Knowing The Signs
Last summer I experienced my first bout of hot flashes (or flushes) and night sweats. For me, a prickly rush of heat erupts from within, completely unannounced, and leaves me clammy, with the back of my neck soaked in sweat. By night, I kick the covers off and struggle to get back to sleep. By day, like many others, I do everything I can to conceal my discomfort and carry on like normal. Without knowing the signs of perimenopause, I didn’t understand what was happening.
This was my first sign of perimenopause, or at least the first one I connected to this stage of life. And I’m not alone. Over 80% of Canadian women connect hot flashes (or flushes) to perimenopause but only a third of us know we might also experience more pain during sex, more body aches, and more anxiety during this midlife change.1
It turns out there are more than 30 symptoms known to be associated with the menopause transition. And as people start to speak more openly about how they feel during perimenopause, the list continues to grow.
Unprepared For Perimenopause
Menopause marks the end of our monthly periods; it’s a natural and normal transition out of the reproductive years. Perimenopause is the time leading up to menopause, when 95% of us with ovaries and with or without a uterus will experience signs and symptoms related to fluctuating estrogen and progesterone.1 It usually spans about six to eight years.1
The perimenopause experience looks different for every woman and it is tricky to predict what this time will look like for each of us. Some people move through the transition fairly easily. Others face debilitating symptoms that warrant medical attention and treatment. 
For years the menopause milestone has been obscured by negativity about aging and misogynistic messaging that loss of a woman’s fertile years marks the end of our “best” (most feminine) years. To avoid drawing attention to this “undesirable” time in a woman’s life, we’ve been taught to quietly endure the symptoms of perimenopause. The result has been silence around the topic and an overall lack of awareness about the menopause transition.
Women Feel Unprepared
In a 2022 survey of Canadian women, less than a quarter of respondents feel very knowledgeable about the signs and symptoms of perimenopause and menopause.1 Which means women feel completely unprepared as they enter this time of life.
But the tide is turning. Thanks to smart and outspoken voices, like Dr. Jen Gunter, who wrote the bestselling Menopause Manifesto, celebrities like Michelle Obama, and recent research efforts of groups like the Menopause Foundation of Canada, we are seeing a shift, a menopause movement. Women are encouraged to speak openly about our (peri)menopausal bodies and the myriad of related symptoms.
Menopause Affects Our Daily Lives
The menopause transition can affect how we think, how we sleep, and how we feel. On average, each of us will experience about seven symptoms related to the menopause transition. For many women these symptoms can be managed with a combination of lifestyle changes, medication(s), and/or menopause hormone therapy.1
Women need trusted information to feel prepared and be on the lookout for symptoms that may significantly impact their well-being and quality of life during these years.
To help women navigate this, we pulled together a researched list of recognized menopause symptoms based on current reliable resources (listed below).
Recognized Symptoms of (Peri)menopause:
Bladder Health
- Urinary frequency and urgency 2,3,4
- Urinary incontinence (or leakage)1,2,4,5,6
- Urinary tract infections 1,2,4,5
Body Changes (size & strength)
- Increased fat tissues (mostly visceral fat) 3,4,5
- Loss of muscle mass or tone 2,3,4,5
- Thickening in the middle of body (or increase in girth) 2,4,5
- Weight gain 3,4,7
Body Changes (other)
- Acne2
- Changes in eye & oral health 7
- Dental pain or issues 7
- Dry eyes or tearing 2
- Dry skin 2
- Hair changes 1
- Increased facial hair 2
- Skin changes or issues 1,2,7
- Thinning hair (or hair loss) 2
Bone Health
- Less than optimal bone mineral density 2,5
- Loss of stature / height 5
- Increased risk of fracture due to bone loss 5
Breasts
- Loss of fullness / density 2
- Soreness / tenderness 2,3
Gut / Bowel
- Anal incontinence (or stool leakage) 2
- Bloating 2
- Constipation 2
Heart
- Heart palpitations 1,2,7
Memory and Thinking (temporary)
- Difficulty concentrating (or with attention) 3,4,5,7
- Memory loss or “brain fog” 1,3,4,5,7
- Difficulty learning 3,4,6
Mental Health
- Anger or rage 3
- Anxiety 1,2,3,6,7
- Depression 1,2,4,5,6,7
- Feeling blue or low mood 2,3
- Irritability 2,3,5,7
- Mood swings 1,5,7
- Panic attacks 7
- Tearfulness 6,7
Pain
- Back pain 5
- Body aches (muscle and joint pain) 1,4,5,7
- Headaches/migraines 1,2,3
Period Changes
- Abnormal menstrual bleeding 1,4
- Bleeding in between periods 4
- Heavy periods 2,3,4,5
- Increased cramps or worsening PMS 3
- Irregular periods (stopping, starting, skipping) 2,4,5,6
- Longer cycles 2,4,5,6
- Shorter cycles 3,5
Sex
- Decreased arousal during sex 1,2
- Decreased desire for sex (or libido) 1,2,3,4,5
- Pain during sex (or intercourse) 1,2,3,4,5
Sleep
- Fatigue 1,2,5,7
- Insomnia 2,4,5
- Sleep disturbances 1,2,3,4,5,6,7
- Trouble falling asleep 2,3,4,6
- Waking up at night 2,3,4,6
- Waking up too early 2,4,6
Vaginal and Vulvar Health
- Thinning of the vaginal tissues (atrophy) 2,4,5,6
- Higher frequency of infections 5
- Vaginal and vulvar dryness (or itching or burning) 1,2,3,4,5
Vasomotor Symptoms
- Hot flashes / flushes 1,2,3,4,5,6,7
- Night sweats 1,2,3,4,5,6,7
- Chills 4,5
All of the symptoms listed here are fair game. They can come in any combination and to any degree. While some are more common than others, you don’t have to have vasomotor symptoms or period changes to be in perimenopause.
