34 Surprising Perimenopause Symptoms You Should Know

Perimenopause | Menopause | Premenopause | Age | Duration | Symptoms

The terminology and signs of menopause are complicated topics. Even many medical professionals often cannot identify the symptoms of perimenopause.

This fact-checked article explains the three primary phases of menopause in simple terms:

• Perimenopause
• Menopause
• Postmenopause

Phase one is going to be covered in depth.

What Is Perimenopause?

When the length of consecutive menstrual cycles shows a persistent difference of at least 7 days, perimenopause has occurred (Delamater et al. 2018¹).

After that, women are considered perimenopausal until menopause occurs. Perimenopause describes the transition phase into menopause – the menopausal transition.

Since the body produces fewer fertility hormones during perimenopause, ovaries, urogenital organs, bones, and arteries change (Peacock et al. 2022²).

Perimenopause vs. Menopause

Menopause is the permanent absence of menstruation for at least 12 months (Peacock et al. 2022³).

Accordingly, menopause marks the completion of the transformation of perimenopause. Therefore, compared to perimenopause, menopause is a point in time, not a time frame.

Once menopause has occurred, a woman can no longer become pregnant naturally (Takahasi et al. 2015⁴).

Perimenopause vs. Postmenopause

Postmenopause describes the time after menopause has occurred. Thus, postmenopause is the opposite of perimenopause, a period before menopause.

After menopause, women spend up to one-third of their lives in postmenopause (Peacock et al. 2022⁵).

In contrast to menopause, changes in cognitive abilities in postmenopause are due to aging rather than hormonal fluctuations (Santoro et al. 2016⁶).

Premenopause vs. Perimenopause

Premenopause or premature menopause is when the menopausal transformation is completed before age 40. Menopause occurs prematurely in about 1% of women (Okeke et al. 2013⁷).

Early menopause, on the other hand, is when it occurs between the ages of 40 and 45. This early menopause affects about 5% of women (Peacock et al. 2022⁸).

Women who experience an earlier onset of menopause have an increased risk of osteoporosis, cardiovascular, neurological, and psychiatric disease, and mortality in general (Shuster et al 2010⁹).

At What Age Do Perimenopause Symptoms Start?

Typically, menopause in women begins at age 45. However, the menopausal transition is slow, as the natural decline of estrogen and progesterone begins in the 30s.

How Long Does Perimenopause Last?

Symptoms of perimenopause last an average of 7.5 years. In contrast, for those women in whom the transition begins before age 45, it lasts an average of 12 years (Avis et al. 2015¹⁰).

On average, women’s perimenopause ends at age 51, when menopause occurs (Peacock et al. 2022¹¹).

First Signs of Perimenopause

An irregular period is the first sign of perimenopause.

In addition, many women also experience other early symptoms of menopause, such as (Okeke et al. 2013¹²):

• Sleep disturbances
• Hot flashes
• Night sweats
• Headaches
• Vaginal dryness

Perimenopause Symptoms

The decline in estrogen production by the ovaries during menopause can lead to physical, psychological, urogenital, as well as vasomotor (affecting the blood vessels) symptoms (Santoro et al. 2016¹³; Peacock et al. 2022¹⁴; Tchernof et al. 1998¹⁵):

• Psychological symptoms
  • Mood swings
  • Poor concentration
  • Sleep disturbances
  • Depression
  • Anxiety
  • Irritability
  • Cancer phobia
  • False pregnancy
• Physical symptoms
  • Dry eyes, mouth, or skin
  • Skin atrophy
  • Joint pain
  • Muscle pain
  • Sensitive breasts
  • Severe PMS symptoms
  • Hair loss or thinning
  • High blood pressure
  • Bone loss
  • Metabolic disorders
  • Insulin resistance
  • Weight gain
• Vasomotor symptoms
  • Hot flashes
  • Cold flashes
  • Night sweats
  • Migraine
  • Palpitations
• Urogenital symptoms
  • Vaginal dryness
  • Pain during sexual intercourse
  • Sexual dysfunction
  • Decreased libido
  • Irregular periods
  • Heavier/weaker periods
  • Frequent urination
  • Incontinence
  • Bladder infection

How to Lose Weight During Perimenopause

In addition to fertility hormones, the sex hormones estrogen and testosterone are particularly affected by the changes of perimenopause.

During the menopausal transition, estrogen levels can fluctuate greatly.

