Perimenopause symptoms: All you need to know

Perimenopause is the time when a woman’s hormones start to fluctuate thus beginning the transition to menopause. Experts state that perimenopause can be anywhere between 2-10 years before your final period. You have reached natural menopause when you have not had a menstrual cycle for a full 12 months following which you have entered the postmenopausal stage of your life.

Although every woman has her own unique set of responses to this naturally occurring stage of life it helps to be aware of the facts and to understand where life circumstances, personal expectations and the natural ageing process cross over.


Perimenopause Common Symptoms Include:

Hot flushes are as a result of oestrogen fluctuations and gradual decline which disturbs your body’s thermostat.

Night sweats are hot flushes occurring at night.

Irregular Periods are determined as any alteration to your normal menstrual cycle.

Vaginal dryness - declining oestrogen causes your vaginal walls to become thinner, dry and less elastic and disrupts the natural lubrication process.

Mood swings - the decline in oestrogen and other hormones occurring during perimenopause directly affects the neurotransmitters in your brain.

Loss of libido is affected by fluctuating hormones, ageing and physiological and psychological problems.


Changes that may occur in Perimenopause include:

Fatigue sometimes referred to as ‘crashing fatigue’. Sudden and overwhelming feeling of reduced energy levels, weakness and exhaustion.

Insomnia exacerbates other menopause symptoms such as mood swings, hot flushes, heart palpitations and irritability.

Concentration difficulties - as oestrogen has many positive effects on the brain, declining oestrogen can lead to a decrease in cognitive function.

Hair Loss - declining hormones cause the production of the adrenal cortical steroid (androstenedione) to become more prevalent causing hair to become thinner.

Dizziness - oestrogen affects the nerves in your body so if lower levels are supplied to the brain this can cause dizziness.

Memory Lapses - ‘brain fog’ is most acute during the early period of postmenopause.

Bloating is related to an increase in water retention and/or intestinal gas caused by fluctuating hormones.

Weight Gain - often referred to as ‘unexplained weight gain’ or ‘middle aged spread’, caused by changing hormone levels. This is a mixture of actual weight gain and/or a shift in body shape.

Bladder Incontinence - oestrogen is responsible for keeping the bladder lining, the urethra and the pelvic region healthy, therefore, reduced oestrogen causes the pelvic muscles to weaken.

Changes in body odour - declining oestrogen sends a false message to the hypothalamus (body temperature) telling your body that it is overheated, resulting in an increase in sweat production.

Brittle Nails are increased by hormone changes weakening the keratin layer, resulting in nails that tear more easily.

Allergies - fluctuating hormones put pressure on your adrenal glands, this extra pressure can lead to adrenal fatigue, which can make you more susceptible to allergies.

Depression - between 8-15% of women experience some level of depression due to constantly changing hormone levels.

Anxiety can be attributed to the physical changes that women encounter during perimenopause, particularly if a woman has experienced symptoms of anxiety disorder in the past.

Panic attacks - women experience panic disorder most frequently during PMS, pregnancy and menopause. Medical experts have concluded that hormone imbalance is most typically the underlying cause.

Heart palpitations, irregular heartbeat or pounding pulse episodes can sometimes be accompanied by hot flushes and night sweats or stress and anxiety.

Irritability occurs in both perimenopause and postmenopausal women due to the emotional and physical effects of the transition towards menopause and beyond.


Pains that may occur in Perimenopause include:

Headaches - due to fluctuating hormone levels, hormonal headaches can trigger an increase in migraine.

Muscle pain and tension - as muscles, tendons and bones all have oestrogen receptors, they become weaker due to a lack of oestrogen which can cause these part of the body to become painful, sore and tense.

Breast pain/tenderness is the result of hormonal changes and can occur at any time with a peak incidence between 30-50 years, covering both childbearing and perimenopause.

Electric shock sensation - there is a range of sensations and although it can happen at any time, it is known to occur immediately before a hot flush.

Gum problems can become more prevalent postmenopause and is associated with both declining oestrogen and the natural ageing process.

Digestive problems are caused by hormonal imbalances which has an effect on gas, constipation, IBS and bloating.

Joint pain - oestrogen positively affects joints by keeping inflammation under control, therefore, as oestrogen levels decline, pain is often the result.

Burning mouth syndrome - burning tongue usually affects women in postmenopause. Oestrogen plays a role in the formulation of saliva, therefore, once oestrogen levels decrease, researchers believe that this can cause burning mouth.

Itchy skin - as oestrogen plays a key role in maintaining healthy skin, declining oestrogen can cause skin to become itchy, dry and crawly.

Tingling extremities is defined by numbness and pins and needles sensation in the extremities (hands and feet). It presents due to hormone shifts affecting the nervous system.

Osteoporosis becomes more prevalent postmenopause. The breakdown of bone outpaces the building of new bone due to the decline in oestrogen and progesterone. This is a serious condition which can lead to severe health problems.


You will find more in-depth information about the symptoms of menopause and associated women’s health concerns at Menopause Health Matters.

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