Medically reviewed by Dr. Tamara Neuhaus MD
Nancy couldn't decide if it was the knee pain or the exhaustion that was making her dread her weekly doubles tennis match. Veronica found herself struggling to focus on what her colleague was saying because her heart was racing and she felt dizzy. Rachel couldn’t explain the tingling in her feet, but she was sure it’s what caused her to trip and fall twice at work this week.
Even if they had confided in each other about the changes happening in their lives, these three women probably wouldn’t have guessed that they were all experiencing the same thing: perimenopause. And here's why:
There are over 20 symptoms associated with perimenopause. And a lot of them masquerade as “signs of aging,” So it can be hard to tell what's what. Plus, the symptoms can be shifty, unpredictable. Some cycle in and out over a decade while others will set up camp and stay for a few years. Your perimenopause “cocktail” will be totally unique to you in every way. And just when you think you’ve got a handle on it, it will probably change.
But wait, there’s more uncertainty: You won't know which symptoms you'll have or how severe they’ll be until they arrive. Lynn sailed through menopause with nary a hot flash. Her 48-year-old daughter, on the other hand, is certain she could power a small factory with her hot flashes and has cried at the drop of a hat for the past six months.
And then there’s the fact that traditionally, women haven’t talked openly about their perimenopause experiences. Either because they feel embarrassed (let’s face it, some of the symptoms can be pretty personal—vaginal dryness, we’re looking at you) or because they haven’t had enough information about perimenopause at their fingertips to help them understand that it could be at the root of their symptoms. And why is that? Because it’s a phase of life that has received very little attention from our medical community, even though it has far-reaching implications on women’s health. This is exactly why we’re focusing our attention on it at The Cusp.
So let’s take a look at the smorgasbord of perimenopause symptoms. Better yet, let’s talk about them.
These are familiar tropes because we've heard about them in pop culture, or because they're the same symptoms we've always associated with periods, PMS, and womanhood in general.
Your cycles may become unpredictable. Regular—or even super—tampons might not stand a chance against your flow anymore. You could bleed for twice as long as usual. Your periods could become much lighter. They also may space out or skip months altogether. They may come closer together, making you feel like you are always on your period! Or all of the above. Not entirely unlike your periods during puberty. And you lived through that. You’ll live through this.
Your body's thermostat becomes hypersensitive during menopause. So it may respond to small shifts with surges of heating (flashes) or cooling (sweats) to bring your temperature up or down. These can be so intense that you have to peel off clothes (or if that’s not situationally appropriate, step outside) or change bedsheets in the middle of the night. Or they could be just mildly annoying.
Many women say things like, "I don't recognize myself." Either because they're crying all the time, bursting with rage, or feeling unmotivated and disconnected from the things they love. The people on the receiving end of this moodiness are often the ones we care about most, including ourselves.
Maybe you’re having a hard time remembering important details at work, or articulating your thoughts in conversations. Or finding your car keys—or your car—if you’ve been in the grocery store long enough. Forgetfulness can wreak havoc on your productivity and your confidence. A sister to Forgetfulness is Brain Fog. It’s exactly what it sounds like. A groggy, slow-motion state of mind that feels not unlike a reaction to allergy meds.
Perimenopause can leave you struggling to fall asleep, stay asleep, or wake up in the morning. This could be a straight-up symptom on its own or a by-product of other menopause symptoms like night sweats or having to pee more often. And it could play into your mood swings and forgetfulness. All that said, there could be factors outside of perimenopause that are keeping you awake, like the general stresses of life. But the headline here is that you’re not getting the sleep you need. Luckily, there are many ways to fix that.
You may actively not want to have sex (as in, I'd rather clean my bathroom grout than have sex with my partner), or it just might not be on your radar anymore. Again, this could be a direct symptom of perimenopause or a reaction to other symptoms we’ll touch on later.
Estrogen impacts your metabolism. So as it starts to dissipate, your metabolism slows. Not only may you find yourself putting on weight, but you're also unable to lose it with the same diet and exercise tricks that worked for you in the past. You also may notice you’re gaining weight in places you never did before (the dreaded perimenopause belly).
Once you’re in the perimenopause trenches, you start to get a little more familiar with other ways your dwindling or erratic hormones are manifesting themselves. Maybe you’ve talked to your doctor or asked a close friend, sister, mother or aunt about them. Maybe you’ve googled them. Maybe you’re just connecting the dots on your own, in which case, bravo, you!
Well, this could help explain your recent loss of libido (see above). Or, you may still really want to have sex, but your vagina hurts enough on its own—sex would just send you over the top. Even if we take sex off the table (or wherever), the itching, burning and watery discharge associated with this symptom can make your day-to-day experience pretty unpleasant.
Speaking of ouch, sex during perimenopause can also get painful if your uterus or bladder has started to drop a little lower in your pelvis—a phenomenon called prolapse. This happens when the muscles that usually hold those organs in place start to weaken, which is aggravated by—you guessed it—lack of estrogen.
If you have experienced an uptick in headaches or migraines during your periods, they’re probably hormone-induced. So you may find relief once those hormones are depleted on the other side of menopause. That said, you’ve got to make it through perimenopause first, and the erratic hormone surges associated with it. Those surges could even trigger hormonal headaches in women who have never had them before.
So, you’ve got your declining estrogen levels which can cause your skin to become dry, itchy and less elastic. And you’ve got your growing testosterone levels which can cause acne. It’s a dermatological double whammy that may leave you asking your body, “What, you couldn’t come up with something more original than acne? BTDT.”
