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Perimenopause is the period of time that leads up to menopause and generally lasts between four and eight years. A time in which estrogen levels decline, it brings with it a number of different symptoms, which vary (in severity as well as type) from person to person.
In this day and age, we know knowledge is power, so understanding the symptoms that accompany perimenopause and menopause is key. That’s why we tapped New York–based double board-certified ob-gyn and reproductive endocrinologist Anate Brauer and Paula Briggs, the chair of the British Menopause Society and consultant of sexual and reproductive health at Liverpool Women’s Hospital, to share what to look for.
7 Signs and Symptoms of Menopause
One of the earliest signs you may be going through perimenopause? “The gap between periods might become shorter or longer, and they often become heavier,” explains Dr. Briggs. This is because the gradual reduction in estrogen impacts ovulation, meaning that time between periods can fluctuate, as can flow. According to the Mayo Clinic, a space of 60 days or more between periods indicates that you are likely in late perimenopause.
A common symptom of menopause, hot flashes (and their after-dark counterparts, night sweats) can be very uncomfortable. Defined by a sudden feeling of heat, usually in the face, neck, and chest, the hot flash can also cause skin to flush and sweat to occur, making it a physical—and often emotionally impactful—experience.
Your sex drive, or libido, changes as your body ages. “This change is primarily driven by hormonal fluctuations, particularly a decrease in estrogen levels,” says Dr. Brauer. “Estrogen plays a crucial role in maintaining sexual function by regulating the health of vaginal tissues, enhancing blood flow to the genitals, and influencing mood.”
Whether it’s waking up constantly at night or not being able to get to sleep in the first place, difficulty sleeping is another key sign. “Alongside disrupted sleep comes brain fog because if you don’t sleep, you tend to have difficulty thinking clearly,” says Dr. Briggs. You may also start to notice feeling more tired, moody, or down during the day.
Many women have spoken out about the mental health issues that can accompany perimenopause, from anxiety to depression. As Kathleen Baird-Murray wrote in a previous Vogue story on the link between menopause and mental health, there is a “shockingly high rate of suicide in women aged 45 to 54 years old, which doctors acknowledge may be related to the biological changes associated with menopause”. But, given the dearth of research in this area, it can be difficult to know whether changes in mood are linked to other factors or the menopause itself, says Dr. Briggs.
A slowed metabolism—which can result in gaining weight—is a standard symptom that can significantly impact a woman’s overall physical and mental health. Again, this can be attributed to estrogen fluctuations. “Estrogen helps regulate fat distribution, insulin sensitivity, and metabolic rate,” says Dr. Brauer. “As estrogen levels decrease, women may experience an increase in abdominal fat, insulin resistance, and a decline in metabolic rate, making it easier to gain weight, especially around the midsection. Aging itself can also contribute to changes in body composition, such as a decrease in muscle mass and an increase in fat mass, further exacerbating weight gain and metabolic slowdown.”
“One of the symptoms that is virtually universal is vaginal dryness and vulval itching, but no one really talks about it,” says Dr. Briggs, adding that 80% of women have some element of these symptoms. You may also find yourself suffering from more urinary tract infections or incontinence during this time due to changes to the tissue in the area.
Supplements to Consider If You’re Going Through Menopause
Whether you’re experiencing mood swings, fatigue, or hot flashes, finding ways to manage menopausal symptoms is key. Luckily, there is an array of supplements to make this hormonal phase of life that much easier. For example, multivitamins help maintain energy and mood, while probiotics (or polyphenols) optimize gut health. Otherwise, if brain fog is your top concern, experts say an omega-3 supplement could be beneficial.