Maybe you’re suddenly waking up at night. Do you have new or more frequent migraines? Is your hair thinning? If you’re in your late 30s, 40s, or 50s and notice a change, it could be due to the hormonal changes inside you. And you should talk to your doctor.
The Ones To Watch
We’ve also compiled a second list of symptoms. The ones we are keeping an eye on because they may be related to menopause, but more research is needed.
Other Reported Symptoms of (Peri)menopause
Body Changes (other)
- Allergies worsening
- Bleeding gums
- Brittle hair and nails
- Burning mouth/tongue
- Changes in body odor
- Changes in taste
- Dry mouth and bad breath
- Itchiness
- Runny nose / post nasal drip
Neuro Symptoms
- Dizzy spells / vertigo
- Electric shock sensations
- Tingling extremities
- Tinnitus
- Skin crawling
Vasomotor
- Hot feet
Common Symptoms Explained
While some perimenopausal symptoms are the direct result of the hormonal chaos inside our bodies. Most are due to a more complex combination of aging, genetics, lifestyle choices, other personal risk factors, and hormonal changes. Here’s a closer look at some of the common symptoms of (peri)menopause.
Period Changes
A telltale sign of perimenopause is irregular periods. Women can experience shorter or longer cycles. Heavier or lighter flow. Maybe you’re skipping periods–anything goes.
Since changes to your period can also be associated with serious health concerns, it is best to speak with your doctor when you start to notice changes to your period or cycle.
Note: The North American Menopause Society (NAMS) warns it is important to speak with your doctor if3:
-
Your periods are extremely heavy
-
Your periods last for more than 7 days (or 2 days longer than usual)
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There are less than 21 days from the start of one period to the start of the next
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You have spotting in between periods
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You have vaginal bleeding after sex
Vasomotor Symptoms
Up to 80% of people in perimenopause experience hot flashes (or flushes) or night sweats, often with chills (or shivering) to follow. These are the vasomotor symptoms of perimenopause.
Declining estrogen contributes to these symptoms, but the exact mechanism is not yet fully understood. Usually, the earlier they start during the menopause transition, the longer they last. They are more common and more severe for Black women. If you’re experiencing bothersome hot flushes, ask your doctor about therapies that might give you some relief.
Sleep Disturbances
It is extremely common to have problems with sleep during perimenopause. Trouble falling asleep, waking up through the night, and waking too early are common complaints. Research shows waking up through the night as having the strongest association with (peri)menopause.5
How midlife hormonal changes influence our sleep has not yet been well defined. Trouble sleeping tends to be compounded by life stresses, night sweats, depression, anxiety and age-related factors. Poor sleep may have a harmful effect on your heart health and impact quality of life, so it is important to speak with your doctor for advice and solutions.
Mental Health
During the menopause transition, women describe an increase in mood swings, irritability, anxiety, depression, feeling blue, panic attacks, tearfulness, lack of motivation and more. Some women will say they just don’t feel like themselves, and others will say they feel like they are losing it.
The fluctuating levels of estrogen are thought to contribute to mood changes during menopause, but the precise cause is complex and there are multiple interacting factors. For example, hot flashes are known to bring on feelings of anxiety and lack of sleep is known to heighten feelings of depression. It’s important to prioritize your mental health and get help if you need it, as it strongly impacts all aspects of your life.
Cognitive Performance
Perimenopausal women may experience temporary issues with memory and concentration, often called brain fog. Cognitive issues are strongly influenced by other menopause symptoms, such as lack of sleep, depression, and anxiety.
