You’ve probably heard of menopause, which officially occurs the year after you completely stop having a period. There’s a transition period before menopause that a lot of women experience called perimenopause. This is a time when perimenopause symptoms start to crop up even though you feel like you’re much too young for that nonsense.
While some women have a completely smooth transition into menopause, others don’t. Some people wrestle with any combination of mood symptoms, unpredictable periods, heavy bleeding during periods, cramping, or unexplainable weight gain. It’s a cluster of extremely frustrating symptoms that can leave you feeling tired, irritable, and a bit like you’re losing your mind as the brain fog sets in…
Perimenopause symptoms can present differently for each person. Here's a short list of common symptoms. In this article, we will take a much deeper look at what happens during perimenopause and how to support your body through the transition.
- Hot flashes
- Infrequent or absent periods
- More frequent periods (shorter cycle)
- Weight gain
- Hair loss
- Mood swings
- Changes in skin and hair texture
- Low libido
What Happens During Perimenopause?
As we age, our ovaries stop ovulating regularly, and hormone levels start to decline. Because the ovaries don’t just flip off like a switch, their slowdown can come with a gradual onset of symptoms. You can still get pregnant during perimenopause, as you’re still ovulating, albeit less often.
What Is The Average Age For Perimenopause?
The average age for menopause is 51. Perimenopause typically begins between 4 and 10 years before menopause. Perimenopause is considered “normal” if it starts after age 42. Before then, your doctor will likely consider it premature and investigate other reasons for the onset of symptoms.
Early menopause is estimated to occur in 1 out of 100 women.
If you are younger than 42 and your doctor indicates perimenopause in your chart, or tells you you’re going through perimenopause without investigating the cause, ask why. Some doctors aren’t concerned with aberrant menstrual patterns or symptoms if you’re not trying to get pregnant. It’s reasonable to request further exploration.
Certain factors, such as smoking history and diet have been shown to affect the onset of perimenopause and menopause.
If you’re not quite there yet, keep in mind that your time in the perimenopause to menopause transitional stage can reflect your reproductive health while menstruating. It’s crucial to get to the root cause of any current period problems to help mitigate future struggles.
What Does Perimenopause Feel Like?
For some women, the years before menopause are unremarkable in terms of symptoms and discomfort. For others, it can be a rollercoaster of emotions, pain, and despair. The physiological symptoms caused by the decline in hormone levels during this time can affect your moods, your mind, your energy levels, your sleep, and more. Women who experience symptoms may feel angry, tired, clumsy, forgetful, anxious, or sad.
It’s common for women to struggle with the looming reality that their reproductive years are coming to a close, which adds fuel to an already raging fire.
If you’re feeling mental and emotional distress, please do not hesitate to seek professional support.
Is There A Test For Perimenopause?
Most of the time, your doctor can diagnose perimenopause based on symptoms. Because of menstrual cycle irregularity during the transition to menopause, levels can be challenging to assess in a single blood test. But a few tests done throughout different phases of the cycle may reveal clues to where your levels are.
Tests that can provide clues include:
- Follicle-stimulating hormones (FSH). A test for levels of follicle-stimulating hormones (FSH) is often used to determine if menopause has occurred. When you’re no longer ovulating, there’s no monthly surge in FSH.
- DUTCH test. In my practice, I order dried urine testing (the DUTCH test) to help evaluate levels of hormones as well.
You can read more about when to test hormones here.
What Are The First Signs Of Perimenopause?
Often the first signs of perimenopause can be subtle. Some women report feeling more tired than usual — but who isn’t tired these days? Another common initial symptom is an angry outburst or overreaction with a partner or family member — which can often be dismissed as garden-variety PMS.
Shorter cycles can also be an initial clue that something is amiss as well. Difficulty sleeping, hair loss, and dry skin might be signs that perimenopause is beginning too.
The symptoms of perimenopause are numerous and diverse. While they’re not the same for all women, let’s dig into the most common ones.
Do You Get Hot Flashes During Perimenopause?
This hallmark, dreaded symptom of menopause is so common that it’s become a sitcom cliché and can start in perimenopause. Hot flashes and night sweats can throw you for a real loop when they start occurring. Because the temperature control center for your body is located in the brain, and it’s influenced by hormones, when hormone levels start changing, hot flashes start.
