Identifying perimenopause: Understanding the early signs of menopause

While in your 40s, almost overnight you may have noticed period irregularities coupled with drenching sweats at night and erratic changes in your mood. All clues to a journey toward menopause.

Over a billion women are expected to be postmenopausal by 2025, yet we know so little about the early signs of perimenopause. Identifying your symptoms early, having open conversations, and enlisting the help of your health experts can guide you toward better health during perimenopause.

The median onset for perimenopause is 47 years. However, some women can start experiencing symptoms as early as their late 30s. The length of perimenopause can also vary anywhere from a few months for some to years for others.

While it is relatively common to expect irregular periods to be one of the first signs that menopause is around the corner, perimenopause symptoms can vary.

A widely known, and experienced symptom of perimenopause is hot flashes. It describes a sudden “flash” of warmth followed by drenching sweats. For one-third of women, hot flashes can be debilitating. Hot flashes usually subside in a year or two after they first appear, however, for some women it could last decades.

Changes to your vagina and urinary tract are among other perimenopausal symptoms reported. The most common among these is vaginal dryness, experienced by around 27% of women. It is not always easy to identify this perimenopausal sign. Vaginal dryness can be felt as new and persistent vaginal irritation or as a decline in lubrication during sex, making the symptoms more troublesome as you progress toward menopause. In addition to dryness, you may also experience changes in your urinary frequency during perimenopause.

A key reason for symptom onset and its fluctuations during the years toward menopause is the decline in the levels of estrogen. Since you are born with all the ovarian follicles you will use during your lifetime, in your late 30s, and 40s this follicular reserve declines. At its lowest levels, follicles release a limited amount of estrogen, your protective hormone. Since some estrogen is still being released, symptoms vary, with some being worse than others.

Community take: I was unable to explain why I was getting irritable so often. I would lash out at my children for small things I previously overlooked and regret it later. At that moment I felt incapable of controlling my emotions. Even though I started having hot flashes a year ago, I didn’t think perimenopause was responsible for these dark clouds changing my mood.

Along with the physical symptoms from estrogen decline, you might also see fluctuations in your mood. Depression prevalence was 42.5% among Indian perimenopausal and postmenopausal women according to one meta-analysis. Both the declining hormones and the psychological stressors of perimenopause are linked to mood symptoms.

Additionally, during perimenopause, you may also experience migraines, insomnia, weight gain, changes in sex drive, fatigue, joint pains, and brain fog all coupled with erratic periods as indicators of perimenopause.

“Peri-” translates to around, so perimenopause is used to describe the years leading up to menopause.

Menopause defines the absence of periods for 12 consecutive months.

Many of the symptoms we have seen above start during perimenopause and can persist during menopause, because of the slow decline of hormones. It is only after a few years into menopause that you will experience relief from many of the troublesome perimenopause symptoms. However, since menopause signifies the natural decline of estrogen, it is also a phase where you are exposed to an increased risk of other health conditions, such as osteoporosis, cardiovascular disease, and Alzheimer’s.

Estrogen provides a protective effect from these conditions during your reproductive years. Speaking with your healthcare provider can help you understand how your estrogen decline is impacting your perimenopause symptoms and if hormone replacement has any benefit for you.

Staying healthy during perimenopause can require an individualized approach, as symptoms are not the same for every woman.

Topping the list would be a nutritious diet which should supplement your hormone fluctuations helping moderate troubling symptoms of perimenopause. Diets rich in fiber, omega-3 fatty acids, lean protein, and probiotics are proven to be most helpful. Some vegetables contain phytoestrogens, a natural source of estrogen, that can help ease the transition to menopause. Soybeans, flax seeds, fruit, garlic, and sweet potatoes are some of the natural sources of phytoestrogens.

Some studies have also shown some benefits in herbal supplementation, such as with chaste-tree berry and black cohosh, in relief of perimenopausal symptoms. A small study on the use of St. John’s wort showed similar results for its impact on the psychological symptoms of menopause. Any supplements you wish to take should be through the guidance of your healthcare provider.

Finally, regular exercise, incorporating regular strength training, and adequate sleep are crucial during perimenopause. Strength training has proven to improve bone density which declines as menopause progresses. It also tackles inflammation, significant hormone fluctuations and can help you get a good night’s rest.

Community take: I feel sleep is the most overlooked and most important thing to heal during menopause. With hot flashes, night sweats, and mounting stress, sleeping was difficult when perimenopause started for me. But soon I built a nighttime routine that worked for me. Dinner 3 hours before, no screens for 2 hours, reading, meditation, journaling, all kids in bed, and one hour before bed just for me. It took me some time to find this balance, but on the nights I sleep well, I am able to handle my symptoms better.

Perimenopause marks the transitional years to menopause. While there are classic symptoms to indicate perimenopause (such as irregular periods), there are no tell-tale signs to suggest it. Tackling your symptoms can be stressful. However, reaching out for help, and adding tailored habitual changes to your daily routine can help you through perimenopause.