Genitourinary Symptoms
The genitourinary syndrome of menopause (GSM) is a collection of symptoms influenced by declining levels of estrogen in the vulva, vagina, urethra, and bladder. Symptoms include: vaginal dryness (or itching or burning), thinning of the vaginal lining (vaginal atrophy), vaginal infections, urinary tract infections, and urinary incontinence (or leakage).
Vaginal symptoms can be harmful to sexual health and relationships and can impact your long-term vaginal health. Urinary incontinence is extremely common in midlife women and is vastly underreported. Leaking urine is likely more related to aging and other factors than menopause. You don’t need to just live with this symptom, there are treatments that can help.
Sexual Health
Many (peri)menopausal women will describe pain or discomfort during sexual intercourse, usually related to changes to the vaginal tissue, leaving it dry and fragile. This, along with the hormonal chaos inside us during perimenopause, can lower libido and pleasure or arousal during sex, which can put strain on intimate relationships. Don’t be shy, ask your doctor for options or solutions.
Body Changes
On average, women will gain 4.5lb in midlife.2 While aging and lifestyle appear to be the main factors at play, hormonal fluctuations can impact where we gain weight. Many women notice a change to their shape, usually a thickening around their middle.
This is because hormonal changes in the body appear to redistribute fat to the abdominal area. In addition, loss of muscle mass occurs with age. A healthy diet and regular exercise is important for midlife and long-term wellbeing.
Pain
Joint pain is very common during perimenopause, with over half of midlife women reporting this symptom. The role of dropping estrogen isn’t yet understood. Some women experience more headaches or migraines.
Fluctuating estrogen is known to influence headache pain, most significantly migraine pain. Some headaches are a sign of a serious health condition, so best to check with your doctor if you have new or worsening headache pain.
Skin and Hair Changes
Hormones are thought to play a role in our skin health.3 Lower estrogen is associated with lower skin collagen and thickness. Many women complain of dryness and itchiness in the perimenopausal years. Thinning hair on the crown of the head can be caused by a combination of shifting hormones, genetics, and other environmental factors.
Everybody (and every body) is Different.
How women feel during (peri)menopause is complex, variable, and individual. Many symptoms co-exist and have a complex and additive effect on each other. It’s also entirely possible for women to experience no symptoms during the menopause transition–there are the lucky few.
If you are between the ages of 40 and 60 and are experiencing any of these symptoms, evaluate how frequent, severe, and bothersome they are. Only you can be the judge of that.
First things first, it’s medically important to have your doctor rule out other potential causes for new symptoms or changes to your health. But if your doctor does determine your symptoms are related to perimenopause, ask for effective ways to alleviate symptoms and feel better during this midlife change.
Five Quick Takeaways
Too many women feel blindsided by the symptoms of perimenopause. Here are some quick takeaways for women entering this period of life:
- Know the wide range of possible symptoms of (peri)menopause. Consult a well researched list (like ours!) or ask a healthcare professional.
- Know your body and trust yourself. You know your body best. Monitor how you feel both physically and emotionally during this period of life. Don’t downplay symptoms you think you should be able to cope with.
- If you notice changes, see your doctor. This is to rule out more serious health conditions and to get expert advice on how to manage perimenopause symptoms.
- If needed, get a referral to a menopause expert. Yes, they exist. If your doctor doesn’t have the training to help you manage your symptoms, ask for a referral to a NAMS certified practitioner.
- Work with a doctor to ease bothersome symptoms. Don’t grin and bear it. Chat with a healthcare professional about treatments and strategies during (peri)menopause, they can be life-changing.
But There’s More
Changes to our body during the menopause transition can increase the risk for long-term health issues. Be sure to read our piece on what you need to know about future risks and how you can protect your health in the years to come.
Resources:
- “The Silence and the Stigma: Menopause in Canada”. Menopause Foundation of Canada, 2022, menopausefoundationcanada.ca
- “The Menopause Guidebook, 9th edition”. The North American Menopause Society, 2020
- “Common Symptoms”. Women Living Better, 26 Jan 2023, womenlivingbetter.org/perimenopause_symptoms/
- Gunter, Jen. The Menopause Manifesto: Own your health with facts and feminism., Citadel, 2021
- “Menopause Symptoms”. Canadian Menopause Society, 26 Jan, 2023, www.sigmamenopause.com/consumers/menopause/symptoms
- Samar, R et al., “The menopause transitionand women’s health at midlife: a progress report from the Study of Women’s Health Across the Nation (SWAN)” Menopause, vol. 26, no. 10 Jul. 2019, pp 1213-1227.
- “Menopausal symptoms”. The Society of Obstetricians and Gyaecologist of Canada, 26 Jan, 2023, www.menopauseandu.ca/am-i-in-menopause/menopausal-symptoms-close-2/
