Understanding Perimenopause Symptoms

Early signs of menopause may start sooner than you think! 

This simple guide covers everything you can expect in the runup to menopause (i.e. perimenopause) – including when it’s most likely to start, how long it lasts, what your hormones are doing, and how to manage troublesome perimenopause symptoms. 

Ready? Let’s go! 

What Is Perimenopause?

Perimenopause is the period of time when the body transitions to menopause. The ‘peri’ part of the word comes from the Greek word meaning ‘around’ or ‘near’. So when you think ‘perimenopause’, think near menopause. But not ‘officially’ menopause just yet!  

The transitional phase of perimenopause lasts between two to eight years (on average). The majority of women enter it during their forties. However, it can begin much earlier in the mid-thirties. Or, later in the mid-fifties. 

Even though menopause has not technically been reached yet during perimenopause, the body will still show some of the classic signs of menopause. Such as: 

• Hot flashes
• Night sweats
• Low libido
• Vaginal dryness 

In terms of fertility, it’s still possible to get pregnant during perimenopause, though the chances of conception are low. 

Deciphering Perimenopause Symptoms and Timelines

One of the very first perimenopausal symptoms is an irregular period. If you track your period, you may notice it’s more difficult to predict. It may skip a few cycles. Or, you may spot more than normal between cycles. Hot flashes and vaginal dryness are other common early signs of perimenopause.  

Over time, your symptoms may change. Some symptoms may improve or stop completely. Other symptoms may worsen. Remember, menopause is a phase that can last for several years. Your body is going through a lot of changes during this time. It’s only normal for the way you feel these changes to evolve. 

One of the biggest misconceptions about perimenopause is that everyone’s experience is the same. You may have heard myths like ‘perimenopause only usually lasts a year’. Or ‘everyone enters perimenopause at 40’. But these myths are just that… myths. 

While it’s important to be aware of average timelines and symptoms, it’s also important to remember everyone’s body and journey to menopause is different. Timelines, signs, and symptoms can vary greatly. 

Physical Symptoms of Perimenopause

The most common physical symptoms of perimenopause include: 

• Irregular periods
• Periods that are heavier/lighter than normal
• Spotting between periods
• Hot flashes
• Night sweats
• Vaginal dryness
• Low libido
• Fatigue
• Low energy levels
• Slowed metabolism
• Weight gain

If you start to notice any symptoms, start tracking them in a diary to see how they change. You should also make an appointment with your doctor to keep them in the loop. 

For an even more in-depth look at what’s going on inside your body, it’s also worth getting your hormones tested. An easy way to do this is with Mira’s Panorama Fertility Lab Test. This finger-prick blood test can be taken at home and allows you to test for five different hormones, including:

• Anti-müllerian hormone (AMH)
• Thyroid-stimulating hormone (TSH)
• Free thyroxine (fT4)
• Prolactin
• Free testosterone

When tested together, these hormones provide invaluable insight into your ovarian reserve and perimenopause timeline. They can also help you make sense of your perimenopausal symptoms, so you can better understand why your body feels the way it does. 

Emotional and Psychological Symptoms of Perimenopause

In addition to physical symptoms, you may also experience some emotional symptoms during perimenopause. This includes: 

• Mood swings
• Irritability
• Anxiety
• Depression
• Memory problems
• Brain fog
• Interrupted sleep
• Insomnia

These symptoms can feel very frustrating and isolating. If you find yourself struggling, there is no shame in seeking help from a counselor, therapist, hormone health specialist, or support group. Even a phone call with a trusted friend can help you feel less alone. 

Underneath It All: What’s Going On With Your Hormones? 

As the body transitions away from being able to have children, the hormones guiding fertility fluctuate and long-term hormone patterns change. 

The key hormones to monitor during this transition are:

• Estrogen – gradually decreases during perimenopause and remains low during menopause. 
• Progesterone – gradually decreases during perimenopause and remains low during menopause. 
• Follicle-stimulating hormone – gradually increases during perimenopause and remains elevated during menopause. 
• Luteinizing hormone – gradually increases during perimenopause and remains elevated during menopause. 

It’s important to note that the gradual shift in hormone levels and patterns does not happen overnight. It also doesn’t happen in a straight line. This is why perimenopausal symptoms can feel chaotic. 

