As women enter their 40s and 50s, shifting hormone levels during the transition into menopause can trigger a host of bothersome physical and emotional changes that disrupt quality of life.

Termed “perimenopause,” this transitional period is characterized by unpredictable menstrual cycles along with more extreme hot flashes, mood volatility, sexual health complaints, and cognition issues that typically occur in early or late menopause.

Understanding what causes these perimenopausal symptoms can help women manage them through tailored lifestyle measures, helpful natural remedies, and personalized medical support when necessary.

What Is Perimenopause Menopause?

Perimenopause refers to the transitional stage leading up to menopause, which officially begins 12 months after a woman’s last menstrual period.

During the perimenopausal transition, which can last up to 10 years, women begin experiencing changes related to declining estrogen levels that will continue into menopause.

While menopause marks the end of menstrual cycles, perimenopause is characterized by irregular menstrual bleeding and unpredictable hormone fluctuations. This instability can trigger a variety of physical and emotional symptoms that impact quality of life.

In contrast with regular menopause when hormone levels taper off slowly, perimenopausal shifts tend to be more extreme and rapid. This contributes to more severe hot flashes, mood swings, sexual health issues, and cognitive difficulties than what is typically seen in early or late menopause.

Understanding how perimenopause differs from menopause allows women to prepare for and proactively manage troublesome symptoms during the years leading up to their final period. Tracking perimenopausal changes over time also allows for early detection and treatment of any resulting health conditions.

What Are the Physical Symptoms of Perimenopause Menopause?

The declining estrogen and spiking follicle-stimulating hormone of perimenopause can trigger an array of bothersome physical symptoms.

These stem from hormonal fluctuations and can start to manifest as women enter the menopausal transition in their 40s.

Changes in Menstrual Cycle

It’s common for women in perimenopause to experience irregular menstrual cycles.

Periods may be heavier or lighter than usual, last longer or be shorter, or the time between cycles may lengthen or shorten unpredictably. Abnormal uterine bleeding is also possible.

Hot Flashes and Night Sweats

Adult woman fanning herself suffering hot flashes.

Spiking and dropping estrogen levels trigger hot flashes and sweating at night.

These sudden feelings of intense heat can be mild to severe and often include flushed skin and profuse sweating that can disrupt sleep and daily activities.

Sleep Disturbances

Hormone fluctuations, night sweats, anxiety, and other perimenopause symptoms can make it difficult to fall or stay asleep.

Lack of restorative rest exacerbates irritability, mood swings, and problems with focus and memory. In other words, tiredness just makes everything feel so much worse!

Vaginal Dryness and Irritation

Declining estrogen causes vaginal tissue to become drier, thinner, and more alkaline.

This atrophy can lead to irritation, discharge, itching, painful sexual intercourse, increased risk of infection, and light bleeding during or after sex.

Urinary Tract Changes

Reduced estrogen allows the urethral lining to thin, which can cause an urgent need to urinate, urine leaking, and increased urinary tract infections.

These symptoms can range from mild irritation to frequent nighttime awakenings, thanks to the intense feeling that you need to go.

Changes in Skin and Hair

Collagen and elastin production slow during perimenopause, leading to sagging skin, and wrinkles. An additional side effect can also include dryness which may result in eczema and psoriasis.

Hair may thin or become drier and more brittle. Sudden hormone drops can trigger excess oiliness and acne.

Joint and Muscle Pain

Senior Woman Suffering from leg and knee pain

Perimenopausal hormones directly impact pain receptors in muscles and connective tissue.

For some women, this causes general achiness similar to arthritis which ranges from mildly annoying to quite disruptive of mobility and flexibility.


Estrogen decline allows pain receptors to fire more easily, triggering headaches that may increase in frequency and severity.

Migraines are particularly common during perimenopause.


Shifting estrogen, poor sleep, low iron, thyroid dysfunction, inflammation, and stress hormones lead to increased tiredness, low stamina, reduced motivation, and difficulty concentrating. The combination of factors can make you feel as though you’ve been run over by a steamroller.

Weight Gain

Fat accumulates more easily with hormonal changes, a slowing metabolism, reduced muscle mass, thyroid issues, and lifestyle changes that often accompany midlife.

Any one of those can cause weight gain, but the combined effect of two or more of the above makes losing weight more difficult.

