Perimenopause is the period of transition from pre-menopause to menopause. It is derived from Greek, and the prefix Peri means around. It is the stage of gradual hormonal fluctuations when menstrual cycles become irregular and fertility decreases. Women may also have periods that are heavier than normal and painful. This is due to the decline in ovarian follicular activity.
At What Age do Women Start to Experience Perimenopause?
There is no specific age at which perimenopause occurs. Some women go symptom free, others may begin experiencing symptoms such as irregular periods, loss of vitality, brain fog, and even hot flashes in their mid or late 30s. Most women usually start the transition in their late 40s or early 50s. It lasts about three to four years on average. It can also last a decade and varies from one woman to another.
Multiple factors can influence perimenopause including genetics, hormones, lifestyle, nutrition, smoking, alcohol use, drugs, stress, UV radiation exposure, sleep deprivation, and underlying chronic diseases. women can monitor major changes that they notice in their health and record them.
How do we Test for Perimenopause?
There is no reliable test that women can use to diagnose perimenopause. A sensitive indicator that some clinicians evaluate is a FSH (follicle-stimulating hormone) blood test. It is done on the third day of the cycle. A high level corresponds to a decrease in fertility.
What are the Symptoms of Perimenopause?
The symptoms associated with perimenopause are not different than those in menopause. They might be more severe with hormonal fluctuations, especially in late perimenopause. They are divided into three main categories. Psychological and cognitive, vasomotor, and urogenital.
Psychological and cognitive symptoms refer to women reporting brain fog, word-finding difficulties, increasing forgetfulness, anxiety, irritability, mood swings, and loss of confidence
Vasomotor symptoms are commonly described as hot flashes and night sweats, insomnia, and daytime fatigue.
Urogenital symptoms also known as genitourinary syndrome are associated with vaginal and bladder problems such as vaginal dryness and itch, incontinence, dysuria or burning and painful urination, urinary urgency, low libido, and increased urinary tract infection.
Other common symptoms reported by women are palpitations, headaches, breast tenderness, skin and hair changes, weight gain, itchy ears, dry eyes, burning tongue, migraine, electric shock sensations, pain in muscle, bone, and joint.
Uncommon and less-reported symptoms are vaginal atrophy, itchy back, hip pain, frozen shoulder, bloating, phantom smells, body rash, hair loss, and exhaustion.
look at the classic symptoms and their causes.
- Hot flashes and night sweats are the most reported symptoms among women in perimenopause. Women describe hot flashes as a heat wave extending rapidly over their face, head, and neck. They can be mild, moderate, and severe. On average, they last 3 to 5 minutes with a frequency of 3 to 4 per day. However, some women may have a different experience. In most cases, hot flashes last about 5 years and peak severely following the final menstrual period. Researchers reported that they are the cause of irregular fluctuation in estrogen. Women who commonly experience them are particularly responsive to fluctuations in their core body temperature.
- Night sweats are the body’s ability to remove excess heat through sweating and flushing. They can be so profuse that some women drench their bed linens. Hot flashes and night sweats commonly cause insomnia.
- Insomnia is the inability to sleep. It is triggered by different factors including pain, stress, and so forth. It can be a problem on its own for women who do not experience any hot flashes and night sweats problems. Insomnia can cause fatigue and irritability. When it becomes chronic, it drives health issues associated with memory impairment, anxiety, reduced immune function, weight gain, tachycardia, hypertension, coronary artery disease, poor problem-solving abilities, and constant fatigue.
- Mood swings are characterized by a state of happiness and confidence that changes quickly into sadness or discouragement. Women usually experience mood swings in early perimenopause due to unpredictable hormonal fluctuations. However, other stressful life challenges should be considered when addressing mood symptoms.
- Brain fog, concentration, and memory issues among anxiety symptoms are additional complaints of women in perimenopause. Researchers do not fully understand the exact cause of these problems. Some studies suggest that hormonal changes, stress, and aging can play a crucial role. Also, these problems can be amplified by underlying mental health issues during perimenopause.
- Vaginal changes are the cause of decreasing estrogen levels. Consequently, these changes affect the tissues of the vulva and the vagina to lose their elasticity, and thickness, a rise in vaginal PH, a decrease in vaginal lubrification and blood flow. They can cause the tissues to become thin, dry, and inflamed as a result, causing painful sexual intercourse, and a lack of sensation. Also, the vagina becomes smaller. Moreover, women are prone to urinary tract infections. These symptoms can be present several years following menopause.
Low libido is closely linked to low blood testosterone which can lower sexual desire in both genders.
- Weight gain is a common issue experienced by some women during the transitional stage. It is unclear why women are gaining weight during perimenopause and beyond. No evidence supports the hormonal changes as a cause of weight gain. However, lifestyle plays a major role.
- Skin and hair changes are less reported than other menopausal symptoms. However, the skin is a major hormonal target for estrogen, androgens, and glucocorticoids. Deficiency of these hormones and other physical and environmental factors will cause skin dryness, pruritus, thinning, wrinkles, sagging, and poor wound healing. On the other hand, the hair loses its density and becomes thinner. Hair growth can also appear on the facial surface.
- Headache is closely linked to hormonal changes. Women who experience menstrual headaches are more likely to have headaches in perimenopause. Other triggers such as stress, lack of sleep, and alcohol,
Perimenopause is characterized by hormonal fluctuations that may affect various physiological functions. The manner in which individuals experience perimenopause is influenced by factors such as personal health profiles, environmental circumstances, and social determinants of health. Developing an understanding of perimenopause and its symptoms can assist women in monitoring significant bodily changes and seeking appropriate interventions when necessary. The perimenopausal transition presents differently among women; for some, it may be asymptomatic, while others may encounter adverse effects impacting overall quality of life.
References
Fritz, M. A., & Speroff, L. (2015). Perimenopause: From research to practice. Journal of Women’s Health, 24(10), 809–815. Retrieved from https://pmc.ncbi.nlm.nih.gov/articles/PMC4834516/
Gatenby, C., & Simpson, P. (2023). Menopause: physiology, definitions, and symptoms. Best Practice & Research Clinical Endocrinology & Metabolism 38(2), doi:10.1016/j.beem.2023.101855
Holte, A., et al. (2024). Perimenopause symptoms, severity, and healthcare seeking in women in the US. npj Women’s Health, 3, 12. https://www.nature.com/articles/s44294-025-00061-3
McCarthy, M., & Raval, A. P. (2020). The perimenopause in a woman’s life: A systemic inflammatory phase that enables later neurodegenerative disease. Journal of Neuroinflammation, 17, 317. https://doi.org/10.1186/s12974-020-01998-9
Novi, J. M., & Ross, H. L. (Eds.). (2009). Perimenopause. New York, NY: CRC Press/Taylor & Francis. (Comprehensive clinical resource on perimenopause physiology and management.)
Santoro, N., Epperson, C. N., & Mathews, S. B. (2020). The menopausal transition: Signs, symptoms, and management. The Journal of Clinical Endocrinology & Metabolism, 105(10), 1075–1088. https://pubmed.ncbi.nlm.nih.gov/33095879/