You’ve likely heard the word before: perimenopause. But you may not know how it’s different from menopause. (And who could blame you? It’s only been recently that people have really talked about it publicly.)

So let’s start there, with a definition. Essentially, perimenopause is premenopause. As you age, your ovaries do, too. Unfertilized eggs decrease in number and quality, and your period becomes irregular. Ovarian aging has a domino effect throughout your body. Beyond a sputtering period, it can prompt mood swings, brain fog, and more.    

Thing is, perimenopause can come on gradually, with just a symptom or two. And some of the symptoms are so vague (sleep problems, anyone?), they could literally be anything. Not to mention that perimenopause typically starts in your mid-40s, when a whole gamut of other age-related changes are happening to your body. So how’s a person to know what’s general and what’s perimenopause? 

Awareness goes a long way. Understanding what’s happening in your body, and knowing what you’re looking for, are the first steps toward figuring out how to help yourself. 

What Causes Perimenopause?

Menopause officially starts when you haven’t had a period for a year. On average, women in the U.S. reach menopause at age 51. Perimenopause is simply the transitional phase leading up to this. It often lasts for four years, or as long as eight. 

As you age, you experience a slowdown of ovarian function, which means your egg count decreases and your hormones begin to fluctuate. These include estrogen, progesterone, testosterone, and the hormone that stimulates follicles, which are responsible for egg production. 

For many women, the first outward sign of all this is a change in menstruation. Initially, you may brush off a missed period or occasional spotting as the result of stress, illness, exercise, or even travel. (Understandable, as all these things can also cause irregular periods.) But perimenopause can pick up steam and take your body on a roller coaster ride.

Once you realize that what you’re experiencing is perimenopause, you can find ways to get relief. But it starts with recognizing the symptoms.

The Most Common Symptoms of Perimenopause

Every woman experiences perimenopause a little bit differently. Some people have just a handful of symptoms. Others, the full gamut. It’s good to know the range so you can take inventory of any changes you’ve noticed, and be on the lookout for new ones.

These are seven of the most typical symptoms of perimenopause. We’ll explain what’s going on and why, and any available treatments. But never hesitate to contact your ob/gyn if you’re wondering about a symptom. There’s no reason to push through pain or mood swings on your own. 

Irregular Menstruation

When you’re no longer ovulating on a predictable schedule, your period can—to continue with the roller coaster metaphor—go off the rails. It might be shorter or longer, or your flow could be lighter or heavier. You may see spotting (also called breakthrough bleeding), or even skip periods. 

In some cases, you may bleed nonstop for weeks or even months—then nothing for months. If your cycle is consistently off (early or late) by seven days or more, you may be in early perimenopause. Sixty days or more between periods, and chances are you're in late perimenopause. 

Why It Happens: Women are born with as many eggs as they’ll ever have—and they age along with you. Ovarian aging is the process toward becoming infertile. 

Your ovaries pump out less estrogen. This affects your levels of progesterone, another hormone produced by your ovaries. These two hormones play a key role in ovulation, or egg release. One outcome of this is releasing eggs more erratically, and your period follows suit.

What Can Help: The first thing is to figure out what’s going on. In the past, a late or skipped period may have meant something much different, so you’ll want to rule out pregnancy. (For the record, you can still get pregnant during perimenopause.) 

If your doctor thinks you’re in perimenopause, it’s helpful to track your periods. A prolonged period can be a worry because it might lead to low iron and anemia. One that goes on for months can be exhausting, and you’ll want to make sure it’s not the result of polyps or another medical issue. 

If you have any concerns or are feeling unusual discomfort, call your ob/gyn. They may prescribe progesterone pills or birth control pills to help regulate your hormones and get your cycle under control. 

Hot Flashes and Night Sweats

Hot flashes and night sweats, known as vasomotor menopausal symptoms (VMS), can really affect your quality of life. Some 3 out of 4 women in perimenopause experience this sudden rush of heat that usually affects the upper body and face. 

Without warning, a woman can break out in sweat, cheeks flushed, hands clammy, and chest pounding—a situation that can last anywhere from seconds to minutes. For others, the symptoms may be so mild, you might think it’s just the room temperature.

