Perimenopause: What are the signs and how to feel better

Irregular periods, hot flashes, vaginal dryness, and brain fog are all common signs of perimenopause, which is the body’s natural transition into menopause.

Everyone’s experience with perimenopause is unique. There is no one-size-fits-all checklist of symptoms, but there are some telltale signs of perimenopause that you may want to be aware of.

Keep reading to learn more about the most common symptoms of perimenopause, why they happen, and what you can do to manage them.

What is perimenopause?

Perimenopause is the stage leading up to menopause. Peri means “around” in Greek, and perimenopause is sometimes referred to as “menopause transition” for this reason.

The terms “perimenopause” and “menopause” are often used interchangeably, but menopause is a single moment in time when a woman hasn’t had a period for 12 consecutive months.

Perimenopause, however, is the time leading up to menopause. It can last for up to 10 years, but the average time that a woman spends in perimenopause is 4 years.

During perimenopause, levels of estrogen and progesterone in the body start to fluctuate and decline, causing the onset of perimenopausal symptoms. Estrogen and progesterone are the main female reproductive hormones.

Not only do they govern the menstrual cycle, but they also play a key role in your overall health. As we’ll see below, estrogen levels can affect mood, cognitive function, bone health, and metabolism.

The start of perimenopause isn’t clearly defined and can vary from woman to woman. It usually starts in your 40s, but some women enter perimenopause in their 30s.

Perimenopause symptoms

Signs of perimenopause can often creep in over time. You may not even notice them at first, and you may find it hard to put your finger on the cause. Below are some of the most common symptoms of perimenopause.

Irregular periods or heavy bleeding

A change in your menstrual cycle, such as irregular or heavy periods, is often the first sign of perimenopause. 

As levels of estrogen and progesterone fluctuate, you may notice that your periods become longer or shorter than usual, lighter or heavier, or you may sometimes skip your period altogether. You may also experience spotting between periods.

Hot flashes

Hot flashes, or vasomotor symptoms (VMS), are one of the most common signs of perimenopause.

Hot flashes are sudden waves of heat across the upper body and face, sometimes accompanied by profuse sweating. In women with light skin tones, hot flashes can lead to redness.

They can last anywhere from a minute or two to several minutes, and some women also experience a rapid heart rate or chills.

The Study of Women's Health Across the Nation (SWAN) found that up to 80% of women experienced hot flashes during perimenopause. On average, these occurred for around 7.4 years and even longer for some women.

The causes and triggers of hot flashes aren’t fully understood. Experts believe that fluctuating hormones affect the hypothalamus, the part of your brain that regulates body temperature.

During a hot flash, your hypothalamus thinks your body is too warm and dilates your blood vessels to cool it down.

Changes in metabolism

Many women will experience weight gain and changes in fat metabolism during perimenopause.

A drop in estrogen is associated with lower levels of good cholesterol (HDL) and higher levels of both bad cholesterol (LDL) and triglycerides, a type of fat found in your blood. This combination can increase the risk of heart disease and type 2 diabetes.

Unpublished research by ZOE scientists recently found that how your body responds to food changes during perimenopause. They found that after menopause, you are more likely to experience unhealthy blood sugar and blood fat spikes.

The ZOE at-home test kit analyzes your unique blood fat and blood sugar responses, helping you identify the best food swaps to make for your body and your health.

Mood changes

Perimenopause can cause changes in your mood. Women often find that this affects their mental health during this time. Anxiety, panic disorders, irritability, feelings of low self-esteem, and depressive episodes can all be part of perimenopause.

Studies specifically looking at the mental health of perimenopausal women are woefully lacking.

One study suggests that women who rarely had anxiety premenopause were more likely to experience high anxiety during perimenopause and after menopause.

Women who had anxiety premenopause, on the other hand, did not see a change in their anxiety levels during perimenopause or after menopause.

Another study found that perimenopausal women were two to four times more likely to experience a major depressive episode.

Estrogen can influence important chemicals in the brain that control your mood. These so-called feel-good hormones include serotonin, dopamine, oxytocin, and noradrenaline.

When hormone levels change during perimenopause, these chemicals can become imbalanced, affecting your mood.

Perimenopause can be a difficult and overwhelming time in a woman’s life. The physical signs of perimenopause can also cause emotional distress, and their psychological impact shouldn’t be underestimated.

Mental health can also be affected by many different factors, so it’s difficult to isolate perimenopause as a single cause.

Vaginal dryness

It’s not uncommon to experience vaginal dryness or stubborn vaginal infections in perimenopause.

As estrogen decreases, your vagina and cervix start producing less natural lubrication, and the vaginal tissue becomes thinner and drier.

This can cause discomfort, and it can also impact your sex life.

Brain fog

Changes in memory, focus, and concentration are very common during perimenopause.

This is known as “brain fog.”

Estrogen, progesterone, and testosterone are all crucial for cognitive function and memory, but there is not enough data to make sense of how perimenopause changes these functions.

Other symptoms of perimenopause, like poor sleep, anxiety, hot flashes, and mood swings can all contribute to brain fog.

Sleep disturbances

You may find that your sleeping patterns and overall quality of sleep take a hit during perimenopause.

Night sweats are hot flashes that occur at night and may also feature during this time. This is because estrogen is responsible for keeping your body temperature low at night.

