Many physical and emotional symptoms related to perimenopause often go undiscussed. Knowing what to expect can help you take a more proactive approach to managing your symptoms.
The transition to menopause, officially known as perimenopause, can have a big effect on both the mind and body. However, perimenopausal symptoms tend to be less discussed than menopausal ones.
It’s not uncommon to feel alone and wonder if what you’re going through is actually real —especially if your symptoms aren’t some of the ‘usual’ ones like hot flashes or menstrual changes.
Considering menopause begins as early as 40 years old for
So here are some of the less common symptoms, why they happen, and how you can treat them.
“Menstrual changes, hot flashes, sleep disturbance including night sweats, changes to vaginal discharge, reduced libido, and mood swings are all common perimenopausal symptoms,” says Dr. Zahra Ameen, consultant gynecologist and obstetrician at London’s Cadogan Clinic.
However, there are other lesser-known symptoms that are less talked about. Here’s what that may look like.
Dry eyes
Are you noticing that your eyes are feeling drier and a little scratchy?
“The lacrimal glands in our eyes keep them moist,” explains Dr. Ameen.
“But the changing hormone levels during perimenopause (and menopause) cause the gland to produce less fluid, and the eyes to become drier.”
Products like humidifiers and eye drops can help. You may also want to consider seeing an optician or other healthcare professional if you’re concerned about your dry eye symptoms.
Skin changes
Whether it’s acne breakouts, dryness, or itchiness, a lot can happen to your skin during perimenopause.
Dr. Ameen adds, “declining levels of estrogen causes the skin to thin and become slack and less elastic, with wrinkles and fine lines becoming more visible.”
Of course, your diet and skin care routine can have an impact, so try to eat a balanced diet and use a decent moisturizer.
If you’re able to, visit a dermatologist or other healthcare professional for personalized advice.
Hair changes
“Hormonal imbalances can also cause thinning hair on the head and more hair on the face,” says Dr. Ameen.
With hair loss, hypothyroidism should be ruled out via a blood test.
If the cause is determined to be perimenopause, then add revitalizing shampoos and conditioners to your haircare routine and opt for a wide-toothed comb to gently brush your hair.
Trying to lower stress levels can also help, whether it’s through yoga, breathing exercises, or creative classes.
Weight gain
Weight gain that seems to be unexplainable is often associated with perimenopause.
“It occurs before and during menopause, partly because of a drop in estrogen levels,” explains cosmetic doctor and hormone expert Dr. Martin Kinsella.
“Low-quality sleep and regular, age-related reductions in metabolism and muscle tone can also contribute to this weight gain,” he adds, “which tends to develop in the abdomen area.”
One potential treatment option is to focus on balancing your hormone levels.
Vaginal dryness
“During menopause, estrogen levels decrease, causing a gradual thinning of the vaginal wall,” says cosmetic doctor and intimate health expert Dr. Shirin Lakhani.
This condition, often called genitourinary syndrome of menopause (GSM), commonly involves vaginal dryness, but it may also result in:
- pain during penetrative sex
- vaginal bleeding and discharge
- a burning or itching sensation
- an urgency to urinate
Treatment can range from vaginal lubricators to hormone replacement therapy (HRT).
Headaches
Some people “have more frequent or worse headaches during perimenopause,” says Kinsella. Others may experience hormonal headaches for the first time.
A type of migraine thought to be triggered by fluctuating ovarian levels may also
Limiting stress and increasing exercise levels can help if perimenopause is the cause. In more severe cases, you may need to visit a doctor for prescription medication or try an alternative therapy like acupuncture.
Emotional changes during perimenopause are often not as talked about. Here’s what this may look like.
Rage
You may start to feel irritable, frustrated, or even angry, as perimenopause can be a challenging period in your life.
Regular exercise can also help, says Kaikavoosi, along with a “healthy, mainly plant-based diet with lots of omega-3 fatty acids in fish oil, nuts, and grains.”
If you’re having trouble dealing with these feelings by yourself, a counselor or therapist can help.
A general practitioner or primary care provider may even be able to help you find a professional who specializes in perimenopause.
Brain fog
Finding it difficult to think, concentrate, or remember things is all part of what’s known as “brain fog.”
This, says Ameen, is “caused by sleep disturbance and fluctuating hormone levels.”
Other causes that aren’t related to perimenopause include:
Explaining your symptoms to a doctor will help them decide which tests need to be carried out to rule out any of the above.
Managing brain fog is similar to managing other emotional symptoms of perimenopause.
Mood shifts
Throughout your life, hormones can influence your mood and even cause a rapid shift from one mood to another.
But during perimenopause, fluctuating levels of estrogen and progesterone can disrupt the production of a mood regulator called serotonin, says Ameen, “leading to more mood swings.”
If people “report significant headaches or vomiting, particularly first thing in the morning, then this will need to be investigated further by their [doctor] in case of other much rarer conditions such as brain lesions,” she adds.
Premenstrual syndrome (PMS), depression, anxiety, and everyday stress can also cause shifts in mood.
Help is out there
If you or someone you know is in crisis and considering suicide or self-harm, please seek support:
- Call or text the 988 Suicide and Crisis Lifeline at 988 or chat at 988lifeline.org. Caring counselors are available to listen and provide free and confidential support 24/7.
- Text HOME to the Crisis Text Line at 741741 to connect with a volunteer crisis counselor for free and confidential support 24/7.
- Not in the United States? Find a helpline in your country with Befrienders Worldwide.
- Call 911 or your local emergency services number if you feel safe to do so.
If you’re calling on behalf of someone else, stay with them until help arrives. You may remove weapons or substances that can cause harm if you can do so safely.
If you’re not in the same household, stay on the phone with them until help arrives.
While general health advice such as exercising, getting adequate sleep, and eating a balanced diet can help perimenopausal symptoms, it’s also a good idea to speak with your doctor about additional treatment options.
During your appointment, try to be as honest as possible and mention each physical and emotional change, even if you’re not sure it’s related.
Depending on the symptoms, your doctor can rule out other conditions, such as thyroid problems and anemia.
Your doctor can then offer treatments such as hormone replacement therapy in an attempt to rebalance your hormone levels and refer you to specialists in menopause or mental health if needed.
The following should also be immediately investigated by a doctor or other healthcare professional:
- heart palpitations
- persistent heartburn or indigestion
- chest pain or discomfort
- unexplained shortness of breath
- severe depression or anxiety
- ongoing heavy vaginal bleeding
- vaginal bleeding that reappears after a year of absence
- bleeding during or after sexual activity
- abdominal pain or bloating
- loss of appetite
- unexplained weight loss
- change in bowel habits
- rectal bleeding
Perimenopause may be inescapable, but that doesn’t mean you need to cope with this natural process and its symptoms silently.
Being aware of the possible symptoms and speaking with a doctor if your symptoms are impacting you can help boost your quality of life during this transitional phase.
And remember, no symptom is too “weird” to discuss or receive help for.
Lauren Sharkey is a U.K.-based journalist and author specializing in women’s issues. When she isn’t trying to discover a way to banish migraines, she can be found uncovering the answers to your lurking health questions. She has also written a book profiling young female activists across the globe and is currently building a community of such resisters. Catch her on Twitter.
