Friday, September 24, 2021

14 Signs You Are In Perimenopause

Are you noticing changes in your body and wondering if you're in perimenopause? These changes usually start several years before menopause, but if you're questioning your symptoms, the good folks from  Winona are sharing a comprehensive list of signs that will help you better understand the journey you are about to begin. 

14 Signs You Are in Perimenopause

As we age, our body starts producing less of the sex hormones progesterone, estrogen, and testosterone. This drop results in some pretty major changes in your mind and body. Menopause occurs when you have gone 12 months without a period, and on average occurs at about 51 years of age. But there is an equally important phase before menopause - that phase is called perimenopause. 

Most women fall into perimenopause about 7-10 years before menopause, and when the production of sex hormones starts decreasing in their 30s and 40s. During this time, they often experience symptoms related to the drop in hormones; symptoms that can negatively impact their quality of life and future health, but many women do not realize they are in perimenopause.

The years leading up to menopause aren’t clear, straightforward, and evident. Some women find themselves experiencing a hormonal rollercoaster that is reminiscent of their teenage years. Others don’t notice the changes in hormone levels. Regardless of the severity of symptoms, all women will experience a significant reduction in their hormone levels with age.

While perimenopause is a prelude to menopause, it has its own symptoms and signs that we should pay more attention to. It's best to get in front of the roller coaster of symptoms before menopause completely takes us for a ride. 

14 Signs That You’re In Perimenopause

Whether you are a teenager or in your 40s, your hormone levels can change from month to month, day to day, and hour to hour, so it doesn't make a lot of sense to use an expensive hormone test to check your hormone levels. Evaluating your symptoms, and the severity of those symptoms can give a much better idea of where you are in your perimenopause and menopause journey. Not every woman will experience all of the perimenopause signs listed below, and each woman will have her mix of each, but it’s good to know what to look out for. 

  1. Irregular Periods

Your periods will start to become more erratic in timing and severity. Some months you will have heavy periods and other months barely anything. This is a telltale sign of approaching menopause. For most women, the length between menstrual cycles shortens in perimenopause to around 21 to 26 days, and missed periods are very common (1,2).

  1. Vaginal Dryness

Perimenopause can cause some very uncomfortable vaginal changes. If you are noticing changes in your vagina including dryness, tenderness, and painful intercourse you are not alone. These symptoms affect more than half of all peri- and menopausal women in the US, yet the majority of them are unaware that it is an easily treatable condition with vaginal estrogen creams and hormone replacement therapy (HRT) (1,2).

The decrease in estrogen that happens with perimenopause makes the vaginal tissue thinner, drier, less elastic, and more fragile. This is a prevalent, chronic, progressive, and painful condition (1,2).  Unlike hot flashes that tend to get better as you move beyond menopause, vaginal atrophy only gets worse. 

  1. Difficulty Sleeping

A good night’s sleep can be hard to find, but with perimenopause, insomnia is even more common. Hormonal decreases often contribute to sleep issues that can continue for decades. When women are in their 20s and early 30s only about 12% report sleep problems, but that number changes to 40% for women in their 40s and 50s. Women report the most sleep issues during perimenopause and all the way through postmenopause (often 20 years).

Hormone Replacement Therapy (HRT) can help improve sleep problems. Peri- and menopausal women can enjoy better sleep when taking estrogen and progesterone (HRT) than when using traditional sleep medications. If your sleep problems are caused by hot flashes or night sweats, 95- 98% of these disruptions can be cured with HRT. HRT is the most proven method for decreasing hot flashes and night sweats (1,2). Progesterone, one of the hormones in HRT, naturally makes you drowsy and is a good option to take before bed. 

  1. Skin & Hair Changes

When estrogen levels drop during perimenopause, it shows (sometimes first) in your skin. Collagen is what helps keep skin toned, fresh-looking, and resilient. As estrogen drops, so does your collagen production. 