Because estrogen is essential in regulating insulin, blood glucose, metabolism, appetite, and body fat distribution, low estrogen levels are associated with weight gain (Mauvais-Jarvis et al. 2013¹⁶).

Therefore, women gain abdominal fat more efficiently during the menopausal transition (Lovejoy et al. 1998¹⁷).

Because estrogen is directly involved in regulating the fat-storage hormone insulin, you gain body fat more efficiently if estrogen levels decrease.

Accordingly, it is no surprise that these hormonal changes likewise favor the development of insulin resistance (Yan et al. 2019¹⁸).

In summary, these severe changes in energy balance and metabolism pose the following risks (Mauvais-Jarvis et al. 2013¹⁹):

• Obesity
• Fatty liver
• Type 2 diabetes
• Inflammation
• Arteriosclerosis

In addition, the decline in sex hormones makes it more difficult for the body to build new lean mass, further slowing metabolism (Maltais et al. 2009²⁰).

Fortunately, diets focusing on hormone balance can promote muscle maintenance and reduce insulin resistance and inflammation even during the menopausal transition.

The two most effective approaches to keep insulin and other major weight loss hormones in check are intermittent fasting and a ketogenic diet.

Intermittent Fasting

Many women going through the menopausal transition try to reduce their excess weight with diets. But conventional calorie reduction promotes muscle loss and can severely limit basal metabolic rate even years after dieting (Fothergill et al. 2017²¹).

Intermittent fasting, on the other hand, boosts metabolism and protects muscle and bone mass from age-related degeneration (Drenick et al. 1964²²; Rudman et al. 1990²³).

Moreover, intermittent fasting is the most effective and safe way to lower insulin levels and counteract insulin resistance, diabetes, fatty liver, and obesity naturally (Catenacci et al. 2016²⁴; Halberg et al. 2005²⁵).

This fact is supported by a study in which over 100 overweight women could reduce insulin levels by nearly one-third and increase insulin sensitivity through intermittent fasting (Harvie et al. 2011²⁶).

In addition, studies show that intermittent fasting can lower inflammatory markers contributing to weight gain and insulin resistance (Faris et al. 2012²⁷).

Balancing feasting and fasting also stabilizes blood sugar levels, which are often responsible for sweet cravings.

A study on uncontrolled eating behavior shows us supporting evidence. Intermittent fasting reduced cravings and depression after just two months and improved the participants’ body image (Hoddy et al. 2015²⁸).

Women whose hormones are out of balance may struggle with sleep problems.

In an intermittent fasting study conducted on 14 women, participants experienced the following improvements in sleep patterns after just one week (Michalsen et al. 2003²⁹):

• Reduced awakenings
• Fewer leg movements
• Longer REM sleep
• Improved sleep quality
• Increased energy level
• Improved concentration
• Emotional balance

Improved sleep also positively affects other psychological symptoms of menopause, such as mood swings (Triantafillou et al. 2019³⁰).

Ketogenic Diet

After fasting, the ketogenic diet is the most effective method to regulate insulin naturally because healthy fats, such as extra virgin olive oil, around which this diet revolves, hardly stimulate insulin production.

On the other hand, carbohydrate-rich foods cause blood sugar and insulin levels to go through the roof.

In contrast, low-carbohydrate diets increase insulin sensitivity, improving blood glucose and lipid levels (Boden et al. 2005³¹).

Accordingly, another study supports that a low-carbohydrate diet is better for menopausal weight loss than a Mediterranean diet, a low-fat diet, or one that meets U.S. Department of Agriculture dietary guidelines (Ford et al. 2017³²).

Moreover, the release of satiety hormones is proportional to the number of fatty acids consumed in the diet (Pironi et al. 1993³³).

For this reason, the ketogenic diet counteracts cravings and keeps you full longer.

Furthermore, a ketogenic diet protects against muscle protein catabolism during a calorie deficit (Manninen 2006³⁴).

Thus, keto may counteract age-related muscle degeneration better than other diets.

Last but not least, studies can also demonstrate a mood-stabilizing, antidepressant effect of the keto diet (Brietzke et al. 2018³⁵).

Perimenopause Is a Natural Process

You don’t have to take a test to ensure you’re in perimenopause. Instead, your doctor will determine if you are in perimenopause based on the regularity of your menstrual cycle and the symptoms listed above.

In addition, she may measure estradiol (E2), the form of estrogen produced in the ovaries and instrumental in ovulation, to determine if the transformation of menopause has begun (Freeman et al. 2007¹⁶).

