- Perimenopause can cause irregular periods, hot flashes, incontinence, and much more.
- Perimenopause occurs when your ovaries decrease estrogen production, triggering hormonal side effects.
- Perimenopause typically starts in your early 40s but can strike as early as your 30s.
- Visit Insider's Health Reference library for more advice.
Perimenopause, also known as menopausal transition, is when your ovaries begin to produce less estrogen. It refers to the years before menopause when menstruation still occurs but you may start to experience menopause-like symptoms like hot flashes, vaginal dryness, and mood changes.
Perimenopause can begin as early as your 30s, but most often starts around age 40 to 44.
Here are 10 common signs and symptoms to help you determine if you're experiencing perimenopause.
1. Irregular periods
As estrogen levels drop, you're likely to experience irregular periods. For example, the length between your periods may be longer or shorter and your flow may be heavier or lighter than usual. You also may skip periods.
2. Hot flashes
More than 80% of menopausal women will experience hot flashes, making them the most common menopause-related symptom. Hot flashes can stick around for a while, lasting between 4 and 7 years on average.
"Hot flashes are caused by hormonal changes in the brain that confuse temperatures in the body and lead to sweating, chills, increased heart rate, and a flushed appearance," says Zaher Merhi, OB-GYN, MD, a board-certified reproductive endocrinologist and the founder of Rejuvenating Fertility Center.
Hot flashes can be managed by:
- Carrying a portable fan
- Drinking cold water
- Dressing in layers that can be removed
- Avoiding alcohol, spicy foods, and caffeine, which can make symptoms worse
- Trying mind-body calming practices like yoga or meditation
If lifestyle changes aren't enough to help you improve your symptoms, non-hormonal medications or hormone replacement therapy (HRT) may help.
3. Mood changes
Mood swings are another common symptom of perimenopause and can be exacerbated by other symptoms like irregular sleep and hot flashes which can leave you feeling upset, depressed, and out of control of your moods.
The first line of defense against moodiness is making lifestyle changes like:
- Regularly exercising
- Eating a balanced diet with fruit, vegetables, and whole grains
- Seeing a therapist or counselor
- Establishing a healthy sleep schedule
Other options include antidepressant medication, HRT, alternative medicine, or low-dose birth control pills.
4. Vaginal dryness
About one third of menopausal women will experience vaginal dryness, Duke says. During perimenopause, the vaginal tissues become thinner and more easily irritated and you may experience a drop in natural lubrication.
"This symptom is usually at its worst during sexual intercourse, and can lead to an avoidance of sexual activity and decreased libido," Merhi says.
Fortunately, vaginal moisturizers and lubricants can help make you more comfortable. Low-dose vaginal estrogen creams and hormone-related medications are another option to ask your doctor about if you're dealing with discomfort.
5. Decreasing fertility
Irregular ovulation during perimenopause means that it will become harder for you to get pregnant because your ovaries are releasing fewer eggs, which means less opportunities for fertilization.
However, if you're still getting your period, it's still possible to get pregnant. So, if you are sexually active and do not want to get pregnant, then use some form of birth control until you have gone 12 consecutive months without your period.
On the other hand, if you do want to get pregnant, you can talk to your healthcare provider about fertility techniques and treatments.
6. Urinary urgency
Urinary incontinence, or the leaking of urine due to loss of bladder control, is a common symptom of hormonal changes due to perimenopause, and it affects about a quarter of menopausal women.
Incontinence can range from a little urine leakage after sneezing or laughing to the total inability to control urine.
If you find that incontinence is disrupting your daily life, talk to your healthcare provider about treatment options, including:
- Medication, which can treat incontinence
- Lifestyle changes like regular exercises that can strengthen your pelvic floor and prevent incontinence
- Bladder training, which can help you build strength to prevent incontinence
- Pelvic floor physical therapy exercises, like Kegel exercises, which can strengthen your pelvic floor muscles
- Surgical options, like sling procedures or artificial urethral sphincters
- Neuromodulation devices, which are pacemakers that stimulate nerves to improve bladder control
- Botox, which can help relax your muscles and prevent incontinence
- Bulking agents, which increase the size of the urethra's lining
7. Bone loss
Osteoporosis, a condition in which bones become brittle and fragile, is the most prevalent disease in menopausal women.
That's because estrogen protects your bones, and the sharp drop in estrogen levels during perimenopause and menopause is one of the strongest risk factors for developing osteoporosis.
Ensuring that you are getting enough calcium and Vitamin D and doing regular weight-bearing and resistance exercises can help keep your bones healthy and strong.
8. Sleep disturbances
Sleep disturbances are one of the most bothersome symptoms of perimenopause, experienced by 40% to 60% of menopausal women.
Examples of sleep disturbances that people may experience due to perimenopause include:
- Hot flashes also called night sweats
- Nighttime awakenings
- Insomnia
- Disordered sleep breathing
Lifestyle changes like having a regular exercise routine, avoiding electronic devices before sleep, and going to bed at the same time every night can help you fall and stay asleep.
You can also ask your doctor about medication like selective serotonin reuptake inhibitors (SSRIs,) which have been shown to help with sleep symptoms in menopausal women.
9. Breast tenderness
Hormone changes during perimenopause can cause breast pain, which may make your breasts feel achy, heavy, and painful to the touch. This pain usually affects both breasts and can sometimes spread to the armpit.
Talk to your doctor about breast pain if it's not improving, you have a high temperature, a history of breast cancer, or if your breast is red, hot, or swollen as those could be signs of an infection or more serious issues like breast cancer.
10. Weight gain
Weight gain is common in perimenopause with women gaining an average of five pounds.
Weight gain during perimenopause is due to hormonal changes that promote the accumulation of fat in your abdominal area. Therefore, you may find yourself gaining more weight around your midsection.
Talk to your doctor about establishing a healthy diet and exercise plan if you're concerned about weight gain.
Insider's takeaway
Perimenopause is an inevitable stage of life for anyone who ovulates.
While side effects like breast pain, vaginal dryness, and hot flashes can be uncomfortable, there are many strategies and therapies available to help you cope during this transition period.
If your symptoms are interrupting your daily life, reach out to your healthcare provider to talk about options.