The Symptoms of Perimenopause: Guidelines on What to Expect

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Perimenopause refers to the years leading up to the decline of ovarian function; slowing down, not completely shutting off. Hormones gradually fall in production over a period of time before the menopause begins. Women produce estrogen, progesterone, and testosterone. Even though the ovaries are not producing as many hormones as they originally did, other parts of the body (adrenal glands, body fat, brain, and skin) have some storage. The timeframe could be two, five, or even ten years before your periods come to a halt. This is nature’s way of telling women that menopause is approaching. Estrogen production usually starts gradually declining when a woman is in her mid-30’s and by the mid-40’s she begins to experience symptoms of estrogen deficiency. Since perimenopause is a normal function, there are no specific tests to address it. Some doctors may check the blood to see where your hormone levels are, but these are not necessary tests.

Menstrual Periods May Change

One of the first symptoms of perimenopause is that menstrual periods may become irregular. Some may be shorter, longer, lighter in flow or heavier. Periods may even skip a month. Some women may experience symptoms like PMS (premenstrual syndrome) for the first time or much worse than they had in the past, symptoms like cramps and headaches. When irregular periods first begin, fears of pregnancy arise. Others think the changes in the menstrual patterns may be a disease or illness, not making the connection that perimenopause is beginning. Period irregularities may last a few years.

Emotional Distress

Women sometimes complain of other issues during the perimenopause, including symptoms such as headaches, fatigue, dizziness, lack of concentration, insomnia, mood swings, poor memory, nervousness and irritability. It’s hard to tell if all these symptoms are actually coming from perimenopause or the emotional stresses that usually accompany the middle years of a woman’s life. Hormonal imbalances can cause issues like these and as a woman gets closer to menopause and the ceasing of menstrual periods, some of these symptoms become prevalent. There are women who have no symptoms at all. The only good thing is that this stage of life is not forever and after a few years after menopause happens and the body adjusts to hormonal drops, the symptoms tend to subside.

Issues With the Skin

With the decline of estrogen come skin issues. Women may experience dry, itchy, and even see wrinkling of their skin. Another issue is vaginal and bladder problems because the vaginal and urethral tissues lose lubrication and elasticity. Loss of tissue tone can contribute to painful intercourse and urethral tenderness. This may also make a woman prone to infections.

Osteopenia and Osteoporosis

Somewhere around the age of 35, women begin to lose calcium. For some women this poses no threat, however for others this may be the developing factor of osteoporosis, a bone disorder that leaves women vulnerable to increased fractures in later life. Because of the declining of estrogen, bone may be lost quicker than it can be replaced. This is an important time to make sure you are taking plenty of calcium, magnesium, and vitamin D either through food or supplementation.

The Bottom Line…

Perimenopause is a natural transition in every woman’s life. Subtle changes will be happening in order to pass through menopause. This is a time to make sure you are eating properly (adopting a healthy diet), exercising, which helps bones stay strong and keeps the body healthy, and practicing stress reduction. Think about doing yoga or meditation which will calm the senses. Confide in your physician if the symptoms of perimenopause are keeping you from enjoying your daily life and of course if your monthly periods are extremely heavy. Treatment can be given for heavy bleeding. Know what to expect as far as the signs of perimenopause, but realize these are normal and should not be an alarming situation.


“Perimenopause” Mayo Clinic

Women’s Bodies, Women’s Wisdom by Christiane Northrup, M.D. [Bantam Books, 1998]

Taber’s Cyclopedic Medical Dictionary [14th Edition, F.A. Davis Company]