Symptoms of Premenopause

Premenopause takes place before perimenopause, which leads up to menopause. More specifically, it's the time between a person's first period and the onset of perimenopause. Premenopause is not a medically accepted term.

This phase is not characterized by any of the classic signs of menopause, such as hot flashes, insomnia, or missed periods. However, people in this stage will begin to experience some hormonal shifts.

Your menstrual cycle begins to change during perimenopause. It's considered the beginning of your transition to menopause. This is when you start to have the symptoms of menopause.

Frequent Symptoms

You won't experience symptoms during premenopause. Symptoms start in perimenopause. They are a result of the ovaries producing less estrogen.

When you enter perimenopause, you may experience the following:

• Irregular, heavier, or longer periods
• Hot flashes and night sweats
• Insomnia
• Heart palpitations
• Headaches
• Vaginal dryness
• Breast tenderness
• Acne flare-ups

Complications

Symptoms don't usually start in premenopause, so it's not associated with complications. The symptoms of perimenopause, however, are serious and life-changing.

Complications of perimenopause can include:

• Vaginal infection or urinary tract infection: Insufficient lubrication can lead to the ripping of tissue, allowing bacteria to enter your system and cause infection. 
• Urinary incontinence: Nearly 70% of women in a large-scale national study reported monthly or more frequent urinary incontinence (at least once over the first nine years of follow-up, they had leaked urine, even a small amount during the month before each annual visit). This means you may "leak" when laughing, sneezing, being startled, or exercising.
• Decreased sexual desire: Be gentle with yourself during this transitional period, and be open and honest with your sexual partner about how you are feeling.

When to See a Doctor

Premenopause is generally not accompanied by symptoms. If you’re not sure you have reached perimenopause but suspect so, contact your doctor to discuss symptoms and seek a diagnosis to rule out other potential causes for your symptoms.

Beyond diagnosis, there will be some other situations that call for medical help, such as:

• Vaginismus: When anxiety or pain is causing you to tense up before, during, or at the thought of sexual intercourse, it can lead to additional tightening, squeezing, and even spasming in your pelvic floor muscles. It makes penetration even more difficult. Talking to a doctor, mental health professional, or sex therapist can help you develop strategies to overcome that.
• Life disruption due to vaginal dryness: If dryness is distracting, such as if you're so itchy you can’t focus or it's so painful you can’t enjoy everyday activities or sex, tell your doctor so they can advise you on options tailored to your personal health. These might include lifestyle changes, appropriate lubrication options, or hormone therapy. 
• Sleepless nights: Not sleeping contributes to additional health concerns like memory impairment, a lower quality of life, relationship issues, and depression. One study of 2,800 participants found that some 97% reported sleep difficulties during depression and 59% indicated that poor sleep significantly affected their quality of life. Try keeping a sleep diary for a few nights to show your doctor. They can use it to help assess the full picture and suggest what may work better for you. 
• Feelings of anxiety or depression: Feelings of anxiety and depression should never be ignored. Talking to your doctor about your mental health during perimenopause is essential in ensuring you receive what you need.

Summary

You won't experience symptoms during premenopause. There's generally nothing to worry about in terms of menopause during this time. Symptoms of menopause like hot flashes and insomnia only start popping up after you enter perimenopause.

A Word From Verywell

Premenopause is the time between your first period and the onset of perimenopause. Symptoms of menopause only start during perimenopause. It can be difficult for loved ones who have never been through the menopausal transition to really understand what's happening once you enter this next stage and what you're experiencing. Talk to them. If you're still struggling to find support, reach out to mental health professionals. You do not need to go through this alone.