Does Perimenopause Make You Tired?
Feeling tired is a common symptom of perimenopause. Because your ovaries produce fewer hormones, your body turns to the adrenal glands to amp up hormone production. This means that you can start to feel tired, especially if your adrenals aren’t in top form before perimenopause starts.
Also, if you’re struggling with night sweats and insomnia that often accompany perimenopause, you can expect to feel tired the next day. It’s difficult to get a good nights’ sleep when you’re waking up drenched in sweat.
Can Perimenopause Make You Feel Ill?
Some women report feeling sick (and not just sick of perimenopause). They feel almost like they have the flu, with headaches, nausea, and a feeling like they can’t get out of bed. Some women report joint pain as well, so when all of these symptoms are co-existing in your body at one time, you can definitely feel ill.
Why Does Perimenopause Cause Weight Gain?
Another common symptom of perimenopause is weight gain. As we age, metabolism slows, and muscle mass decreases. We often tend to reduce activity levels as well. Plus, if you’re battling some of the more severe symptoms of these hormonal fluctuations and can’t find the motivation to get out of bed, exercise is likely the last thing on your mind.
On top of that, many women in their 40’s and 50’s find themselves in stressful situations — kids leaving for college, marriages becoming complicated, aging parents. These stressors can cause cortisol levels to rise, which contributes to weight gain as well.
In addition to stressors, insomnia and decreased sleep quality leads to an increase in ghrelin (your hunger hormone) which increases hunger and likely calorie consumption.
In a study that followed 485 women aged 42-50, it was found women gained about 5-10 pounds over the course of 3 years. This weight gain was also associated with increases in blood pressure, triglycerides, and fasting insulin levels.
Poor sleep further contributes to higher fasting glucose levels creating further risk factors for difficult blood sugar management.
This weight gain could be a result of changing estrogen levels. Estrogen levels soar in the early stages of perimenopause, and by the latter stages, estrogen fades out. Lower levels of estrogen are associated with insulin resistance, which can cause weight gain.
Changing levels of ghrelin, the hormone that makes you feel hungry, may be to blame for this weight gain as well. Studies show that levels of ghrelin rise in mid-life, which may lead to overeating.
Does Perimenopause Make You Feel Crazy?
If you consider the fact that many perimenopausal women suffer from sleep deprivation, sudden changes in body temperature, mood swings, and weight gain, then yes, sometimes, women in perimenopause can feel like they’re going crazy.
If your symptoms feel overwhelming or begin to disrupt your functioning in everyday life, open a conversation with your doctor.
Can Perimenopause Cause Anxiety?
The fluctuating levels of hormones during perimenopause most certainly can cause anxiety or depression. Studies have shown that even women who are not prone to anxiety are likely to develop it in menopause and the years leading up to it.
Other Common Perimenopause Symptoms
Here’s a list of the possible symptoms of perimenopause (brace yourself, it’s long):
- Hot flashes
- Night sweats
- Painful sex
- Vaginal dryness
- Dry skin
- Dry eyes
- Hair loss or thinning hair
- Hairs growing on your face
- Irregular periods
- Heavy periods
- Shorter cycles
- Weight Gain
- Decreased Libido
- Saggier breasts
- Tender breasts
- Mood swings
- Unexplained crying, or crying that’s disproportional to the situation
- Brain fog
- Difficulty concentrating
- Increased heart rate and palpitations
- Decreased pelvic floor strength
- Urinary tract infections
- Increased cholesterol levels
- Joint pain
How Bad Can Perimenopause Make You Feel?
If you’re experiencing the worst of these symptoms, it can naturally make you feel pretty awful. But take heart. There are many supplements that, when combined with diet and lifestyle changes, can help manage the symptoms and help make the transition to menopause a much less painful one.
Supplements That May Help With Perimenopause
- Black Cohosh may help reduce hot flashes. It’s one of the superstar ingredients in my Balance formula.
- A high-quality probiotic to help support a healthy microbiome, which can help with supporting healthy estrogen levels or when struggling with estrogen dominance.
