Perimenopause is the phase leading up to menopause, during which a woman’s body begins to undergo hormonal changes as it transitions out of the reproductive years. This period, which typically starts in a woman’s 40s, but can begin earlier, and may last for several years. Understanding the signs and symptoms of perimenopause is crucial, as they help women prepare for and manage the physical and emotional changes that come with this life stage.
1. Irregular Periods
One of the hallmark signs of perimenopause is changes in the menstrual cycle. Periods may become irregular, with variations in the length of cycles, heavier or lighter bleeding, and missed periods. At first, these changes occur because the ovaries do not consistently release an egg every month, leading to low progesterone levels. In turn, the pituitary gland increases the production of a hormone called FSH in an attempt to get the ovaries to ovulate more regularly. This increase in FSH at first causes the ovaries to overproduce estradiol which leads to a shortening of the time between periods. The increased estradiol levels also lead to heavier periods that can sometimes be prolonged. Eventually the ovaries can no longer respond to the elevated FSH levels leading to a gradual decrease in the production of estrogen. Eventually, menstruation stops altogether, signaling the onset of menopause.
2. Mood Swings and Irritability
The hormonal changes during perimenopause can have a significant impact on mood. Many women report experiencing mood swings, anxiety, irritability, or even feelings of sadness and depression. These emotional changes can be particularly challenging and may sometimes be mistaken for other mental health conditions. Fluctuating estrogen levels and decreased progesterone levels are believed to play a key role in these emotional shifts.
3. Sleep Disturbances
Hormonal changes can also affect sleep patterns. Many women going through perimenopause experience difficulty falling asleep or staying asleep, often due to night sweats or anxiety. This lack of restful sleep can lead to feelings of tiredness during the day, contributing to further irritability and difficulty concentrating. This is due to the declining progesterone levels.
4. Hot Flashes and Night Sweats
Hot flashes, or sudden feelings of warmth, often accompanied by sweating and flushed skin, are a common symptom of perimenopause. These can last from a few seconds to several minutes and may happen multiple times a day. When they occur at night, they are known as night sweats and can disrupt sleep, leaving women feeling fatigued and irritable. These symptoms are caused by hormonal fluctuations that affect the body’s temperature regulation.
5. Vaginal Dryness and Decreased Libido
As estrogen levels decline, many women experience vaginal dryness and discomfort during intercourse. This can be accompanied by a decrease in sexual desire, or libido. Reduced estrogen also affects the elasticity and moisture of the vaginal tissues, making them more prone to irritation and discomfort. These changes may impact a woman’s sexual health and intimacy. It can also lead to a chronic itching or burning sensation in the vagina and the vulva which can lead women to believe they have chronic or recurrent vaginal infections.
6. Memory and Cognitive Changes
Some women report experiencing difficulty concentrating, memory lapses, or a general sense of “brain fog” during perimenopause. These cognitive changes can be attributed to fluctuating hormone levels, particularly estrogen, which is thought to have an effect on brain function. While these changes are often temporary, they can be frustrating and contribute to stress during this transition period.
7. Physical Changes: Weight Gain and Changes in Skin
Perimenopause can also bring about physical changes such as weight gain, particularly around the abdomen along with a redistribution of weight from the hips thighs and buttocks to the abdomen. Slower metabolism, combined with hormonal shifts, may contribute to this change. Skin may become drier and less elastic, and hair may thin or become more brittle due to changes in estrogen and other hormones. Women may also see more facial hair on the chin and upper lip.
8. Breast Tenderness
Many women experience breast tenderness or soreness during perimenopause. This is often due to hormonal fluctuations, particularly changes in estrogen and progesterone levels. This symptom can resemble the breast tenderness felt during premenstrual syndrome (PMS), but it can also occur more unpredictably during perimenopause.
Conclusion
Perimenopause is a natural phase in a woman’s life, but it can bring about a range of physical, emotional, and psychological changes. While some women experience only mild symptoms, others may find the transition more challenging. It’s important for women to understand these symptoms and seek support from healthcare providers to manage them effectively. With the right strategies, women can navigate perimenopause with greater comfort and confidence.
About Elizabeth Case, MD
Dr. Elizabeth Case is a board-certified member of the American Board of Obstetricians and Gynecologists and a certified NAMS provider. A graduate of the University of Kentucky College of Medicine, Dr. Case completed an internship in Obstetrics and Gynecology from Indiana University School of Medicine, where she also served as an assistant professor of Obstetrics and Gynecology.
Dr. Case can be contacted at (859) 258-5220. For help scheduling an appointment, or to find the location closest to you, call (859) 258-4362 or visit LexingtonClinic.com.
