Understanding perimenopause is crucial for women’s health and quality of life as it marks a significant transitional phase that can bring about a variety of physical and emotional changes. Perimenopause can last several years, during this time hormonal fluctuations can lead to a range of symptoms that impact everything from mood and sleep to sex and physical well-being. Recognising and understanding the challenges that the perimenopausal phase can bring is essential for women to navigate this stage of life with confidence and maintain their health and quality of life.
Perimenopause is characterised by significant hormonal changes, primarily involving two key hormones; oestrogen and progesterone. These hormonal fluctuations are the driving force behind the various symptoms that are experienced during this time.
In the years leading up to menopause, oestrogen levels gradually decline however this decline is not linear. Progesterone is another essential hormone that’s production becomes erratic during the perimenopause phase. The imbalance of these two hormones can bring many symptoms such as irregular periods, hot flushes, night sweats, vaginal dryness, mood swings and sleep concerns…to name only a few.
The duration of perimenopause varies from woman to woman but on average lasts for roughly 4 years. In some cases however it can extend anywhere from a few months to 10 years! Menopause is reached when a woman has gone 12 consecutive months without a period.
What are the Common symptoms of Perimenopause
There are 34 main symptoms that come with perimenopause, they are listed below.
- Irregular periods – this tends to be one of the first symptoms most women experience. Your periods may start to become shorter or longer and maybe heavier or lighter than usual. This is due to the natural decline in oestrogen meaning that your ovaries may not release an egg every month.
- Hot flushes - One of the biggest symptoms repotrted is hot flushes. These are believed to occur as a result of the decline in oestrogen causing the hypothalamus (body’s temperature regulator) to become more sensitive.
- Night sweats – hot flushes but during the night. This causes disturbed sleep and fatigue.
- Vaginal dryness – Low oestrogen levels can cause dryness and thinning of body tissues impacting your vaginal tissue too! This can lead to painful sex and sometimes bleeding with sexual intercourse.
- Breast tenderness – Hormonal changes can cause breast swelling and pain, this is due to oestrogen and progesterone ratios being out of balance.
- Lowered libido – Our levels of testosterone can drop as we age impacting our sex drive hugely. On top of this, vaginal dryness, not sleeping and mood changes can also impact libido hugely.
- Joint pain – Oestrogen helps to keep joints nicely lubricated to move smoothly, it also regulates fluid and decreases inflammation. With the decline of oestrogen and a decrease of collagen production this can cause join pain and stiffness.
- Weight gain – Weight gain around the abdomen is common during perimenopause due to oestrogen levels dropping off, your body starts to store fat around your waist rather than your hips and glutes.
- Stress incontinence – Pelvic floor muscles weaken as we age and a decrease of muscle mass is seen that reduces the ability to control your bladder.
- Digestive problems – Constipation and diarrhoea can become more prevalent as progesterone levels fluctuate.
- Bloating – Oestrogen doesn’t just decline in perimenopause it can also rise as well causing more fluid retention leading to bloating.
- Muscle tension – Like joint pain, oestrogen is essential for muscle health, with the drop in oestrogen this can lead to stiffness and less flexibility.
- Body odor – Especially those who experience hot flushes may also have an increase in body odour. The hormonal fluctuations and increased stress/anxiety can cause this.
- Hair loss – Hair loss and hair thinning are seen as levels lower of oestrogen and progesterone and testosterone starts to increase.
- Itchy skin – Also known as pruritus, this is commonly due to the decline in oestrogen as it helps maintain healthy skin and moisture levels.
- Burning mouth – Similar feeling to when you burn your mouth on a hot cup of tea. This is also usually experienced with a metallic taste in the mouth.
- Pins and needles – Hormones affect the central nervous system which controls tingling feelings, as your hormones fluctuate this is a common symptom.
- Changes in taste – your mouth may taste a little different or food can even taste different to usual. This is thought to be due to oestrogen impacting your saliva production, making your mouth dryer and harder to taste food as saliva is needed to breakdown food for sweet, salty, bitter, sour and savoury taste receptors.
- Insomnia – Mostly due to the flotation of progesterone levels. Night sweats, heart palpitations and anxiety can also impact insomnia.
- Heart palpitations – Oestrogen decline can lead to overstimulation of the heart causing arrhythmias – when your heart flutters or races for a few seconds to minutes.
- Mood swings – Oestrogen plays a part in regulating neurotransmitters; dopamine, serotonin and norepinephrine. These influence mood, memory and cognition. As oestrogen declines these can become out of balance.
- Anxiety – Imbalance of hormones especially oestrogen and progesterone can cause panic attacks and increased anxiety.
- Depression – Mood disorders are common in perimenopause, this can be due to the decline in essential hormones but also as a result of all of these symptoms listed.
- Irritability – Some research suggests this is due to the imbalance of neurotransmitters when we go through a decline of oestrogen and progesterone. With increased testosterone this can shift moods into anger and irritability.
- Stress – Cortisol is seen to increase in most women during perimenopause, this is our stress hormone.
- Confusion – this can be seen with the changing hormone levels during perimenopause.
- Memory loss – Lower oestrogen levels play a big role here.
- Mental fatigue – Women experience cognitive fatigue as a result of the fluctuating levels of progesterone and oestrogen ratios.
- Difficulty concentrating – Perimenopause not only causes hormonal changes, but it also causes nervous system changes in our brain, it is considered a neuroendocrine change process bringing on cognitive symptoms.
- Headaches – Dips of oestrogen levels are seen to commonly cause headaches.
- Dizziness – Oestrogen levels declining can impact insulin production making it harder to keep blood sugar levels stable which can lead to dizziness.
- Panic disorder – With all these symptoms and the ups and downs of hormonal levels during perimenopause, panic disorders are commonly seen.
- Brain fog – Lowered oestrogen levels are seen to play a role here.
- Fatigue – Fluctuating hormonal levels can throw the body out of balance increasing fatigue. Sleep disturbances, stress and hot flushes play a big part here also.
The Power of a Support System
A supportive network, friends and family play a crucial role in providing emotional support during perimenopause. The emotional and psychological symptoms that accompany perimenopause can take a huge toll on a woman’s health and wellbeing. Having a support system in place offers a safe space.
Equally important is self-care and self-compassion in managing the perimenopause phase. Self-care involves prioritising yourself through practices that nurture the mind and body. Self-compassion involves treating yourself with kindness and understand, even when faced with the challenging symptoms.
There are a variety of symptoms that you can experience during the perimenopause phase, these include emotional, cognitive and physical symptoms. Remember that you are not alone during this phase. Empowering yourself with knowledge is the first step toward navigating this transitional phase with confidence and resilience.