- Vitamin B complex could help with energy and support the adrenals. Vitamin B6 is also a precursor to serotonin production, which is a neurotransmitter that helps combat anxiety and depression. And, B vitamins may also help with symptoms such as nausea experienced in perimenopause.
- Vitamin C with adaptogens may help support healthy adrenal function.
- Passionflower may help soothe the nervous system and promote a sense of calm.
- Diindolylmethane (DIM) to help support a normal estrogen metabolism in the liver.
- Melatonin to support brain function and to support normal sleep patterns.
- L-theanine to help keep the edge off of stress and feel calmer.
- Maca to help calm hot flashes and support adrenals.
- Saw Palmetto to encourage a normal testosterone metabolism.
- DHEA to address hair loss and thinning hair.
- Zinc to help support normal testosterone levels.
- Omega 3 Fatty Acids and Turmeric to help support a normal inflammatory response.
- N-Acetyl-Cysteine (NAC) to support a healthy mood and antioxidant levels.
- Sulforaphane glucosinolate for liver estrogen metabolism support
- Magnesium Glycinate for bone, muscle and nerve health and also to help with sleep disturbance.
Nutrition and Lifestyle Recommendations for the Transition to Menopause
A little extra attention in the nutrition and lifestyle department can go a long way to an easier transition to menopause.
- Prioritize sleep hygiene. Turn of screens and turn lights down an hour before bed, and read or practice a relaxing activity to wind down. Head back to bead at a regular time each night.
- Take active steps to manage stress and cortisol. Yoga, breathwork, and meditation can help mitigate stress and modulate the extra stress hormones women can have during the transition to menopause.
- Nutrition. Eat a diet that is rich in whole foods.
- Movement. Prioritize regular exercise that you enjoy.
How Do Periods Change During Perimenopause?
During the menopausal transition years, women often experience changes to their period, including:
- Absent periods (You’re officially in menopause when you haven’t had a period for 12 months.)
- Irregular periods
- Heavier periods
- Shorter period (near the beginning of perimenopause),
- Longer period (towards the end of perimenopause)
Do Periods Get Closer Together Before Menopause?
No two women experience perimenopause in the exact same way. While some have periods that are closer together, others have their periods get further apart. Some women even have both — one month their period comes closer to the last, the next month it’s further apart.
It’s important to note that if you regularly have periods very frequently, it may indicate that something else other than the menopausal transition is going on. It’s best to see your doctor make sure nothing more serious is affecting your bleeding.
Do Periods Get Heavier Before Menopause?
Many women do experience heavier periods in perimenopause. In the beginning stages of perimenopause, estrogen levels are high, which means that heavy bleeding is more likely to occur. Also, if your cycle is all over the place, and you didn’t shed your uterine lining last month, it can mean an even heavier flow this month.
In some cases, a condition known as endometrial hyperplasia can develop, which can become problematic and in some instances, cancerous.
Some women have the incredibly frustrating experience of bleeding through a tampon and a pad during this time. They have to diligently change protection every hour. Now is the time to invest in black underwear or period panties, ladies.
What Are The Signs That You Need Hormone Replacement Therapy?
Hormone replacement therapy (HRT) is a medical treatment that aims to replace the loss of sex hormones during menopause with a small amount of hormones. Depending on the circumstances, synthetic estrogen or progestin are used to “replace” the hormones your body is no longer making. While every woman has to make a personal decision regarding HRT when the time comes, it is worth noting that while the traditional medical community once regarded it as a miracle “cure” for menopause, they now caution against it for the potentially serious side effects it can cause.
Some of the ways HRT is administered are:
- Vaginal Rings
Some of the more severe side effects that scientists are concerned about include:
- Heart attack
- Blood clot
- Gallbladder disease
You should not consider HRT if you have or have had any of these issues.
Synthetic Vs. Bioidentical Hormone Replacement
It’s important to note that there are differences in the types of HRT your doctor may recommend. Functional, integrative, or naturopathic physicians tend to utilize bioidentical hormones in their practices. Traditional doctors may offer synthetic hormones instead.
But what’s the difference? Unlike synthetic hormones, bioidentical hormones are chemically identical to those your body produces. They are used to replace what you’ve lost and to help mitigate symptoms of hormone deficiency.