Difficulty Concentrating (AKA Brain Fog)

It’s very common to hear women going into perimenopause and menopause itself complain of “brain fog”. This mental fuzziness and increasing forgetfulness can be quite frightening, especially when it happens at work.

Brain fog is often due to the combined effects of sleep deprivation, stress hormones, inflammation, and fluctuating estrogen’s effects on neurotransmitters and cognition.

Focusing, learning new things, multitasking, and retrieving words becomes harder.

How to Manage the Physical Symptoms of Perimenopause Menopause

While bothersome, the wide range of perimenopause symptoms can often be prevented or reduced through proactive lifestyle measures without necessarily needing medical treatment.

Simple changes to daily habits can make it possible for women to take control in balancing hormone levels and minimizing discomforts.

Lifestyle Changes

Implementing positive lifestyle adjustments helps stabilize hormones while also directly easing troublesome perimenopause symptoms like hot flashes, bladder problems, pain, low energy, and sleep disruption.

Beneficial practices include nutrition modifications, regular exercise, good sleep hygiene, stress relief techniques, proper hydration, and smoking cessation.

1. Diet

Eating a balanced, nutrient-dense diet high in plants feeds the endocrine system and promotes hormonal balance. Emphasize whole foods over processed items, choose healthy fats, and moderate carbohydrates.

Avoid triggers like spicy dishes, caffeine, or alcohol which can worsen hot flashes and anxiety.

2. Exercise

Engaging in regular cardio and strength training has remarkable benefits for perimenopausal and menopausal women.

Physical activity boosts mood, energy, and sleep quality while reducing hot flashes, pain, and stubborn body fat. Aim for 30 minutes daily, mixing lower-impact activities like walking or gentle yoga with some muscle-strengthening moves.

3. Sleep Hygiene

Getting enough high-quality rest is essential during hormonal transitions. Set yourself up for sounder sleep by limiting afternoon caffeine, establishing a consistent bedtime routine, and making your bedroom a cool, extremely dark, gadget-free sanctuary for slumber.

Consider blackout shades, a white noise app, and a lowered thermostat temp if night sweats routinely wake you.

4. Stress Management

Anxiety and overwhelmed feelings often accompany perimenopause due to work pressures, parenting demands, aging parents, body changes, and fluctuating hormones magnifying normal stressors.

Regularly carve out dedicated personal time for relaxing hobbies, social connection, meditation, or talk therapy sessions to prevent burnout.

5. Hydration

African Woman Drinking Water after exercising

Drinking adequate water and herbal teas keeps cells functioning optimally, prevents headaches, lowers the risk of urinary tract infections, and helps reduce the severity of hot flashes.

Cool water also offers quick relief at the moment when overheated from a hot flash. Aim for at least 64 ounces of non-caffeinated, non-alcoholic fluids daily.

6. Smoking Cessation

Smokers reach menopause one to four years earlier than non-smokers, which exacerbates symptoms.

Quitting now protects health, slows aging, reduces hot flash frequency, and prevents devastating diseases like lung cancer that spike for women once estrogen production halts.

Natural Remedies

In addition to lifestyle measures, some women obtain symptom relief from various natural therapies that promote hormone regulation and healthy aging.

These generally safe, non-prescription options include herbal supplements, mind-body balance techniques, and acupuncture.

1. Herbal Supplements

Certain plants contain bioactive compounds that mimic estrogen’s effects or promote more balanced hormone production.

Herbs like black cohosh, red clover, dong quai, evening primrose oil, and maca root help moderate common symptoms like hot flashes, vaginal dryness, mood swings, and sleep disruption without directly introducing hormones as medical treatments do.

Keep in mind that the effectiveness of each herb might vary from woman to woman. It might be worth experimenting to see what works best for you.

2. Mind-body Practices

Techniques that elicit the “relaxation response” curb everyday stress while lowering hormones like adrenaline and cortisol. These hormones exacerbate menopausal symptoms when chronically elevated.

Therapeutic techniques that you can try include diaphragmatic breathing, biofeedback, visualization, hypnotherapy, yoga, tai chi, qigong, and cognitive behavioral therapy. These empower personal control over temporary discomforts.

3. Acupuncture

Young Woman Undergoing Acupuncture

In this traditional Chinese system, a practitioner stimulates anatomical points along energy meridians using extremely thin needles to resolve imbalances thought to underlying disease states.

Modulating key points balances yin, yang, and qi flow, exerting regulatory effects on the hypothalamus-pituitary gland organ network to stabilize hormones.