Lower levels of progesterone are linked with finding it harder to fall asleep and stay asleep during the night.  


During perimenopause, the pelvic floor can become weaker and make you more susceptible to bladder leaks. Around 68% of SWAN respondents reported experiencing urinary incontinence.

You may experience a sudden and urgent need to pass urine (urge incontinence) or find that you involuntarily leak when you sneeze, cough, laugh, or exert yourself physically (stress incontinence). In some cases, you may experience both types of incontinence (mixed incontinence).


Osteoporosis is a condition that makes your bones more fragile due to loss of density.

Estrogen helps keep our bones strong and healthy, but as it decreases during perimenopause, it puts you at greater risk of developing osteoporosis.

Perimenopause treatments

Perimenopause is a natural stage of life, but it can also be an overwhelming one.

There is a range of treatments that can help you manage or minimize perimenopausal symptoms and improve your quality of life. 

Hormone replacement therapy

Hormone replacement therapy (HRT) involves taking synthetic forms of estrogen and progesterone to replace your body’s natural hormones. It can be taken in the form of a pill, patch, implant, gel, or cream. Contrary to popular belief, you don’t have to wait until your periods stop to start HRT.

A doctor can prescribe HRT to help relieve symptoms like hot flashes, vaginal dryness, and night sweats.

Your healthcare professional will prescribe the best type of HRT for you, based on your symptoms, lifestyle preferences, risk factors, and if your periods are still regular.  

The latest research shows that HRT is safe for most women, but HRT is not recommended if you have a history of:

•   heart disease

•   blood clots

•   stroke

•   estrogen-dependent cancer

•   allergic reactions to hormone medication

•   liver disease

•   vaginal bleeding issues

Vaginal estrogen

Estrogen can also be administered directly to the vagina to relieve dryness and painful intercourse.

It can come in the form of a cream, suppository, or ring that releases low amounts of estrogen that are absorbed by the vaginal wall.

Prescription medication

In the United States, two non-hormonal medicines are available to treat perimenopause symptoms.

Selective serotonin reuptake inhibitors (SSRIs) are a type of antidepressant that women can take to treat hot flashes.

The other drug, which is called Osphena, can help with pain during sex.

Alternative therapies

Although there is no scientific consensus on whether alternative and complementary therapies work for perimenopausal symptoms, you may find them helpful. 

When practiced regularly and in conjunction with other treatments, therapies such as acupuncture, meditation, and yoga may reduce stress and improve sleep.

Cognitive behavioral therapy (CBT) might help manage the emotional symptoms of perimenopause.

Lifestyle and home remedies

For many women, lifestyle changes make their symptoms more manageable.

The key is to implement changes you can easily fit into your life and that you can consistently put into practice. Some changes you can make are:

  • Exercising regularly: Exercise can improve mood, sleep, bone health, weight management, and risk of cardiovascular disease. 

  • Getting adequate sleep: This can be challenging if you’re suffering from sleep issues, but getting enough sleep impacts your health. ZOE research also found that it impacts how your body responds to food. Going to sleep 30 minutes earlier, even if you can’t sleep as long as recommended, can help prevent unhealthy blood sugar spikes the following day.

  • Quitting smoking: Smoking cigarettes has consistently been found to increase hot flashes.

  • Using over-the-counter vaginal lubricants or moisturizers: They can help improve sexual function by reducing vaginal dryness and discomfort during intercourse.

  • Limiting alcohol and caffeine: They can irritate the lining of the bladder and trigger incontinence, affect the quality of your sleep, and trigger hot flashes

Eating the right foods for your body: Prioritize a diet that includes plenty of high-quality plant foods, such as vegetables, fruit, nuts and seeds, legumes, and wholegrains.

How can nutrition help?

Your eating habits and changes to your metabolism during perimenopause impact your long-term health.

Perimenopause can increase your risk of developing heart disease and type 2 diabetes. Eating foods that don’t cause big spikes in blood fat and blood sugar can lower this risk.

Protein is also crucial during perimenopause, when your muscle mass naturally decreases.

The ZOE program can identify your individual responses to food by analyzing your blood sugar and blood fat. Using cutting-edge science, ZOE helps you find the best foods for your body, based on your sugar and fat metabolism and your gut microbiome.

Declining estrogen during perimenopause can make your bones weaker and increase your risk of osteoporosis. Adding foods rich in calcium and vitamin D into your diet is important for preventing fractures.

Your body doesn’t produce calcium on its own, but luckily, eating calcium-rich foods is easy to include in your diet. Some foods rich in both calcium and vitamin D that support bone health are:


Common signs of perimenopause include weight gain, hot flashes, irregular periods, and vaginal dryness.

Perimenopause is also linked to changes in metabolism, a higher risk of type 2 diabetes and heart disease, and reduced bone density.

You can manage perimenopausal symptoms with prescription treatments like HRT or by changing your diet and doing exercise.

Changing your eating habits can be especially beneficial during perimenopause. Not only can your diet help manage daily symptoms, but it can also reduce your risk of disease as you age.

Entering perimenopause is a healthy and normal part of every woman’s life, and it can be a great time to learn more about your body and prioritize your well-being.

You can take a free quiz to learn more about how ZOE can help you understand your body’s unique responses to food and to identify the best foods for your body and your metabolism.


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