Like many things in life, estrogen is one of those wonders you don’t fully appreciate until it’s gone. It impacts nearly every aspect of our health: our heart, bones, skin, brain, muscles, the list goes on. Falling estrogen levels in perimenopause trigger a wide array of symptoms, making us acutely aware of its absence.
Menopause symptoms fall into four primary categories: physical, cognitive, mood, urinary/sexual/vaginal (GSM). You may feel some or none of these as you travel through the three phases of menopause. Whatever your experience, it’s important to learn about the physical and mental health implications of menopause.
If you have any of these symptoms, talk to a menopause-informed healthcare provider.
It’s about time we talked openly about low libido. A diminished sex drive during the menopausal transition is common and may be due to several factors, including decreased levels of estrogen and progesterone that accompany menopause. It may be difficult to remember the last time you actually craved sex, and that can cause emotional stress. Learn more here.
Changes in your period are often the first sign of perimenopause. It’s different for everyone, but you know something has changed. You may bleed a lot or very little. You used to be able to prepare for your period but now reliability goes out the window. As you progress further into perimenopause, you may sometimes skip periods altogether. If bleeding stops for several months, then restarts, the countdown to menopause begins again.
You can usually handle what life throws at you, but lately you can’t shake off your worries, even about the small things. You may feel irritable, restless, or panicky. The phrase "gut reaction" has deeper meaning. Exhaustion and tension may be more common. It's important to tell your doctor if you have these symptoms, as anxiety is treatable. Learn more about menopause and mental health here.
You’re forgetful, fuzzy, and more easily distracted. It’s difficult to focus (especially at work) and easy to lose track of what you set out to do. Even basic words may be difficult to recall. You might ask yourself, “What’s wrong with me?” or you may miss the old you. You are not alone, as many menopausal women report feeling the same.
Symptoms of UTIs may include a burning sensation while urinating, increased urinary frequency, change in the odor or color of your pee, cramps, fever, and/or nausea. As part of the menopause transition, declining estrogen levels are upending your vagina’s bacterial balance and causing its tissue to thin, both of which contribute to UTIs. Talk to a healthcare provider if you suspect an infection. Learn more here.
A hot flash is the sudden, intense spreading of heat, usually in the chest, neck, or face, that lasts from 30 seconds to several minutes. Your face may turn red, your heart rate increases, and you may sweat… a lot! Hot flashes that occur while you’re sleeping are called night sweats, and may leave you and your sheets drenched. These erratic temperature fluctuations are called vasomotor symptoms (VMS).
Many women gain weight during the menopausal transition, especially in their abdomen and thighs. It’s more than just pounds, as one's shape shifts, especially around the middle (think a bit more “apple” and less “hourglass”). Hormones may not be the only cause to midlife weight gain, as aging, genetics, and lifestyle also play a role.
Difficulty falling asleep, frequent waking, and trouble falling back to sleep are hallmarks of perimenopause. More than half of perimenopausal women experience sleep issues. Dysregulated sleep, which is often the result of dysregulated body temperature, can lead to mood changes. Of course, mood changes can, in turn, lead to sleep issues.
It's time to talk openly about painful sex. As estrogen levels drop, the vaginal wall thins, becoming dry and less elastic. This means more discomfort during or after intercourse. More than 25 percent of postmenopausal women report dyspareunia, the medical term for this kind of pain. Dyspareunia hurts physically and emotionally, and it may hurt your relationship. If you are suffering, talk with a menopause-trained doctor about treatment options. Learn more here.
Your heart may pound, flutter, or skip a beat. Zigzagging hormone levels can cause your heart rate to spike as much as 16 extra beats per minute. To make things more uncomfortable, palpitations often accompany hot flashes. While it’s important to connect heart palpitations to the menopause transition, they may be indicators of other long-term health risks and should be reported to your doctor.
Pain, heat, and puffiness in the neck, back, knees, ankles, fingers, elbows, or jaw are common complaints from women in the menopause transition. In fact, 50% of perimenopausal women experience joint pain. When you wake in the morning, you may feel especially stiff and creaky because estrogen, which reduces inflammation, is in decline.
Your patience is at zero and you’re easily exasperated. You’re quick to anger (okay, fury) and small things may set you off. You are not the only one feeling cranky. Perimenopausal women report irritability as their most common symptom. While you may blame yourself, your shorter fuse is likely the result of hormone fluctuations. Learn more about menopause and mental health.
Please answer the questions to complete the symptoms checklist. While not a diagnostic tool, it is a printable resource to share with your doctor to have an informed discussion about perimenopause.