What Are the Signs of Perimenopause? (And What to Do If You Have Them, According to Doctors and Experts)

Remember in adolescence when you started having your period? At first, it was sort of a drag, but then you learned to deal with (and maybe even embrace) your own personal assortment of cramps, menstrual fluid, water retention, bad moods and whatever else, including possibly headaches and exhaustion? Well, guess what? When your body gets ready to stop menstruating for good, you get to experience a whole new grab-bag of bodily changes! That not-quite-done-bleeding-forever time is called perimenopause. We asked doctors and experts in women’s wellness field to help us understand it a little better and guide us toward some products and clinical interventions to make this transitionary time—which occurs at a median age of 47—flow a little smoother.

Perimenopause means “around menopause”; It refers to the transitional time, which according to Johns Hopkins Medical Center can last between 2 and 10 years, in when a person experiences changes in the menstrual cycle. When you haven’t had a period for 12 months, you’re said to be in menopause. But until then, if you’re experiencing any of a collection of common hormonally-induced symptoms, you’re said to be in perimenopause.

• Menstrual Irregularity

The most common symptom and the herald of impending perimenopause is menstrual irregularity,” says Dr. Sharon D. Malone, Medical Director of Alloy. “Initially the periods start coming too close together, i.e., cycles that had been 28 days apart may start coming at 22-25 day intervals. From there anything is fair game—too soon, too heavy, too long.”

• Hot Flashes

The Journal of Midlife Health defines a hot flash as a feeling of heat, sweating, flushing, anxiety and chills lasting for one to five minutes. That’s the science-y definition, but for a more visceral description, hear author Darcey Steinke, writing in her excellent memoir Flash Count Diary: “I wake, heart thwacking, as heat flows up from my stomach, courses behind my face, and radiates out through the top of my head.”

• Poor Sleep

The Sleep Foundation says that 40 percent of women in their late 40s and early 50s report sleep problems, and that hormonally related sleep issues can include night sweats, insomnia, sleep-disordered breathing and restless leg syndrome.

• Pee Slips

A recent study showed that with age, pee frequency and urinary incontinence increases.

• Painful sex

It’s called dyspareunia—painful vaginal sex—and it has been linked to lessening amounts of estrogen leaving vaginal tissues dry, less elastic and fragile. The Mayo Clinic estimates that 20 to 30 percent of menopausal women not on hormone replacement therapy suffer this condition, and physicians report that the tenderness begins even before the complete cessation of menses.

• Depression/Anxiety

Leslie Faerstein is a New York City psychotherapist who primarily works with women over 50, and she reports “many different reactions to perimenopause and menopause. For some, it’s a joy not to have a period anymore. For others, there is sadness and often depression about losing what they feel makes them a woman. It may also trigger feelings about no longer being able to bear children—even if they already have children and don’t want any more,” she says. “It’s knowing that this stage of their life is over and they are aging.” Faerstein recommends finding a professional to work through these feelings if they become overwhelming and depression increases. “You don’t have to suffer,” she says, brightly.

• Body Odor

According to Faerstein, body odor from hot flashes, night sweats as well as vagina chemistry changes that can cause bad odors.

• Other Issues

“Less common symptoms are dry eyes, itchy skin, hair loss and formication—feeling like insects or ants are crawling under your skin,” says Dr. Malone. (Ok just—yuk.) Dr. Malone says there are more than 30 symptoms associated with perimenopause and menopause. “People can have some, all or none of the symptoms,” she says. “There is no way to predict in advance who is going to get what, but a good rule of thumb is [to ask] what type of menopausal symptoms did your mother or older sisters experience?”

Long story short: Talk to your doctor. But, not so fast—you’ll want to make sure that your physician has experience in treating your symptoms and is sympathetic to your issues. First, you might want to review a good perimenopause explainer from the Cleveland Clinic. Possibly talk to trusted friends and family about their experiences. And ask your physician if they have any special training for menopause-related issues. According to Dr. Claudia Levine, co-founder of educationally focused My Menopause Jewelbox, the North American Menopause Society offers a Certified Menopause Practioner (CMP) certification and a Find a Menopause Practioner link on their website. “At Jewelbox we recommend this all the time to people whose current provider doesn't have the expertise they're looking for. Studies show many providers don't feel well trained in this area of care,” she says. “There are also many new online telehealth platforms offering peri/menopausal care including Gennev, Elektra Health and Alloy.” According to Anne Fulenwider, co-founder of Alloy, “Most medical schools do not teach menopause, so there’s a real dearth of trained practitioners overall.” She notes that the NAMS site lists fewer than 1,000 doctors for North America, a lack of access to expertise that Alloy hopes to remedy with their online menopause-specific services.