Night sweats are just hot flashes that happen during the night. They can also be barely noticeable, or they can wake you up. If you have lots of them—and lots of disrupted slumper—this can sap your energy for the next day. 

Why They Happen: The connection between hot flashes and perimenopause is not well understood, though fluctuating hormones seem to be a factor. Our body temperature is regulated by the hypothalamus, which wants to maintain what’s called the thermoneutral zone. This zone is the range of high and low temperatures at which we feel comfortable. To keep our core body temp within that range, we’ll sweat to cool off, or shiver to warm up. 

In perimenopause, your body’s core temperature often rises. The body starts sweating profusely to cool you down. Sometimes, it can overcorrect, resulting in shivering after. In addition, your skin can break out in red blotches. 

What Can Help: Hot flashes and night sweats don’t impact women universally. Some experience hot flashes once a week, others throughout the day. And they can change over time, beginning in perimenopause and recurring after menopause. 

If these symptoms are frequent and uncomfortable, your doctor might suggest hormone therapy, essentially small doses of estrogen, to help treat them. 

But what can you do to alleviate the more mild hot flashes? Research suggests that in perimenopause, your hypothalamus is overly sensitive to changes in core temperature. Since your core is affected by environmental temperature, a slight increase in external heat can trigger a hot flash. Try these at-home helpers:

• Keep your core temp low. When you get even a little warm, your hypothalamus reads a much higher core temp rise and reacts to get you cool. Dress in layers so you aren’t stuck in a wool sweater. Lower the room temperature by opening windows or lowering the thermostat. Or drink a cold beverage the moment you sense a hot flash starting.
• Beware spicy foods, caffeine, and alcohol. Ingesting hot food or beverages can spark hot flashes by putting your body temp out of its comfort zone. Either avoid these foods and drinks, or prepare yourself.
• Try to de-stress. When you are stressed, your heart rate, levels of cortisol, and blood pressure can increase—causing your core temp to surge. Slowing down and taking steps to lower these metrics is a way to stave off hot flashes. Explore practicing mindfulness or doing breathwork or calming meditations.

Smoking and being overweight are associated with a higher frequency of hot flashes, too. If you’ve considered quitting nicotine, now’s the time! Regular exercise and a balanced diet can help with weight management and may improve your health overall.

Insomnia

You know the scenario: One minute you’re completely out, the next, it’s 3 am and you’re wide awake, mentally reviewing your to-do list. But it’s worse during the whole menopause transition. 

About 10% of adults in the general population have true insomnia. In perimenopause and menopause, research has shown that 1 in 4 women experience insomnia. 

Why It Happens: Estrogen, progesterone, and testosterone play a role in regulating sleep and mood. When those hormones shift during perimenopause, one result is broken sleep. 

What Can Help: Practice good sleep hygiene. Go to bed at the same time each night, shut down devices an hour before bed, and keep your bedroom cool and dark. Avoid alcohol and caffeine, particularly later in the day, to give yourself the best chance for a night of restorative sleep. 

If these at-home suggestions don’t do much, talk to your clinician about other options. One is hormone replacement therapy to balance your estrogen and progesterone. Another is boosting your melatonin levels with a supplement. Melatonin is another hormone that’s key to circadian rhythms, or sleep regulation. It decreases as we age. 

Vaginal Dryness and Pain

Perimenopause can usher in problems below the belt. Vaginal tissues may lose moisture and elasticity. This includes the vulva, the area outside of your vagina. When the vagina is dry, it can lead to painful sex and vaginitis, or vaginal inflammation.

Why It Happens: Estrogen helps keep vaginal tissues lubricated and moist. When it wanes, the walls and surrounding area of your vagina become drier and less springy. It can hurt when you exercise, urinate, and have sex. On top of dryness and ouchy sex, vaginitis can tack on burning and itchiness.

What Can Help: Vaginal dryness can be a confusing symptom. Mentally, you might be aroused, but physically, your body is sending a different signal. Vaginal lubricants or moisturizers can help reduce the friction. Over-the-counter (OTC) lubes like K-Y or Astroglide work fine. Or you can try moisturizers like Vagisil or Replens. If you’re not sure, you can talk about sex with your ob/gyn—it’s part of their job!

Staying sexually active can actually be helpful, as it maintains blood flow to the vagina. Which in turn keeps vaginal tissue moist and healthy. Of course, you don’t need a partner for this. You can use a vibrator or clitoris stimulator for a similar effect.

