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Perimenopause: Early Signs & Symptoms


As we age, we hear a lot about the challenges of menopause from other women who have experienced the menopausal transition: the time in our lives when our oestrogen and progesterone levels drop and our menstrual cycles eventually come to an end. But something that isn’t talked about nearly enough is perimenopause: the transitional period to menopause that’s defined by rapidly fluctuating hormones and a wide range of bodily changes. This process affects us physically, mentally, and emotionally, and for some women, the perimenopausal stage can be much more challenging than menopause itself.


Though perimenopause is a natural process and a normal part of a woman’s life, the hormonal imbalances and potentially long list of very challenging symptoms that go along with it don’t have to become your new normal. The first step to balancing your hormones and getting your life back, however, is recognizing the early signs and symptoms of perimenopause.


Here are a few clues to help you determine whether what you’re dealing with is indeed the start of the menopausal transition.


Longer, Shorter, or Irregular Menstrual Cycles

Menstrual irregularities can be one of the earliest signs of perimenopause, occurring until your period stops altogether and has been absent for at least 12 consecutive months (at which point you would reach menopause). You may have shorter cycles and the occasional skipped period in early perimenopause, but amenorrhea will typically occur for longer periods of time later on in the menopausal transition.


According to an article published in the peer-reviewed journal Clinical Obstetrics and Gynecology, shorter cycles of 21 days or less are more common in early perimenopause — while longer cycles (of 36 days or more) are more likely to occur in late perimenopause. Additionally, about 77 percent of women report having at least three episodes of prolonged bleeding during the menopausal transition.


Hot Flushes and Night Sweats

Like the menstrual irregularities described above, vasomotor symptoms (including hot flushes and night sweats) are very common in perimenopause. As many as 80 percent of perimenopausal women experience vasomotor symptoms as estradiol levels drop, and about 39 percent experience them early on in perimenopause. These symptoms often increase in severity as the menopausal transition progresses.


Some examples of the more common vasomotor symptoms in perimenopause include:


  • Hot flushes in the neck, chest, and/or face.

  • Hot flushes followed by chills.

  • Hot flushes and sweating that occur at night (night sweats).

  • Increased daytime sweating.


Understandably, these vasomotor symptoms — especially night sweats — can lead to sleep disturbances in perimenopause. These sleep disturbances may include poor quality sleep, difficulty falling and staying asleep, daytime sleepiness, and poor daytime functioning. Some women may also experience restless legs syndrome (RLS) and/or obstructive sleep apnoea, but these symptoms are typically worse after menopause.


Changes in Mood, Energy Levels, and Libido

Several other early symptoms of perimenopause include declining mood and energy levels. Tiredness, fatigue, and low motivation are also common.


As Dr. Sarah Gottfried states in her book The Hormone Cure: Reclaim Balance, Sleep and Sex Drive; Lose Weight; Feel Focused, Vital, and Energized Naturally with the Gottfried Protocol, perimenopause can even resemble the years leading up to puberty in adolescent females. Just as how many females experience mood changes in puberty, women may experience anxiety, depression, tearfulness, social withdrawal, and emotional instability in perimenopause.


In fact, perimenopause has been associated with the highest rates of psychological distress. According to the results of a multiethnic community study published in the American Journal of Public Health, rates of emotional distress were 28.9 percent among those in early perimenopause and 25.6 percent among those in late perimenopause. At 22 percent, rates were lowest among postmenopausal women.


Symptoms of psychological distress in early perimenopause vary but may include:


  • Poor self-esteem.

  • Low mood.

  • Poor memory, concentration, and brain fog.

  • Increased anxiety.


Perimenopausal women may also notice a loss of libido, occurring with or without vaginal dryness, pain, and discomfort. For many women, these changes in desire can be a major source of distress.


According to the results of a web-based survey published in Menopause International, about 41 percent of perimenopausal respondents were experiencing reduced libido with distress at the time of the study. About 38 percent reported vaginal dryness, and 78 percent of the perimenopausal respondents felt that their vaginal dryness was a primary cause for their reduced libido. In comparison, just 22 percent of postmenopausal respondents reported reduced libido with distress.



You Can Balance Your Hormones in Perimenopause

Perimenopause is a natural transition that occurs in the years leading up to menopause, but menstrual irregularities, hot flushes, sleep disturbances, low mood, and reduced libido don’t have to hold you back from living your best life. It is my mission to help women just like you, and through a series of gentle diet and lifestyle modifications, I will help you to rebalance your hormones and get your life back!


Ready to balance your hormones, boost your energy levels, and start getting your life back? Book your 30-minute Health Transformation Call to learn about my different programmes and services, including my 1-2-1 Nutrition & Lifestyle Programmes and Health MOT. Whatever your health goals may be, I look forward to supporting you every step of the way!



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