Thinning hair on your head. Unwanted hair on your face. Really? Both? Here’s what’s up with that: Estrogen and progesterone help your hair grow faster and stay in your scalp longer. Conversely, as these hormones decrease, your hair grows slower and falls out faster. At the same time, your ratio of androgens—male hormones—increases. Hence the little whiskers and peach fuzz popping up on your face.
Estrogen, that wonder hormone (honestly, how do men get by with so little of it?), helps reduce inflammation. So as your supply decreases, you may start to notice old joint injuries start to hurt again. Or new aches and pains may crop up.
All our lives, our bodies are both building new bone and breaking down old bone. But when there’s not as much estrogen building new bone, there’s more breaking down than building up. Unless you get a bone density scan, often the only way to know you’re losing bone mass is when a seemingly minor fall or bump breaks a bone, or when vertebrae collapse causing back pain, stooped posture or loss of height.
Tender breasts, bloating, and constipation can stay with you during perimenopause, as you’re still having periods. And they may intensify with the hormonal surges. One of the best things about reaching clinical menopause (the one year anniversary of your last period): these all go away.
While perimenopause isn’t known to cause clinical depression (characterized by a chemical imbalance in the brain) women with a history of clinical depression—even postpartum depression—tend to be vulnerable to more episodes during perimenopause. And women in this phase of life with no history of depression may still struggle with feelings of depression. But look at what we’re dealing with: changes to our bodies—many unwelcome at best and painful at worst, identity crises, sleep issues, all coinciding with stressful life changes like increased career demands and caring for both children and aging parents. It’s hardly surprising!
If you’re prone to anxiety or panic attacks, you’re more likely to experience them during perimenopause than women who aren’t. If you’re just prone to worry, that tendency may tip into anxiety. Many women report having their first run-ins with panic attacks in their mid-forties to fifties, and they tend to be related to outside factors like stressful life events other existing health issues. But let’s be honest, there’s a lot to stress out or be anxious about at this point in your life.
Hormone fluctuations can impact your energy levels. So can the sleep issues that accompany perimenopause, which are often caused by other perimenopause symptoms, like night sweats, joint pain, etc.
Also known as arrhythmia, occasional heart palpitations aren’t uncommon during perimenopause. They can feel like a quick flutter or an erratic series of beats. They usually last a few seconds—sometimes a few minutes—and generally are not something to worry about. But it’s a good idea to tell your doctor about them, especially if they happen often.
Very little is understood about the link between dizziness and perimenopause, but it’s a commonly reported experience for women in this life phase. Since there are other causes of dizziness, it’s wise to let your doctor know if you’re experiencing it.
When estrogen goes MIA the tissues that line your urethra—that little pipe that connects your bladder to the outside world—start to get thinner. Also, the muscles that support your urethra and bladder start to weaken. All this can limit the amount of urine you can hold and the duration you can hold it. As a result, you may find yourself having to pee way more often, including multiple times during the night (hello again, sleep issues). And when you gotta go: You. Gotta. Go. Or you may notice that when you laugh or sneeze or cough, a little bit of pee leaks out. Same thing might happen when you lift something heavy. Basically anything that puts stress on your bladder can cause a wee accident (see what we did there?).
Maybe you’re extra embarrassed about these. Or they just seem so unrelated to perimenopause that you haven’t thought to google them as possible perimenopause symptoms. Or there’s simply not much information or understanding about how they link to perimenopause. But they’re real. So we’re talking about them.
You know that pins-and-needles feeling when your foot “falls asleep” after being in an awkward position for too long? Sometimes that happens during perimenopause, only without the awkward position phase. It’s called Paresthesia. In itself, it’s not dangerous. But it could cause you to trip and fall. And if you’re losing bone mass, you could be looking at a broken bone. Since tingling extremities could also be an indication of fibromyalgia or stroke, you’ll want to let your doctor know about this symptom.
Asthma, hay fever, and eczema can start-up or get worse as your hormone levels drop. Researchers aren’t sure why, yet. But estrogen’s role in controlling inflammation is likely involved.
Estrogen, progesterone, and cortisol all play a role in moderating our stress levels. So as estrogen and progesterone levels dip, the balance can be thrown out of whack. As a result, your body could constantly react as if it’s under stress, causing your muscles to remain tense or stiff. So add that to your list of reasons to take up/do more yoga.
No, you’re not crazy. Nor are you weird. Nor dirty. Our bodily secretions change as our hormones give out on us, both in pH levels and volume, what with hot flashes and urinary incontinence. From armpits to cleavage to vagina to feet, things can start to smell funky. At the same time, perimenopause can make your own sense of smell more acute. So it’s possible that you’re the only one noticing the change in your personal bouquet. Well, you and possibly your perimenopausal besties.
If looking at these lists freaks you out, take a deep breath and remember: you’re not going to get ALL of these symptoms. And the ones you do get? They won’t last forever. Most women experience symptoms up until about four years after their last period. And by then, they’re more intermittent and less disruptive. Better still, there are treatments that can tame every symptom listed above. And coming out on the other side of menopause does have its benefits. You never have to buy (or use) tampons again. Cramps—history. Breast tenderness—gone. Unexpected pregnancy—not gonna happen. And a lot of women speak of feeling much more confident during this second half of their life. That’s a symptom that shouldn’t just be talked about; it’s one we should shout from the rooftops.