Perimenopausal Symptoms

Perimenopause, the transitional phase leading up to menopause, is marked by fluctuating hormone levels that can significantly impact a woman’s physical, psychological, and emotional well-being. This period can span several years and is often accompanied by a wide range of symptoms. Recognising and understanding these symptoms can empower women to seek appropriate support and treatment. Below, we outline the various categories of perimenopausal symptoms, including their impact on daily life. The variation in severity from one person to another is huge, having milder symptoms does not mean you are not perimenopausal. Clinical guidelines within the UK recommend, for women under the age of 45 years, to complete a blood test to check FSH levels to help the diagnosis the perimenopause. However for many women this result is normal, yet they are still experiencing symptoms due to diminishing hormone levels and can be diagnosed on these symptoms alone.

Vasomotor symptoms of the perimenopause

Vasomotor symptoms, such as hot flushes and night sweats, are among the most well-known manifestations of perimenopause. Hot flushes are characterised by sudden waves of heat, typically affecting the upper body, often accompanied by sweating and a rapid heartbeat. Night sweats, the nocturnal equivalent, can disrupt sleep and lead to fatigue. These symptoms are linked to fluctuating oestrogen levels, which affect the hypothalamus—the part of the brain that regulates body temperature. Hot flushes can be triggered by foods such as curries, caffeine and alcohol. Vasomotor symptoms can be triggered by anxiety and vice versa. Women in the perimenopause can experience vasomotor symptoms which are transient and are worse at different times of the menstrual cycle, particularly in the last few days before the onset of a period when hormone levels are often at their lowest.

Anxiety, depression and psychological symptoms of the perimenopause

Many women experience psychological changes during perimenopause, including mood swings, irritability, anxiety, and depression. These symptoms are partly attributed to fluctuating hormone levels, particularly oestrogen and progesterone, which influence neurotransmitters in the brain. Women may also report heightened emotional sensitivity or feelings of overwhelm. Addressing these symptoms is essential for maintaining mental health and quality of life. The psychological symptoms can be significant for many women, included in these is an increase in PMS symptoms such as irritability, anger and concentration changes. Many women are misdiagnosed with anxiety or depression in the perimenopause in their early 40's.

Musculoskeletal symptoms of the perimenopause

Hormonal changes during perimenopause can lead to joint pain, stiffness, and muscle aches. Reduced oestrogen levels can affect collagen production and joint lubrication, leading to discomfort and decreased mobility. There is an increased incidence of musculoskeletal injury and conditions such as frozen shoulder and planta fasciitis. Due to the decline of oestrogen, post menopausal women are at an increased risk of osteopenia and osteoporosis.

Cognitive symptoms of the perimenopause

Perimenopause is often associated with cognitive changes, including memory lapses, difficulty concentrating, and a phenomenon commonly referred to as ‘brain fog.’ These symptoms can be distressing, particularly for women in demanding professional or personal roles. While these changes are often temporary, they can impact confidence and productivity. women often describe struggling to recall the correct words when having a conversation, articulating their thoughts or remembering the train of thought they started.

Effects on sleep & metabolism during the perimenopause

Sleep disturbances are a common concern during perimenopause, often exacerbated by night sweats and increased anxiety. Women may find it difficult to fall or stay asleep, leading to insomnia and daytime fatigue. many women report waking in the early hours, 2-3am and struggling to get back to sleep. Additionally, hormonal changes can slow down metabolism, contributing to weight gain and reduced energy levels. Poor sleep and metabolic changes can also negatively affect mood and overall health.

Genitourinary symptoms of the perimenopause

Genitourinary symptoms, collectively referred to as the genitourinary syndrome of menopause (GSM), include vaginal dryness, irritation, and discomfort during sexual activity. Women may also experience urinary frequency, urgency, or recurrent urinary tract infections (UTIs). These symptoms result from a decline in oestrogen, which affects the tissues of the vagina and urinary tract, leading to thinning, reduced elasticity, and increased susceptibility to irritation.

Physical & other symptoms of the perimenopause

Perimenopause can bring a variety of physical changes, including weight gain, fatigue, and changes in skin and hair. Weight gain is often linked to shifts in body metabolism and fat distribution, with many women noticing an increase in abdominal fat. Thinning hair, dry skin, and brittle nails are also common complaints, influenced by reduced collagen and hormonal fluctuations.

Additional symptoms may include an increase in headaches or migraines, dizziness, vertigo, palpitations, itchy skin and an increase in allergy response can all be linked to the perimenopause transition.

Treatment and support of perimenopause symptoms