1. Hot Flashes or Hot Flushes

Hot flashes one of the most common symptoms of menopause are sudden episodes of feeling warm, flushed, or hot all over the body. Hotflashes are caused by low or changing estrogen levels.

2. Night Sweats

Night sweats are episodes of excessive sweating that occur while you’re sleeping. They can be severe enough to soak your bedclothes and wake you up

3. Difficulty Sleeping

Sleep problems are common during perimenopause. This is because hormonal changes can cause hot flashes, mood disorders, night sweats, and weight gain, all of which can affect sleep quality.

4. Mood Swings and Irritability

Mood swings and irritability are common symptoms of perimenopause.

• They can include:
• Feeling angry, weepy or sad for no apparent reason
• Experiencing sudden mood shifts
• Becoming easily irritated or frustrated by minor things in life

5. Anxiety and Panic Attacks

The symptoms of anxiety and panic attacks in perimenopause is caused by changes in estrogen and it’s impacts on stress hormones such as cortisol.

6. Brain Fog during Perimenopause

• Brain fog can occur in perimenopause which is a symptom of reduced cognitive function and can cause:
• difficulty concentrating,
• difficulty focusing and remembering.
• having trouble multitasking.

7. Vaginal Dryness in Perimenopause

Low estrogen levels contribute to vaginal dryness and symptoms include:

• Dryness and irritation of vagina, vulva and urethra
• Increased pain during sex.
• Itching or burning sensation in the vagina.
• Painful urination or difficulty peeing.

8. Breast Pain

Breast soreness in common in perimenopause.

9. Weight Gain during Perimenopause

Weight gain in perimenopause is due to both hormonal and metabolic changes. These include:

• Loss of muscle and bone mass,
• Increasing insulin resistance
• Slowing down of metabolic rate due to loss of estrogen
• changes to appetite
• increased abdominal fat (also known as visceral fat).

10. Loss of Sexual Interest/Decreased Libido

Reduced sexual interest or low libido in perimenopause is due to changes is sex hormones: estrogen, progesterone, and testosterone

11. Loss of Sexual Interest/Decreased Libido

Low estrogen levels can contribute to urinary incontinence in women. Stress incontinence is associated with a weak pelvic floor, and urge incontinence is often due to irritable bladder wall muscles.

12. Skin and Hair Changes

During perimenopause, many women notice their skin becoming drier and also can experience itchy skin. Some women also develop hormonal acne. Changes to the hair include hair loss, thinning of the hair, and greying of the hair.

13. Digestive Problems

Digestive problems in perimenopause include:

• Excessive flatulence
• Bloating
• Nausea
• Abdominal cramps
• Stomach bloating
• Indigestion
• Diarrhea

14. Hair Loss

Changes to your hair accompany perimenopause. It can include:

• Thinning hair on the head/other parts of the body
• Increased facial hair
• Dry, brittle, and fragile hair that breaks easily

15. Bloating

Digestion can slow down during perimenopause, resulting in feeling bloated, and constipation.

16. Irregular periods

During the latter part of perimenopause the length of time between periods increases and periods become irregular and infrequent.

17. Heavy Periods

When estrogen levels are high and progesterone levels are low there is often a high build up of endometrial lining (increased lining) combined with a lack of ovulation (lack of signaling to stop building the lining or to shed the lining). this can result in heavy and prolonged periods.

18. Bone Loss

Bone loss is the gradual and caused by a decrease in estrogen levels. It begins approximately 8 years prior to menopause and continues after menopause. The loss of bone structure results in weak bones, reduced bone density, and bones that are more prone to fracture. Eventually some women may develop osteoporosis.

19. Painful Periods

During the earlier part of perimenopause when estrogen levels rise, it can cause your uterus to release more prostaglandins, which increase the severity of your period cramps (dysmenorrhea). Also some women develop a condition called endometriosis or adenomyosis which can cause painful bleeding.

20. Sarcopenia, Muscle Aches and Joint Pain

Muscle mass and strength is lost from around 8 years prior to menopause and continues for approximately 4 years after. This breakdown of muscle can cause muscle and joint pain and muscle tension. The loss of muscle mass and strength is called sarcopenia and is the major cause of frailty in older people. 10 percent of muscle mass in lost over a 3 year period around perimenopause and up to 50 percent of muscle mass lost post-menopause in women who do not train with muscle resistance exercise. Additionally lower hormones impacts the production of cartilage which can contribute to joint pain in perimenopause and menopause and is often the beginnings of osteoarthritis.

21. Low Energy

Fluctuating hormones, and changes in metabolism and sleep during perimenopause can all contribute to low energy.

22. Infertility

During perimenopause women experience both ovulatory and anovulatory cycles. Women can both be fertile and have reduced fertility. It is important to continue to use contraception until you are post -menopausal if you want to avoid pregnancy and to seek support from your health provider if you are having difficulty conceiving during perimenopause.

23. Gum and Teeth Issues

Gum and mouth issues associated with perimenopause include:

• Gum disease
• Soreness, redness, or bleeding of the gums.
• Changes in tooth sensitivity or appearance (e.g., yellowing).
• Increased incidence of tooth decay or loss of teeth due to decreased saliva production during menopause.

24. Acid Reflux

Heartburn and acid reflux are common in perimenopause due to hormonal fluctuations. It can be improved with changes in diet and lifestyle.

25. Nail changes

Changes to the nails during perimenopause are common and includes:

• Dry, brittle nails that break easily
• Discoloration of the nail beds
• Thinning or loss of cuticles.

26. Dizziness

Fluctuating hormone levels can cause changes in blood pressure and heart rates, and blood sugar levels and can contribute to dizzy spells.

27. Bacterial vaginosis

Some women experience increased episodes of bacterial vaginosis due to changes in vaginal estrogen. A lack of estrogen reduces lactobacillus which usually helps to keep the vagina acidic.

28. Formication

Some women experience the sensation of bugs crawling under their skin or on their skin.

29. Urinary tract infections or UTIs

Lack of estrogen to the bladder and urethral and vulva tissues changes the bacterial flora of these intimate areas. It also increases the fragility of the tissue and increases the likelihood of infection especially urinary tract infections.

30. Headaches

Fluctuating hormone levels can cause tension headaches and migraines. They can worsen headaches in women who get them prior to perimenopause and can cause new onset of headaches in women who rarely had them. Headaches and migraines can be particularly worse premenstrually or in the few days prior to getting a period.

31. Autoimmune Diseases in Perimenopause

Hormonal changes during perimenopause cause changes to the immune system and make women more susceptible to developing autoimmune disorders such as thyroid autoimmune diseases like Hashimoto’s, Graves and other conditions such lupus and rheumatoid arthritis (Desai 2019).

32. Allergies During Perimenopause

Allergies can worsen or new allergies can develop during perimenopause. These include allergy related disorders including eczema, hayfever and asthma. Fluctuating estrogen levels and low progesterone levels during perimenopause can trigger alter the immune system and trigger an increase in allergic responses, including mast cell release of histamines. (Shah 2012).

33. Irregular Heartbeat

Fluctuations in hormone levels can cause changes to heart rhythm and function. This can be experienced as:

• palpitations or skipped beats,
• racing heartbeat
• shortness of breath or
• chest pain.

It is important to speak to your doctor if you experience any of these symptoms during perimenopause.

34. Burning mouth syndrome

Burning mouth syndrome occurs in some perimenopausal women. It described as burning, tender, tingling, hot, scalding, and numb sensation in the oral mucosa.