Acupuncture also increases natural pain-relieving endorphins that improve general comfort and well-being. It can be effective for perimenopausal women experiencing severe hot flashes, headaches, pain, anxiety, palpitations, or insomnia. Effects accumulate with a series of treatments.

Keep in mind that evidence-based studies that support acupuncture aren’t abundant, and results may sometimes tend to be subjective from person to person. However, it’s worth a try since, even if it doesn’t achieve the desired effect, it won’t harm you.

Medical Treatments

If bothersome signs and symptoms persist despite proactive lifestyle modifications and natural therapies, various medical interventions can provide relief.

These include hormone therapy, low-dose antidepressants, and prescription vaginal moisturizers.

1. Hormone Therapy

Still the most potent treatment for relieving acute menopause transition symptoms, systemic hormone therapy (HRT) restores optimal hormonal balance using bioidentical estradiol and/or progesterone in pills, skin patches, gels, sprays, or compounded creams.

While long-term use has some health risks, short-term HRT is considered quite safe and effective for managing hot flashes, insomnia, sexual health complaints, and quality of life impairments that haven’t sufficiently improved through other interventions during perimenopause or the first years following menopause.

Finding the minimal effective hormone dosing helps optimize benefit versus safety. Careful consideration of personal and family medical history informs whether HRT is appropriate and which delivery method best meets an individual’s needs.

2. Low-dose Antidepressants

Selective serotonin reuptake inhibitors (SSRIs) like paroxetine can calm down hot flashes and mood swings by increasing serotonin signaling. This signaling is basically the body’s language in calling for more serotonin secretion, which often gets disrupted when estrogen secretion is reduced.

Even at dosages below those used to treat clinical anxiety or depression, these medications offer neurological and thermoregulatory stability during major hormonal shifts. In other words, they can reduce the impact caused by those hormonal changes. They also help with irritability, sleep disruption, and pain sensitivity – common concerns during the menopause transition.

Those with severe night sweats and related insomnia may especially benefit. Low-dose SSRIs provide symptom relief with fewer risks of adverse effects which some report from hormone therapy.

3. Vaginal Moisturizers

Local estrogen or moisturizing creams, inserts, and oral tablets deliver needed lubrication and tissue support directly to vulvovaginal tissues without raising total body estrogen exposure as occurs with systemic hormones.

This allows symptom relief while minimizing cancer and blood clot risks that oral or transdermal products may theoretically pose. Women using only local vaginal treatments can sidestep undergoing routine breast cancer screening that national guidelines advise for those on systemic hormone therapy.

Locally administered prescription products reverse or reduce uncomfortable vaginal dryness, irritation, discharge, and painful intercourse better than over-the-counter options alone.

Take the Quiz

Wondering whether your specific mix of perimenopausal changes matches common symptom patterns? Take a quick quiz to identify your unique “menopause symptom personality.”

Understanding how your experience compares with different menopause profiles described by other women provides validation and direction in tackling troublesome complaints.

This awareness can then guide you as you discover tailored lifestyle measures, helpful home remedies, and personalized medical decisions should certain symptoms become truly disruptive to emotional or physical well-being. Identify your menopause type now to unlock targeted symptom management strategies.

Would You Like to Know More?

Want to go deeper into optimizing this transitional life stage? Sign up to get practical tips for balancing hormones and relieving symptoms in your inbox.

Topics span nutrition, fitness, stress relief, proper sleep, helpful supplements, clarifying medical options, nurturing relationships, finding meaning amidst change, and aligning environments to support your process.

Investing in support that helps you thrive as the wise, confident midlife woman you’re becoming is a smart thing to do.

Final Words

Navigating perimenopausal discomforts and erratic cycles doesn’t need to undermine a woman’s daily functioning or sense of well-being.

Through awareness of what triggers bothersome symptoms, you can put in place proactive self-care steps, safe complementary therapies, and suitable medical interventions when appropriate.

Most women can achieve hormonal balance and resume thriving in their careers, relationships, and lifestyles during this transition into wisdom-bestowing midlife.

About The Author

Written by Elly McGuinness, a freelance writer with extensive experience in the health and fitness industry and a passion for holistic wellness.

Full Disclosure

As an Amazon Associate we earn from qualifying purchases.  We get a small commission at no extra cost to you for which we thank you.  It helps us continue to bring informative content to women who are going through menopause.

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