is the skin and hair changes. Women frequently complain about their skin becoming drier and their hair losing its shine and thickness during this phase.

What to Expect:

• Your skin feels drier and rougher.
• Fine lines become more noticeable.
• You may notice a reduction in hair volume.
• Hair becomes drier and frizzier.

Why It Happens:

• Oestrogen is responsible for maintaining your skin’s moisture and elasticity, as well as your hair follicle health. A decline in oestrogen during perimenopause can thus affect skin and hair health.

9. Headaches

Hormonal headaches and migraine attacks are more frequent, more severe, and harder to treat during perimenopause due to the fluctuations in hormones. Perimenopause can create new migraines or worsen existing ones. 

What To Expect: 

• Frequent headaches or migraines. 
• Throbbing pain on one side of the head. 
• Sensitivity to light. 
• Sensitivity to sound. 

Why It Happens: 

• The declining levels of oestrogen during perimenopause can act as a trigger for migraine attacks in some women. 
• Low oestrogen levels can cause serotonin (a neurotransmitter with pain-relieving qualities) to drop, resulting in poorer pain modulation and increased sensitivity to headache triggers.

How Long Does Perimenopause Last?

Wondering when perimenopause will pack its bags? Let’s find out.

In most women, perimenopause starts in their 40s and can last anywhere from four to ten years. The duration and severity of symptoms are unique and vary from person to person. For some, perimenopause may only last a few years, while others may feel like they’re stuck in there forever!

We have already seen how menstrual cycles fluctuate during perimenopause. Once you’ve gone a full 12 months without a period, you’ve officially reached menopause – a milestone that marks the end of your reproductive years. From this point onward, you enter postmenopause, the phase that follows menopause.

When to See a Doctor

Perimenopause and menopause are natural stages in every woman’s life, and their symptoms are usually manageable. But there are some signs you need to be watchful of, and you should see a doctor if you experience them: 

• Excessively heavy and/or long periods. 
• Bleeding in between your periods. 
• Extreme mood changes, severe anxiety, or depression. 
• Insomnia or sleep difficulties drastically reduce your ability to function. 
• Significant and unexplained weight changes. 
• Severe headaches or migraines. 
• Painful sex and severe vaginal dryness. 
• Frequent urinary tract infections.

Treatment Options for Perimenopause Symptoms

When it comes to managing perimenopause symptoms, you have different options! From lifestyle changes and natural remedies to medical treatments, the right treatment depends on your health needs and symptoms. 

Here are some of the most commonly used methods to help women navigate perimenopause with comfort and ease.

1. Hormone Replacement Therapy (HRT) 

HRT replenishes the hormones (either oestrogen, progesterone, or both) that are lowered as you enter perimenopause, helping alleviate hot flashes, mood changes, and vaginal dryness. Keep in mind that HRT may not be right for everyone; you will want to speak with a healthcare provider about if it may be the best treatment for you. 

2. Lifestyle Changes 

Your lifestyle is a hidden gem for managing perimenopause. Here are some guiding tips that may help: 

• Eating a healthy and balanced diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats supports your health and management of body weight. 
• A regular exercise routine does not just affect weight gain but also helps improve your mood and energy levels. 
• Practices like yoga, meditation, and breathing techniques can help with emotional changes that can happen during perimenopause.

3. Non-Hormonal Medications

If you are unable to use hormonal therapy, there are certain medications that will help manage your symptoms related to perimenopause. This could include some antidepressants, anti-seizure medications such as gabapentin, sleeping medications like low-dose trazodone or melatonin, and some blood pressure medications.

4. Natural Remedies

Did you know that over a whopping 70% of women prefer natural treatments to manage their menopausal symptoms? Natural remedies are gaining popularity because of their gentler, holistic approach with fewer side effects.

Natural remedies like black cohosh, red clover, and evening primrose oil have been proven for their effects in relieving perimenopausal symptoms. However, before you start out on these remedies, you should take your doctor’s advice on what’s best for you.

Read more - Perimenopause Symptoms & Natural Ayurvedic Remedies.

The Bottom Line

Just like climbing a mountain, perimenopause can feel like a steep, exhausting trek, leaving you drained and wondering when it’ll come to an end. But by understanding the signs and knowing what to expect during perimenopause, you can take charge of this phase of life and embrace this powerful transition that only women have the strength to experience!