Before menopause, women experience a transitional period during which falling estrogen levels lead to symptoms typical of menopause. This period, perimenopause, is tricky to identify since it varies so much. It can last from months to years. Some women transition in the first half of their 30s and some midway into their 50s. While some women experience few of these symptoms or only mild versions of them, for others, this stage is what Harvard Health Publishing called the “rocky road to menopause” in a 2022 article.
If you notice these common signs, especially if you’re already in your mid-40s, you may have entered perimenopause:
• Irregular periods. A typical symptom of menopause is when periods are infrequent, skipped, are less heavy or are heavier than normal or extend or contract in length. According to the Cleveland Clinic, irregular periods are typically the first symptom of perimenopause. A woman hasn’t entered menopause until her periods have stopped for a full year. Though irregular periods or heavier periods may be related to menopause, this may warrant a visit to see the gynecologist to rule out other conditions.
• Hot flashes — sudden, brief bursts of heat, occurring at irregular intervals. These bursts may vary in length, frequency and intensity and may be — but are not always —accompanied by sweating.
• Sleep difficulties. Hormone changes plus (possible) hot flashes and night sweats can interrupt sleep. Many women also develop nocturia during perimenopause — that is, the need to get up to pee during the night. Insomnia is also common during this transitional stage.
• Vaginal dryness and bladder issues. Vaginal tissues can thin during perimenopause, causing irritation and sometimes burning during urination. Women may also be more prone to urinary and vaginal infections and some leakage during this stage according to the Mayo Clinic.
• Libido changes. Lower libido is common during perimenopause. The discomfort and pain caused by vaginal dryness can contribute to this change.
• Mood changes. According to the Menopause Association, anxiety and mild depression are frequent during perimenopause. Irritability and mood swings are also common.
• Brain fog. According to the Menopause Society, 40 to 60% of women experience some cognitive symptoms during this period, such as “difficulty remembering words, names, anecdotes and numbers; an inability to focus and concentrate; and distractibility.”
• Joint pain. A new condition has been identified to describe the widespread joint and muscle pain some women experience due to estrogen level fluctuations during perimenopause and menopause. While joint pain was formerly thought to be a rare symptom, a 2024 study in Climacteric reports that over 70% of women “will experience musculoskeletal symptoms and 25% will be disabled by them through the transition from perimenopause to postmenopause.” While your provider might want to rule out osteoarthritis first, there are distinct differences between that condition and this one, so it is helpful to track your symptoms carefully before talking with your provider about treatments.
Perimenopause can be difficult. You do not have to navigate it alone. The National Menopause Foundation has a free online community for women who want to talk with peers about what they’re going through: NationalMenopauseFoundation.org/Community.
Please consult with your primary care provider or gynecologist for medical advice, however. There are numerous myths and false remedies shared by those with no medical knowledge. Since this stage varies so much, what works for one woman might not for another. Your provider knows you and your medical history well enough to give you sound advice. Commonly prescribed treatments include vaginal estrogen, hormone therapy, antidepressants and medications that target hot flashes. Your provider will assess your health and your other medical conditions and provide recommendations appropriately. If you don’t currently have a provider, please reach out to Eskenazi Health Connections at 317-880-7666.
Ananda Kannappan, M.D., primary care physician and Lifestyle Medicine practitioner with Eskenazi Health Center Grande