Perimenopause and its symptoms are a natural aging process that every woman goes through. You should see a doctor if you notice abnormal bleeding or other symptoms significantly affecting your daily life.

If you struggle with perimenopause weight loss due to hormone imbalance, I recommend reading my new book: Wiser Intermittent Fasting for Women Over 50.

Perimenopause Symptoms FAQ

What are the first signs of perimenopause?

An irregular period is the first sign of perimenopause. In addition, many women also experience vaginal dryness, sleep disturbances, hot flashes, night sweats, and headaches.

What is the typical age for perimenopause?

Perimenopause typically starts at age 45.

What are five of the most common symptoms of perimenopause?

The five most common perimenopause symptoms are irregular periods, vaginal dryness, sleep disturbances, hot flashes, and night sweats.

How does a woman feel in perimenopause?

Since hormones fluctuate during perimenopause, your feelings fluctuate as well. Hence, perimenopausal women often experience hot and cold flashes, mood swings, and lack of concentration.

Studies ▾

#1-12

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²Peacock K, Ketvertis KM. Menopause. 2022 Jan;. PubMed PMID: 29939603.

³Peacock K, Ketvertis KM. Menopause. 2022 Jan;. PubMed PMID: 29939603.

⁴Takahashi TA, Johnson KM. Menopause. Med Clin North Am. 2015 May;99(3):521-34. doi: 10.1016/j.mcna.2015.01.006. Review. PubMed PMID: 25841598.

⁵Peacock K, Ketvertis KM. Menopause. 2022 Jan;. PubMed PMID: 29939603.

⁶Santoro N, Epperson CN, Mathews SB. Menopausal Symptoms and Their Management. Endocrinol Metab Clin North Am. 2015 Sep;44(3):497-515. doi: 10.1016/j.ecl.2015.05.001. Review. PubMed PMID: 26316239; PubMed Central PMCID: PMC4890704.

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¹⁰Avis NE, Crawford SL, Greendale G, Bromberger JT, Everson-Rose SA, Gold EB, Hess R, Joffe H, Kravitz HM, Tepper PG, Thurston RC. Duration of menopausal vasomotor symptoms over the menopause transition. JAMA Intern Med. 2015 Apr;175(4):531-9. doi: 10.1001/jamainternmed.2014.8063. PubMed PMID: 25686030; PubMed Central PMCID: PMC4433164.

¹¹Peacock K, Ketvertis KM. Menopause. 2022 Jan;. PubMed PMID: 29939603.

¹²Okeke T, Anyaehie U, Ezenyeaku C. Premature menopause. Ann Med Health Sci Res. 2013 Jan;3(1):90-5. doi: 10.4103/2141-9248.109458. PubMed PMID: 23634337; PubMed Central PMCID: PMC3634232.

#13-18

¹³Santoro N, Epperson CN, Mathews SB. Menopausal Symptoms and Their Management. Endocrinol Metab Clin North Am. 2015 Sep;44(3):497-515. doi: 10.1016/j.ecl.2015.05.001. Review. PubMed PMID: 26316239; PubMed Central PMCID: PMC4890704.

¹⁴Peacock K, Ketvertis KM. Menopause. 2022 Jan;. PubMed PMID: 29939603.

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¹⁷Lovejoy JC. The influence of sex hormones on obesity across the female life span. J Womens Health. 1998 Dec;7(10):1247-56. doi: 10.1089/jwh.1998.7.1247. Review. PubMed PMID: 9929857.

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#19-25

¹⁹Mauvais-Jarvis F, Clegg DJ, Hevener AL. The role of estrogens in control of energy balance and glucose homeostasis. Endocr Rev. 2013 Jun;34(3):309-38. doi: 10.1210/er.2012-1055. Epub 2013 Mar 4. Review. PubMed PMID: 23460719; PubMed Central PMCID: PMC3660717.

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²¹Fothergill E, Guo J, Howard L, Kerns JC, Knuth ND, Brychta R, Chen KY, Skarulis MC, Walter M, Walter PJ, Hall KD. Persistent metabolic adaptation 6 years after “The Biggest Loser” competition. Obesity (Silver Spring). 2016 Aug;24(8):1612-9. doi: 10.1002/oby.21538. Epub 2016 May 2. PubMed PMID: 27136388; PubMed Central PMCID: PMC4989512.

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