If an OTC product isn’t doing the trick, ask your doctor about other solutions. They might suggest low-dose estrogen creams, rings, or suppositories. These are applied directly to the vagina, where the estrogen is absorbed by the vaginal tissue. 

Whether from dryness, burning, itchiness, or pain, persistent discomfort warrants a visit to your ob/gyn. You’ll want to rule out other possible conditions, like a yeast infection, virus, sexually transmitted infection, or allergic reaction.

Mood Changes

It’s kinda wild when you consider you’ve been dealing with PMS for, oh, decades. Now you can get PMS-like symptoms, but instead of just a monthly visit, they can show up any time! Some 40% of perimenopausal women deal with mood swings, irritability, extreme emotional sensitivity, poor attention span, and low energy.

Why It Happens: It starts with an F but it’s not a four-letter word (though you might feel like uttering one). Yep, fluctuating hormones are to thank for fluctuating emotions.

Why aren’t these symptoms on a schedule, as they are with a typical period? Well, your periods may no longer be typical. And even if they are, the overall vacillation of hormones means moodiness can strike at any moment. 

What Can Help: Keeping your body moving is good for your mind. In fact, exercising for 50 minutes at least four times a week has been shown to alleviate mood swings and other perimenopausal symptoms. Same for help-me-relax techniques, such as deep breathing. Being aware of your heart rate, breathing, and muscle tension can help you track and decrease your stress.

You’ll also want to fill your plate with foods that don’t trigger stress hormones like cortisol and adrenaline. Be sure to stock up on healthy proteins including organic meats and poultry, vegetables, fruits, and whole grains.

Depression and Anxiety

When you’re depressed, you’re more than just sad. You may experience feelings of hopelessness, worthlessness, or numbness. You might not be interested in doing the things you normally love. 

Anxiety is associated with ruminating, or constant worrying. Beyond the mental anguish, this can lead to muscle pain, stomach upset, and sweating. Both anxiety and depression make it hard to concentrate and sometimes even practice self-care.

Why It Happens: If you have a history of anxiety or depression, be aware that perimenopause can trigger their return. In fact, research shows this can be the top predictor for depression during this time. The theory? If you’ve had earlier episodes of anxiety or depression, you’ve demonstrated a physiological sensitivity to hormonal changes. 

What Can Help: First off, know that you are not alone. And that what you’re experiencing isn’t uncommon. Reach out to family and friends for support. Ask your ob/gyn about managing your symptoms. They might suggest antidepressants.

A mental health pro will have even more suggestions. For one, it’s really nice having someone nonjudgmental to talk to. They can also teach you evidence-based techniques for getting through hard moments. And offer ways to keep up your hygiene when even showering seems like too much effort.

Memory Loss and Brain Fog 

“Memory loss” sounds scary. But it mostly shows up during perimenopause as general forgetfulness and trouble remembering names. Brain fog is mostly related to concentration issues. Not fun, but they usually clear up once you’re in menopause.

Why They Happen: Estrogen and brain function—what the what? Estrogen is a neurotransmitter. Researchers suggest that when its levels wobble, brain function is interrupted, resulting in cognitive issues.

What Can Help: We wish we had some specific offbeat tip, but the usual stuff applies: Stay active (physically and socially), do mental exercises (yes to the Wordle!), prioritize sleep, and eat a healthy diet. If memory gaps or brain fog are concerning or more serious, speak with your doctor right away.

Whether you’ve got just a few symptoms or the whole shebang (in which case, we’re so sorry!), the most important thing is to reach out to your ob/gyn about anything that makes you go hmmm. They can assess your overall health, and make sure your body is moving through this life phase as best it can. Plus, relief! No need to bear all the aches and annoyance when there’s treatment available.

Simple Ways to Chill Out

Did you know that external toastiness can trigger a hot flash, too? Set yourself up to keep your cool.

At work: Dress in layers, even if it’s frigid outdoors. When you feel the heat coming on, you can pare down quickly.

At home: Lower the thermostat or open the windows. Sleep with a circulating fan to keep air moving.

On the go: Carry an insulated water bottle with you. Drinking a cool beverage can help minimize a flash.