Perimenopausal Symptoms: What You Should Know

You may already know the hallmark symptoms of menopause such as hot flashes, weight gain and mood changes. But a lot happens during menopause-and perimenopause, the months and sometimes years leading into menopause-that doesn't make headlines.

"Women experience a broad range of symptoms during the perimenopausal transition because there are estrogen receptors all over the body," said Jessica L. Chan, MD, a reproductive endocrinologist at Cedars-Sinai.

Read: Making Sense of Menopause

Jessica L. Chan, MD

The Lesser-Known Symptoms of Menopause

The National Menopause Foundation's symptom checklist includes 36 symptoms that signal the start of menopause, from burning mouth to tingling extremities. While some of these less-discussed symptoms are rare, others are almost universal. One thing you can count on: Every woman's experience of menopause is unique.

Navigating menopause can be a challenge, but guidance from a physician, and physician-recommended medication, can help women navigate the change.

Here's what you need to know to address a few of the less-discussed symptoms of perimenopause and beyond.

Your heart might skip a beat.

The hormonal fluxes that happen in the months and years leading up to menopause can cause heart palpitations (estrogen helps regulate heart rate and keeps cholesterol levels in check). If you have heart palpitations that last more than a few minutes, or you feel faint or short of breath, see your doctor to rule out something more serious.

You may feel dry (in all sorts of places).

As estrogen levels plummet, so too does the amount of oil your skin produces.

"In addition to dry and itchy skin, your hair and nails may need extra moisture," said Erica T. Wang, MD, a reproductive endocrinologist at Cedars-Sinai. Your eyes, scalp and vagina may also feel dry and itchy.

Read: Perimenopause Explained

Erica T. Wang, MD, MAS

Your sex life may change.

It's common for women to expect their sex lives to tank during perimenopause and menopause-and that can happen.

"Without estrogen, the vagina may not only feel dry, but it also loses elasticity, which can make sex painful for some women," said Chan. "But other women may find they want to have more sex because of erratic surges in estrogen."

You may lose sleep.

Perimenopausal symptoms such as hot flashes, night sweats and mood disturbances can keep you up at night, but dips in progesterone also interfere with the sleep cycle. So, instead of cycling into deep restorative sleep, you may cycle in and out of lighter sleep periods throughout the night.

Read: Why Hot Flashes Occur and How to Treat Them

You may have difficulty concentrating.

Hormonal changes, including drops in estrogen and progesterone, can compromise your ability to think clearly. The reason: Estrogen plays a role in the production of a growth factor called brain derived neurotrophic factor, or BDNF, that is linked to enhanced memory and cognition.

You may struggle to build muscle.

In addition to a drop in estrogen, many peri- and post-menopausal women experience lower levels of testosterone. Unfortunately, the combination can make it more challenging to build lean muscle.

Your bones may need some attention.

Estrogen helps protect bone, so it makes sense that your risk of bone loss increases after menopause. You can help counteract the damage by incorporating weight-bearing activities into your daily routine (especially weightlifting) and ensuring your diet is rich in protein, calcium and vitamin D.

Read: Should You Take an At-Home Menopause Test?

The Take-Home Message

If you experience any of these symptoms, or others not listed, talk to your doctor. Menopausal changes can begin as early as your late 30s. In some cases, hormone therapy, topical estrogen creams and other treatments can help alleviate bothersome symptoms, which can last for years after your last period.

"Menopause, like puberty, doesn't happen overnight, and it's part of our natural life cycle," said Wang.

Decreasing estrogen levels can make you feel like you're aging at an accelerated rate, but a physician can help you maximize your health and wellbeing during the transition.

Read: Hormone Replacement Therapy: Is It Right for You?