Of all the stages of a woman’s reproductive life, perimenopause may be the most confusing. It’s difficult to know for sure when it’s starting, what your symptoms mean and when it shifts over to actual menopause.
“Women can start to notice some symptoms of perimenopause as early as their 30s,” says Rajita Patil, M.D., an ob/gyn and director of UCLA Health’s Comprehensive Menopause Care program. “But the symptoms are so varied that many women — and even their doctors — don’t recognize them as signs of perimenopause.”
Realizing that your symptoms may be related to changes in your menstrual cycle is the first step to getting the relief you need.
How do I know if I am in perimenopause?
Perimenopause is a transitional phase that can begin in your 30s, 40s or 50s and last for several years — ending when you hit menopause.
“The definition is based on the regularity of your periods,” says Dr. Patil. “If you are someone who has had a very regular menstrual cycle for years and suddenly your period is off by several days, that’s an indication of perimenopause.”
Of course, for some women, irregularity is the norm. And for others, regularity is due to hormonal birth control methods. “Using hormonal birth control really masks perimenopause,” says Dr. Patil.
And while there is no definitive test to tell you if you’re in perimenopause, your levels of follicle-stimulating hormone (FSH) provide a clue. “At levels over 25, we start to think it may be perimenopause,” she says, “and if they’re 50 or more, it is most likely perimenopause.”
What are the signs of perimenopause?
Your first indication will likely be periods that become less predictable. But there are numerous other symptoms that may stem from the hormonal shifts of perimenopause. “Your sensitivity to the natural drop in estrogens before your period increases,” says Dr. Patil. “So it’s not unusual to experience more mood symptoms, PMS and fatigue at that point in your cycle.”
As you transition through perimenopause toward menopause, hormone levels continue to decrease. “And because there are estrogen receptors throughout the entire body, declining levels can cause symptoms throughout the entire body,” says Dr. Patil. Lower estrogen levels can impact your brain, heart, joints and muscles, bladder, skin and hair.
There are plenty of well-known symptoms that start in perimenopause and peak as you transition to menopause. Hot flashes, night sweats, vaginal dryness and mood swings are the ones everyone talks about. But several lesser-known symptoms can also be attributed to the hormonal shifts of perimenopause. These include:
- Anxiety and depression (worsening or new onset)
- Brain fog and fatigue
- Drop in libido
- Heart palpitations
- Hair loss
- Insomnia
- Joint pain
- Muscle aches
- Needing to pee more frequently (and urgently)
- Skin changes (dryness and wrinkling)
Why it’s important to see your doctor about perimenopause symptoms
Perimenopause symptoms can range from mildly annoying to debilitating. But they only tell part of the story. “Fluctuations in estrogen impact our organ systems,” says Dr. Patil. “It’s not just about dealing with symptoms in the moment. It’s just as important to look at the bigger picture for our long-term health.” As women transition to menopause, their risk of several diseases — including osteoporosis and heart disease — increases.
Too many women write off their symptoms or just tough it out. But it’s important to bring them to your doctor’s attention. Dr. Patil recommends keeping a journal of symptoms, tracking when they occur and how the timing relates to your periods. This information can help your doctor identify how symptoms might line up with hormonal shifts.
“Don’t suffer silently,” says Dr. Patil. “Recognize what’s going on and then advocate for the care you need.”
How to get relief from perimenopause symptoms
Hormone therapy to bolster dropping hormone levels can improve hot flashes, mood, joint pain, sleep and protect your bones. But hormones aren’t the only solution for perimenopausal issues.
Other very effective nonhormonal medications can target specific symptoms too— such as fezolinetant for hot flashes. “If we fix hot flashes, that can often help fix sleep, improve mood and reduce brain fog,” says Dr. Patil.
Even without medication, there are steps you can take to relieve symptoms and protect health. “As you reach perimenopause, your diet, exercise and sleep habits become even more important,” says Dr. Patil. Lifestyle modifications can help you:
- Prevent weight gain: Weight gain is common during perimenopause. So is redistribution of fat so that more of it lands around your middle. How you eat, sleep and exercise all play into helping stave off these changes.
- Boost bone strength: You still need at least 150 minutes of moderate intensity aerobic activity each week (such as swimming or walking). But to truly protect your bones and prevent osteoporosis, you also need to lift weights and make sure that some of your aerobic exercise provides enough impact to put pressure on your bones (such as running or jumping).
- Protect your heart: Eating a heart-healthy diet includes lots of fruits, vegetables, whole grains and lean (preferably plant-based) proteins.
- Get good sleep: Sleep is a vital part of your day, and as you get older, it becomes even more important. If good sleep is elusive, Dr. Patil recommends trying mind-body relaxation techniques (like yoga or meditation).
Whatever symptoms you start noticing, it’s important to pay attention to them. With the right information — and the right treatments — you can make this transition much smoother.
