The transition to menopause, officially known as perimenopause, can have a big effect on both the mind and body.
Unfortunately, perimenopausal symptoms tend to be less discussed than menopausal ones.
So it’s easy 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.
Seeing as perimenopause can begin as early as your 30s and last for up to a decade, it’s vital to open up discussions about what it feels like.
So here are some of the less common symptoms, why they happen, and how you can treat them.
In addition to menstrual cycle 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.
But some signs can also have more serious causes.
For example, “palpitations (rapid heartbeat) can be caused by fluctuations of hormones at the time of perimenopause,” explains Dr. Laila Kaikavoosi, founder of the Online Menopause Centre.
But if they persist, it’s important to check that there’s no underlying cardiac issue.
Similarly, the following should also be immediately investigated by a doctor or other healthcare professional:
- 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
| Symptom | How to relieve it quickly |
| Dry eyes | Use eye drops |
| Dry skin | Moisturize regularly |
| Vaginal dryness | Use a vaginal lubricator |
| Headache | Take an over-the-counter painkiller and drink plenty of water |
You can blame your hormones for some of the physical changes that come with perimenopause. Fluctuations in the likes of estrogen can have a wide-ranging effect on the body.
Here are some of perimenopause’s lesser known physical symptoms to watch out for.
Dry eyes
Noticed that your eyes are feeling drier and a little scratchy?
“The lacrimal glands in our eyes keep them moist,” explains Ameen. “But the changing hormone levels during perimenopause (and menopause) cause the gland to produce less fluid, and the eyes to become drier.”
Dry eyes can also be caused by the likes of smoking, medications like some antidepressants, or even a dry and dusty environment.
Products like humidifiers and eye drops can help —see an optician or other healthcare professional if you’re concerned.
Skin changes
Whether it’s acne breakouts, dryness, or itchiness, a lot can happen to your skin during perimenopause.
And 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 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.”
If you’re worried, treatment to balance your hormone levels can help.
It’s worth noting that fluid retention as a result of disease can also lead to weight gain, as can antidepressants and birth control pills.
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
Ameen describes GSM as “a chronic and progressive syndrome that’s underdiagnosed and undertreated.”
An appointment with a doctor or specialist gynecologist is required, as
“They’ll want to discuss vaginal health, diet, exercise, alcohol intake, and may also want to carry out vaginal swabs investigating for STIs,” says Ameen.
Treatment can range from vaginal lubricators to hormone replacement therapy (HRT).
Ameen notes that anyone with an intact uterus who’s considering systemic HRT “must take estrogen and progesterone in combination to protect the lining of the womb from being overstimulated and developing cancer in the future.”
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
Other headache causes include stress, not drinking or eating enough, and vision problems.
(If your eyes are straining, visit an optician as soon as possible.)
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.
Whether it’s difficulty concentrating or unpredictable mood swings, people can experience a range of emotional and mental effects during perimenopause.
Plus, mental health conditions like anxiety or depression can worsen in this period.
“If you do experience symptoms that are causing you a problem, it’s important to speak with [a] doctor in the first instance or a hormone specialist who will be able to check your hormone levels and create an individualized treatment plan,” says Kinsella.
Here are some of the less obvious signs to watch out for as not all of the symptoms are widely discussed.
Rage
You may start to feel irritable, frustrated, or even angry as perimenopause can be a challenging period in your life.
“Hormonal fluctuations play a huge role in emotional well-being,” explains Kaikavoosi. But she adds, “These symptoms can also be caused as a direct effect of lack of sleep and low energy levels.”
Hypothyroidism can also have similar symptoms, so it’s important to make an appointment with a doctor or other healthcare professional to get an official diagnosis as to what’s causing your symptoms.
Managing these feelings can be tricky. But if you notice certain triggers such as smoking or caffeine, it’s best to limit or avoid them as much as possible.
Instead, try to increase the number of relaxing activities that you do, whether it’s daily meditation or some gardening.
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 are 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.
Try to commit to regular exercise, eating a balanced diet, carving out time for relaxation, and considering HRT.
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.
The likes of premenstrual syndrome (PMS), depression, and everyday stress can also cause shifts in mood.
Exercise —a natural releaser of serotonin —can help address them, as can a diet rich in fruit and vegetables but limited in alcohol, refined sugars, and highly processed foods.
Don’t forget those relaxation practices, too.
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 keep a diary of how you’re feeling each day.
Not only can this help you notice a pattern, but a diary can also be a great piece of evidence for a doctor or other healthcare professional.
And if you’re worried about mentioning certain symptoms out loud to a doctor, having everything written down can make the process a lot easier.
During your appointment, try to be honest and open and mention every single physical and emotional change, even if you’re not sure it’s related.
Depending on the symptoms, they can rule out other conditions, such as thyroid problems or an overactive bladder.
They can then offer treatments such as HRT in an attempt to rebalance your hormone levels and refer you to specialists in menopause or mental health if needed.
Talking to someone about how you’re feeling can be scary. But those you trust can help support you through this time.
Try speaking to a close friend or relative who can listen to you and accompany you if you decide to see an emergency doctor.
Be as open with them as you can and tell them if you’ve taken any medication or have access to medication or weapons.
If the thoughts begin to ease, it’s still worth booking an appointment with a mental health professional such as a therapist.
This is another area in which a friend or family member can help.
There are also a number of support services to contact in times of crisis. If you’re in the United States, the following hotlines are confidential and available 24/7:
- To reach the National Suicide Prevention Lifeline, call 1-800-273-8255.
- To connect with a Crisis Text Line counselor, text HOME to 741741.
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 you’re the symptoms are impacted you can help boost the quality of your 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.