It is very common for women to notice their skin getting thinner, drier, less youthful-looking, and small wrinkles deepening in perimenopause. Remember this is in your mid-to-late 30s. These changes are not necessarily a losing battle. HRT and specific skincare products can make all the difference in the appearance of your skin and hair if started early enough. 

  1. Irritability & Mood Problems

As women, we know firsthand all about hormonal fluctuations. They start at puberty and follow us every month thereafter. We have seen how women vary in their response to these hormone changes and how the changes directly correlate with mood changes and mental health. Sadly, the medical profession often discounts the reality of mental health and hormone levels, especially during peri- and menopause. 

The irritability and mood symptoms that we suffer during peri- and menopause often stem from dropping hormones, but there are also other causes for these changes including the lack of sleep, life transitions (like kids moving away from home, aging parents, and other issues) that arise in your 40s and 50s. 

Fixing the underlying hormonal imbalance is one of the most effective ways of reducing peri- and menopausal mood swings. When a woman’s estrogen level drops, so do levels of a mood-regulating neurotransmitter chemical in her brain, called ‘serotonin.’ This drop can lead to depression, fatigue, and mood disorders.  It is vitally important to take these mood changes seriously and take steps to mitigate this perimenopause symptom.

  1. Decreased Libido & Painful Intercourse

In menopausal women, the main cause of low sex drive is hormonal imbalance. Libido can also be impacted by other menopause symptoms such as vaginal dryness, pain during intercourse, and/or depression. 

When estrogen levels drop, the vaginal tissue becomes drier, thinner, less elastic and the vagina can become smaller. The vagina is frequently itchy, easily irritated, and more prone to infections in menopause.

Another sign of approaching menopause is increasing pain with intercourse. The lack of estrogen and testosterone can impact lubrication and moisture that is so common with peri- and menopause. This can lead to sex becoming uncomfortable and often painful. This may be treated with topical vaginal estrogen, body creams, patches, or oral HRT, and of course, water-based lubrication can be helpful.

  1. Weight Gain & Slowed Metabolism

Hormonal changes during peri- and menopause influence weight gain and where you distribute the weight you are gaining. With perimenopause, the hormones estrogen and progesterone, and testosterone decrease. As estrogen drops, weight gain around the midsection begins to ‘take shape.’ 

Many people call this increase in belly fat “menopausal weight gain.” Multiple studies have shown that estrogen protects against belly weight gain. Gaining weight in the belly area is particularly unhealthy because it increases the risk of developing type 2 diabetes, heart disease, and some forms of cancer (3).

Hormones control metabolism, where fat is deposited (stored), overall appetite, and weight balance. The most effective way to get hormones back on track, stop the scale creep, and return to a healthy weight is to correct hormonal imbalances with Hormone Replacement Therapy (HRT). HRT is made from yams and is identical to the hormones our body naturally makes. Once hormones are back in balance, weight loss can begin.   

  1. Brain Fog

If you are like most women experiencing peri- and menopause, you might notice a decline in your cognitive performance with brain fog, confusion, or memory problems. You are likely wondering if the memory loss may be due to early dementia or Alzheimer's disease. It is most likely due to the significant drop in hormones.


Memory loss – whether it’s difficulty remembering a person's name or searching for your keys in your hand  – is a normal part of aging. It may not come as any surprise, but researchers have confirmed that the “brain fog” that often seems to roll in with perimenopause is real (4). 


As estrogen levels start to wane, so do the protective functions it provides in brain function. Many women find themselves becoming increasingly forgetful or feeling “foggy.”  That might look like missing appointments or just feeling a step behind in the conversation. It can be very concerning, but estrogen may benefit the mental function because it reduces hot flashes and so many other menopause symptoms (5).

"The more hot flashes a woman has, the worse her memory performance. And when we intervene to address those hot flashes (with HRT), her memory performance bounces back." (5). 

Findings like these are renewing the idea that it may be possible to use HRT at peri- and menopause to prevent brain fog and even Alzheimer's and other forms of dementia later on (5).

  1. Hot Flashes 

Hot flashes are likely the most obvious sign of menopause, but what many people don’t know is that they are also a sign of perimenopause. Hot flashes can begin 10 years before true menopause sets in, and are caused by a decreased production of the hormone estrogen.  