Another hormone to keep an eye on is testosterone, which naturally decreases during perimenopause. This drop in testosterone also contributes to many of the uncomfortable perimenopausal symptoms. 

The Power of At-Home Hormone Testing During Perimenopause

Your doctor may or may not conduct a perimenopause test during your transition to menopause. Even if they do, it won’t likely be on a regular basis. 

For more routine insight into how your hormones are fluctuating, you can track your hormone levels at home with Mira’s Menopause Transitions Kit. This kit (which includes the Mira Hormone Monitor, Fertility Max Wands, and Ovum Wands) enables you to track four key reproductive hormones in urine, including:

• Estrogen-Estradiol Metabolite (E3G) – a biomarker for estradiol
• Pregnanediol Glucuronide (PdG) – a biomarker for progesterone
• Luteinizing Hormone (LH)
• Follicle-stimulating Hormone (FSH)

When tracked over time in the Mira App, you can see first-hand how your transition to menopause is going. You can see if you’re still ovulating and fertile. You can also keep track of how your perimenopausal symptoms change alongside hormonal fluctuations. 

Most importantly, Mira’s Menopause Transitions Mode allows you to define your exact menopause stage; empowering you to make informed, proactive decisions for your reproductive health. 

Additional Health Changes to Expect During Perimenopause

Beyond the key physical, emotional, and psychological symptoms, there are additional health changes to be aware of during perimenopause. This includes:

• Bone loss, leading to an increased risk of osteoporosis
• Increased risk of weight gain, high cholesterol, high blood pressure, cardiovascular disease, heart attack, and stroke
• Signs of aging, such as a more prominent appearance of wrinkles, sun damage, and bruising 
• Dry, itchy skin and an increased risk of rosacea
• Overall thinning of the hair and hair loss 

Again – everyone’s experience of perimenopause is unique. To ensure your transition to menopause goes as smoothly as possible, speak with your doctor for personalized support. 

Managing Perimenopause Symptoms: Lifestyle Changes, Natural Remedies, and Medical Treatments

Lifestyle Changes

Many symptoms of menopause can be managed by making lifestyle changes. Here are some practical tips: 

• Protect your heart health by maintaining a balanced diet, being mindful of portions, and staying active with regular exercise. 
• Protect your bone health by consuming plenty of calcium-rich foods – such as dairy products, leafy green vegetables, soy beans, tofu, and nuts. 
• Limit the impact of hot flashes and night sweats by keeping stress levels to a minimum. Think lots of warm baths, massages, yoga, and/or listening to a meditation playlist.  
• Prioritize sleep quality by going to bed and waking up at the same time each day, limiting screen time in your bedroom, and avoiding caffeine in the afternoon.

Over time, you’ll soon learn what triggers your symptoms and what makes them feel better. 

Herbal Remedies and Supplements

Certain natural remedies have long been used to treat menopause symptoms. Some of the most commonly recommended supplements include black cohosh, ginseng, evening primrose oil, and red clover. You should be able to find these in your local pharmacy or natural foods store. 

If you are actively trying to conceive (TTC) during perimenopause, it’s also worth checking out Mira’s Prenatal Multi-Vitamins and Fertility Tea. Both can be helpful for easing uncomfortable symptoms, balancing hormones, and relieving tension. 

Medical Treatments

In some cases, your doctor may recommend certain medical treatments to ease symptoms. The most common medical treatments for perimenopause include:

• Menopausal Hormonal Therapy – such as the synthetic forms of estrogen, progesterone, and in some cases testosterone. 
• Non-Hormonal Prescription Medications – for example, medications such as clonidine, gabapentin, and certain antidepressants. 
• Birth Control – for example, combination oral contraceptives containing the synthetic forms of estrogen and progesterone. 

Before starting any medication, always seek guidance from your doctor.

Final Thoughts

Change can be difficult. Especially changes that impact your well-being and ability to conceive. During this time, it’s important to be kind to yourself. 

In some cases, symptoms may interfere with your ability to carry out your responsibilities at home or work. If this happens – don’t dismiss them! Seek support from a medical professional immediately. They can help you identify potential treatments and lifestyle changes to improve your quality of life. 

In addition to your doctor, we’d love to support you in our Hormone Health Clinic for Fertility! Our trained hormone health specialists can help you with all things nutrition, lifestyle, supplements, hormone tracking and more! 

Frequently Asked Questions