Perimenopause Symptoms - A to Z
Written and Medically Reviewed by Ryah Nabielski, MS, RDN
Many of the menopausal symptoms you might be familiar with, including the classic hot flash, begin in perimenopause and potentially years before your last period. You aren’t going crazy. It isn’t all in your head. It’s not just part of being a woman or getting older. There are real physical symptoms women experience because of fluctuating and declining hormone levels as the brain and body recalibrate away from reproduction.
Some symptoms are more common than others, including hot flashes, night sweats, insomnia, genitourinary symptoms (like vaginal dryness and UTIs), mood changes, and increased abdominal fat. Sixty to 86% of women will seek medical care for their symptoms, yet women remain significantly undertreated. [1]
Seventy-five percent of women will experience vasomotor symptoms, like hot flashes and night sweats. These symptoms may last around 4 years, but some will experience them for over a decade! [1, 2]
One study suggests that insomnia affects 31 to 42% of perimenopausal women, yet sleep disturbance is one of the most common symptoms I see in my practice. [3]
In early perimenopause, you may have more symptoms of high estrogen or estrogen dominance, like heavy periods, sore breasts, and PMS, but as periods become less regular and farther apart, symptoms of low estrogen, like dryness and hot flashes, tend to increase.
I’ll also note that some women experience minimal physical symptoms and have a pretty smooth transition. However, they are still at higher risk for chronic diseases after menopause and may suffer from some of the silent symptoms, such as insulin resistance.
A to Z List of Perimenopausal Symptoms
Besides the classic symptoms, many other symptoms may show up during the menopausal transition. Here’s a list of possible perimenopausal symptoms:
Anxiety
Appetite changes
Autoimmune disease – new onset or flare
Bloating
Body odor changes
Bone loss
Brain fog
Breast changes in size and shape
Breast tenderness and pain
Brittle nails
Burning mouth syndrome
Constipation
Cramps and painful periods
Depression
Dizziness
Dry skin
Ear ringing (tinnitus)
Electric zap sensations
Fatigue
Fatty liver
Fine lines and wrinkles
Frozen shoulder
Hair changes
Headaches
Heartburn
Heart palpitations
Heavy periods
Hot flashes
Inflammation
Insomnia, sleep disturbance
Insulin resistance/elevated blood sugar
Irregular menstrual cycles
Irritability
Itchy ears
Joint pain
Low libido
Lipid changes – increased cholesterol and triglycerides
Night sweats
“Not feeling like myself”
Microbiome changes
Memory loss
Migraines – new onset or worsening
Misophonia – emotional response to sounds (like chewing)
Mood swings or changes
Muscle pain
Oral health changes, increased cavities
Ovulation/mid-cycle pain
Phantom smells
PMS – worse
Poor concentration
Skin crawling sensation
Stiffer arteries
Temporomandibular joint dysfunction (TMJ)
Urinary tract infections
Urinary urgency or incontinence
Vaginal dryness
Vaginal infections
Weight gain – especially midsection
How Nutrition Can Help
While there are things you can do for symptom management, like cool down your bedroom or take sleep-supportive supplements, you can’t stop menopause from coming. But you can support your body through the process.
You can use nutrition to support hormonal health and the underlying metabolic changes of perimenopause. Nutrition isn’t the only tool you need, but it is foundational. You can’t skip it. Use nutrition to:
· Balance blood sugar
· Prevent or reverse insulin resistance
· Maintain muscle and bone mass
· Support a healthy microbiome and digestive health
· Support brain health and mood
· Manage weight
· Help prevent chronic diseases like diabetes, heart disease, and osteoporosis
If you’d like to learn how to use nutrition to do these things, please subscribe to this newsletter. Or, for individual, personalized support, please reach out.
And I promise it’s not all bad news. In my next article, I’ll talk about the bright side of perimenopause.
Ryah Nabielski, MS, RDN is virtual functional nutritionist with over 17 years of clinical experience, specializing in women’s health, hormones, perimenopause, and autoimmune disease. She lives in the Denver, CO area with her family and works with clients via Telehealth throughout Colorado, South Dakota, and other states. She loves hiking, farmers markets, dark chocolate, and a good novel.
Disclaimer: This article is for informational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the counsel of your physician, dietitian, or other qualified health care provider.
References
1. Duralde, E. R., Sobel, T. H., & Manson, J. E. (2023). Management of perimenopausal and menopausal symptoms. BMJ (Clinical research ed.), 382, e072612.
2. Forma, E., Urbańska, K., & Bryś, M. (2024). Menopause Hot Flashes and Molecular Mechanisms Modulated by Food-Derived Nutrients. Nutrients, 16(5), 655.
3. Ciano, C., King, T. S., Wright, R. R., Perlis, M., & Sawyer, A. M. (2017). Longitudinal Study of Insomnia Symptoms Among Women During Perimenopause. Journal of obstetric, gynecologic, and neonatal nursing : JOGNN, 46(6), 804–813.