Be sure to bring up the difference with your physician, as some reviews suggest that bioidentical hormones tend to produce greater patient satisfaction and decrease the risks and side effects outlined above.
You can read about bioidentical progesterone cream here.
Can A Woman Orgasm After Menopause?
A great sex life is still achievable in perimenopause and beyond.
The hormonal changes experienced during this time may present some challenges. Dropping estrogen levels mean vaginal dryness, decreased pelvic floor muscle strength, vaginal atrophy, and less sensitivity in the clitoris. Declining levels of testosterone can mean lowered libido. So several things are working against sexual pleasure at this stage in the game.
However, many women find that with a regimen of pelvic floor exercises, along with lube and some small lifestyle tweaks, that they can enjoy orgasm well after menopause. Some of the suggestions for increasing orgasm and sex drive before and after menopause include:
- Reducing alcohol intake
- Exercise and diet — these measures can help reduce health conditions that can decrease blood flow and the need for medications that may affect the same
Perimenopause Doesn’t Have To Be Completely Miserable
While it’s true so many of the symptoms and struggles of perimenopausal women seem like a completely miserable time, it is possible to minimize the impact the drop in your hormones has on your body.
By mindfully supporting the adrenals, minimizing inflammation, and ensuring that your diet and exercise regimen is on point, you really can have a lot of control over how the years leading up to menopause go for you.
If you need a little bit of direction in that regard, I’m always here to help.And if you’re looking for a nudge in the right direction, I’ve created a hormone balancing kit that will get you started on the right foot. It’s chock full of hormone supporting tips and tricks, plus a 4-week meal plan to get you back on track.
Gold EB. The timing of the age at which natural menopause occurs. Obstet Gynecol Clin North Am. 2011;38(3):425–440. doi:10.1016/j.ogc.2011.05.002
Santoro N. Perimenopause: From Research to Practice. J Womens Health (Larchmt). 2016;25(4):332–339. doi:10.1089/jwh.2015.5556
Wing RR, Matthews KA, Kuller LH, Meilahn EN, Plantinga PL. Weight gain at the time of menopause. Arch Intern Med. 1991;151(1):97–102.
Biundo B, Gogola M. Estradiol: THE EMERGING EVIDENCE FOR A PROTECTIVE ROLE AGAINST INSULIN RESISTANCE AND OBESITY. Int J Pharm Compd. 2015;19(4):289–293.
Lizcano F, Guzmán G. Estrogen Deficiency and the Origin of Obesity during Menopause. Biomed Res Int. 2014;2014:757461. doi:10.1155/2014/757461
Sowers MR, Wildman RP, Mancuso P, et al. Change in adipocytokines and ghrelin with menopause. Maturitas. 2008;59(2):149–157. doi:10.1016/j.maturitas.2007.12.006
Bromberger JT, Kravitz HM, Chang Y, et al. Does risk for anxiety increase during the menopausal transition? Study of women's health across the nation. Menopause. 2013;20(5):488–495. doi:10.1097/GME.0b013e3182730599
Decreased Response and Pleasure, Sexual Side Effects of Menopause https://www.menopause.org/for-women/sexual-health-menopause-online/sexual-problems-at-midlife/decreased-response-and-pleasure.
Mocelin R, Marcon M, D'ambros S, et al. N-Acetylcysteine Reverses Anxiety and Oxidative Damage Induced by Unpredictable Chronic Stress in Zebrafish. Mol Neurobiol. 2019;56(2):1188–1195. doi:10.1007/s12035-018-1165-y
Facts About Menopausal Hormone Therapy – NHLBI – NIH.
Menopausal Hormone Therapy and Cancer Risk. 13 Feb. 2015,
Holtorf K. The bioidentical hormone debate: are bioidentical hormones (estradiol, estriol, and progesterone) safer or more efficacious than commonly used synthetic versions in hormone replacement therapy?. Postgrad Med. 2009;121(1):73-85. doi:10.3810/pgm.2009.01.1949
Newson LR. Best practice for HRT: unpicking the evidence. Br J Gen Pract. 2016;66(653):597–598. doi:10.3399/bjgp16X687097