Hot flashes are a sudden feeling of warmth that spreads over the body, creating flushing and sweating, especially on the face and upper body. The experience of hot flashes can range from mild/light flashes to severe heat that lasts from 30 seconds to 10 minutes.  

There are specific things that a woman can do to help the different types of hot flashes. HRT, however, is one of the most effective methods to reduce hot flashes and night sweats for most women. 

  1. Night Sweats

Severe hot flashes that occur during sleep and are accompanied by profuse sweating are ‘night sweats.’ Many women experience night sweats, which not only cause disruptions to sleep, but can lead to increased irritability, depression, and stress. 

Perimenopausal hormone changes can cause women to wake up many times during the night, tossing, turning, and suffering from insomnia. Women going through perimenopause may find that their sleep is less restful and getting to sleep becomes increasingly difficult.  

For night sweats, women can consider sheets and looser-fitting sleepwear that are cool, such as cotton, and blankets that are easy to remove. Some women have tried a ‘chill pillow’ filled with water. An old favorite is a fan or multiple fans.

  1. Achy joints 

Joint pain is one of the most commonly under-acknowledged symptoms of perimenopause. It is often related to the effects of fluctuating hormone levels on the immune system. Estrogen helps prevent inflammation in the joints, so low levels of estrogen during perimenopause can lead to increased inflammation, and increased joint pain. Yes, you are getting older but joint pain doesn’t have to coincide with it. Try getting your hormone levels back to normal before taking all of that ibuprofen.

  1. Headaches

While we all suffer from headaches occasionally, as perimenopause starts some women can suffer from incredible headaches that include flu-like symptoms. Some women that previously suffered serious headaches before perimenopause may find relief with the drop in hormones with menopause. It depends on the woman, but most scientists agree that the headaches associated with perimenopause are due to the change in the hormone and the improvements are likely due to the decrease in the fluctuations of hormones (6).

Hormone replacement therapy (HRT) can help headaches, but that outcome will be unique to you. Like many symptoms of perimenopause, women don’t realize headaches are a part of an underlying problem and they simply try to work through it with aspirin and painkillers. By taking HRT you can normalize the levels of hormones possibly for the first time since puberty. Balancing hormones is key to preventing future headaches.

  1. Chronic Fatigue

One of the most common perimenopause symptoms is an ongoing, persistent feeling of weakness, tiredness, and low energy. Estrogen, progesterone, and testosterone all play a critical role in your energy levels. As their levels drop, so do your energy levels. 


The same hormonal changes that cause the other perimenopausal symptoms that we mentioned can also affect your energy levels, leading to fatigue. If you aren’t getting enough sleep, or are chronically anxious, fatigue will follow. 

  1. Increased Incontinence & UTIs

Estrogen replacement can return the vaginal tissue to a more youthful state and give better support to the bladder and urethra. This can go a long way to improve urinary incontinence. As estrogen levels drop, vaginal tissues supporting the bladder and urethra thin and become weaker making it more common to pee a bit when you cough or laugh.


With perimenopause, urinary tract infections (UTIs) can increase. As the hormones estrogen and testosterone drop, vaginal dryness increases, and the vaginal tissues become thinner. This thinning of the tissues creates a potential for more E. coli bacteria to move up the urethra and cause an infection. This may also be treated with topical vaginal estrogen.



Perimenopause is the time when your body is going through a series of hormonal changes. If you are suffering, know that you are not alone and there is help available. Perimenopause typically starts around the time when you may be experiencing other changes and stresses that also contribute to your symptoms. All women have different signs that they are experiencing. However, any one or a combination of these signs may be a way that your body is trying to tell you that you are experiencing perimenopause. To help remedy these symptoms and promote long-term health benefits, we suggest visiting to find out more about how you can improve your perimenopause and ultimately your menopause experience.









  1. A bloody great and interesting post, I was lucky in that for me my periods just stopped, no other issues



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