Perimenopause Signs

Understanding the Early Signs of Menopause

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Perimenopause literally means the time “around” menopause. It's a term used by medical providers to describe the beginning of the estrogen decline which leads to menopause. Many women also use the word to describe premenopausal symptoms.

When Does Perimenopause Start and End?

Perimenopause begins with the first signs or symptoms of menopause. For some women, this is as early as their thirties. By their mid-forties, most women notice at least occasional signs that their estrogen is beginning to decline.

Officially, perimenopause ends with the diagnosis of menopause. This is when you’ve had twelve consecutive months without a period.

What Causes Perimenopause?

As your ovaries change and are less able to produce estrogen and progesterone, your body responds. This may be subtle at first and become more noticeable as you approach menopause.

Your hormone levels can fluctuate wildly during perimenopause, dipping and even rising to higher levels than before. You will have your own unique response to these changing levels, depending on how variable they are and how sensitive you are to changes. Some women notice symptoms at the first small variation and others never have symptoms at all.

What Are the Usual Signs of Perimenopause?

There are several clues that women commonly notice when they are in perimenopause:

  • Changes in Menstrual Cycle. Often, the first sign of your upcoming menopause is a change in your menstrual cycle. This may include shorter or longer cycles, heavier or lighter periods, or irregular periods. The most common change is a shorter cycle.
  • Hot Flashes. Now and then, you may notice a hot flash or night sweat that comes out of the blue. This may be your first sign of waning estrogen. You may also notice that these occur along with changes in your cycle.
  • Vaginal SymptomsIf sex becomes more painful or you become more susceptible to urinary tract infections, you may be losing some of the natural lubrication that estrogen and progesterone provide. For some women, this is an early sign that menopause is on the way.
  • Trouble Sleeping. Some women are unaware of any menopause symptoms until they start losing sleep. You may have trouble falling asleep, staying asleep, or you may wake with night sweats. Some women notice that they seem to wake at exactly the same time each night or early morning and can’t get back to sleep.
  • Mood ChangesYour mood may be unpredictable as you move into perimenopause. Usually, this is an unexplained sadness or irritability. You may find yourself feeling "PMS-y," but not at the usual time of the month.

Is It Perimenopause or Something Else?

It's difficult to tell on your own if you're experiencing perimenopause or if your symptoms are the result of some other condition.

If you are having symptoms that seem like those of menopause and you are over 35, it could very well be perimenopause. If those symptoms disrupt your life, make an appointment to discuss them with your healthcare provider. If they are subtle or not too bothersome, talk to your provider at your next annual exam.

Since many symptoms of menopause can also be signs of something more serious, discuss any symptom that worries you with your provider. Be sure to check with your doctor if you:

  • Are bleeding heavily with periods or after sex and this has not been evaluated before.
  • Notice recurring heart palpitations.
  • Have abdominal pain.
  • Are short of breath, weak, or have any numbness.
  • Are feeling extraordinarily overwhelmed, anxious, or extremely “down.”
  • Are worried about any symptom you have because it is new for you.

If I Think I’m In Perimenopause, What Should I Do?

If you suddenly realize that something you are experiencing is related to menopause, don’t panic. This is, after all, a natural event — just like puberty. True, it means that you are beginning a change. But it is also a perfect opportunity to take your health seriously. When you enter perimenopause you can:

Consider Your Health. If you haven’t made your health a priority in your life up until now, this would be the time to start. Think about how you want to feel in 10 years. What activities will you want to take part in? What will your body need in order to do those things?

Start a plan for your “healthy self” with the first sign of menopause. You know what changes you’ve wanted to make. Use this as your signal to start.

Consider Pregnancy. If pregnancy is not how you want to spend your perimenopause, remember birth control. Just because your estrogen is beginning to slide does not mean you can’t get pregnant. Although you are probably less fertile than you were a decade ago, many women have “surprise” pregnancies in perimenopause.

Sexually transmitted disease is also a risk if you are not in a steady, monogamous relationship. Protect yourself.

Keep a Calendar. Whenever you are beginning a change in your body, it helps to keep track of it. Not only does it give you reliable information about what’s happening and how often, it serves as a reality check for you.

If you see that you’ve been without a good night’s sleep for five nights running, you will understand why you are having trouble concentrating at work. A perimenopause calendar is a great tool for tracking your progress and symptoms. Keep track of your menstrual cycle, noticeable symptoms, life events, and the remedies you try. Take it with you to your next doctor’s appointment.

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Article Sources
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  1. Office on Women's Health. Menopause basics. Updated March 18, 2019.

  2. American College of Obstetricians and Gynecologists. Perimenopausal Bleeding and Bleeding After Menopause. Updated November 2018.

  3. The North American Menopause Society. Menopause 101: A primer for the perimenopausal.