How Do I Know If I’m Perimenopausal? Menopause Symptoms List + Self-Care Tips

Menopause is a natural part of aging for women, but there’s no predictable pattern or timeline for the symptoms, doctors say. While some symptoms are well known, others can catch a woman by surprise and cause concern–even though they’re normal. Many myths exist about what to expect when going through menopause, it’s important to know your body well enough to know what’s happening and get reassurance that what’s going on is normal.

Read on for a menopause symptoms list and five self-care tips to help you navigate this transition.

9 Signs You’re Starting Menopause: Menopause Symptoms List

Irregular periods

Irregular periods are a common sign you’re starting menopause. During perimenopause–the period of time around menopause when your ovaries gradually stop working–estrogen levels fluctuate and eventually decrease, causing changes in your menstrual cycle.

Your periods may get shorter, longer, heavier, or lighter–or you may skip some altogether. This may cause frustration and uncertainty, but it’s normal.

Irregular periods can also be a sign of other health conditions, so talk to your natural healthcare provider to determine the cause of your symptoms.

Anxiety and/or depression

Menopause and anxiety often go hand in hand, as do menopause and depression. These symptoms are normal and due to hormonal changes–but don’t ignore them.

“If you have a history of anxiety and/or depression, you are likely to experience it again in perimenopause,” Dr. Sholes-Douglas says. “Decreasing progesterone and overactive adrenals may be partially responsible for the anxiety you’re feeling, and progesterone has been implicated in depression, too. So, don’t think depression and anxiety are just ‘all in your head.’”

Hair loss and/or hair growth

“Hormone changes can cause hair growth where you least want it,” Dr. Sholes-Douglas says. “At the same time, these hormone changes–specifically, decreasing estrogen and the changing ratio of estrogen to testosterone–are responsible for thinning hair on the scalp, especially on the crown and near the forehead.”

Behavioral changes

Behavior can tip off a woman to menopausal symptoms. If you’re not feeling like yourself and your partner has complained about you treating them differently, Dr. Sholes-Douglas cautions it could be an indication of lower estrogen levels.

“Estrogen is actually a key driver of women’s nurturing behavior and desire to take care of others,” she says. “When levels decline in perimenopause, women can find themselves thinking, feeling, and behaving in a way that’s unfamiliar. This biological change can have huge consequences for family dynamics.”

Vaginal changes

“Age and hormones affect the appearance of the vagina,” Dr. Sholes-Douglas says. “The pubic hair can go gray, thin, or disappear altogether; the skin can change color; and the labia minora can lengthen or sag. All of these changes are completely normal.”

You may also notice vaginal dryness, which can cause irritation, burning, and/or pain with intercourse. While uncomfortable, these symptoms are completely normal.

Incontinence

“Decreasing estrogen is responsible for the thinning of the vaginal walls,” Dr. Sholes-Douglas says, “and that means the urethra doesn’t have the support it used to in order to hold urine in. Urine leakage is very common; around 50% of women will experience some form of incontinence in their lifetime.

Try cutting back on your caffeine and alcohol consumption, losing excess weight, and practicing Kegels (pelvic floor exercises) to reduce leakage and strengthen your pelvic muscles.

Hot flashes or menopause night sweats

Hot flashes are a well-known symptom of menopause, but they can also occur during perimenopause. And it’s important to note that they’re not just uncomfortable and disruptive–but may indicate a higher risk of serious health problems like heart disease and diabetes.

A study published in Menopause, the journal of The North American Menopause Society, found that women with more severe night sweats, with or without hot flashes, had a higher risk of diabetes, even after adjusting for obesity and race. Any incidence of hot flashes was associated with an 18% increased diabetes risk, and this risk continued to climb on the basis of the severity and duration of the hot flashes.

Menopause night sweats can also negatively impact sleep quality, leading to increased stress, anxiety, depression, and risk of chronic diseases.

Sleep problems

Hormonal changes during perimenopause can lead to sleep disturbances and a decrease in the amount of deep, restorative sleep you get. Women may experience insomnia, waking up frequently during the night, or difficulty falling asleep.

Lack of sleep can cause fatigue, irritability, and difficulty concentrating during the day. It can also increase your risk of depression, anxiety, weight gain, high blood pressure, and cardiovascular disease.

Weight gain

Many women experience weight gain during menopause, particularly in the abdominal area. This weight gain can be attributed to a decrease in estrogen, which leads to a slower metabolism, and a reduction in muscle mass.

As you age, your body naturally loses muscle mass, which means you burn fewer calories even when resting. Additionally, hormonal changes during menopause can cause insulin resistance, which can also contribute to weight gain.

So what to do if you think you are perimenopausal? “Every woman is different, but there’s no need to worry and suffer in silence,” Dr. Sholes-Douglas says. “Talk with your gynecologist to learn more about the symptoms, discuss what you’re experiencing, and ways to treat them.”

You can also engage in healthy lifestyle behaviors at home. “Menopause is a perfect time to encourage behavior changes that reduce menopause symptoms, as well as the risk of diabetes and heart disease,” says Dr. JoAnn Pinkerton, NAMS executive director of the Women’s Health Initiative (WHI).

Try these menopause self-care tips to start feeling better and improve your overall health and well-being:

Exercise regularly

Exercise can help reduce the severity and frequency of hot flashes and other menopausal symptoms. It can also help with weight management, bone health, and overall well-being.

Get enough sleep

Aim for seven to eight hours of sleep every night to boost your mood and reduce stress. Develop a calming bedtime routine and avoid screens before bed to sleep more soundly.

Avoid excess alcohol and smoking

Excessive alcohol consumption can exacerbate hot flashes, while smoking can cause hormonal imbalances, worsening menopausal symptoms.

Eat a heart-healthy diet

A diet rich in fruits, vegetables, whole grains, lean protein, and healthy fats can help manage menopausal symptoms and reduce the risk of heart disease and diabetes.

Consider hormone therapy alternatives

Traditional hormone replacement therapy (HRT) may effectively manage menopausal symptoms, but it’s not without its risks. There are natural alternatives to HRT, including supplements like St. John’s Wort, chaste tree, and vitamin E, which can reduce your symptoms.

Menopause is a natural and inevitable part of aging for women. While it can cause a range of unpleasant symptoms, you can manage these changes and maintain optimal health with the right lifestyle choices and natural interventions.

Listen to your body, pay attention to any unusual symptoms, and seek the help of a natural healthcare provider if needed. With the right care and support, you can navigate this transition with grace and ease, and continue to lead a happy and healthy life.

About Dr. Arianna Sholes-Douglas, MD, FACOG

Dr. Arianna Sholes-Douglas, author of The Menopause Myth: What Your Mother, Doctor, And Friends Haven’t Told You About Life After 35, is the founder and visionary of Tula Wellness Center, a unique medical practice in Tucson, Ariz., focusing on women’s health and beauty.

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