From the Guidelines
Perimenopause symptoms typically include hot flashes, night sweats, irregular menstrual cycles, sleep disturbances, mood changes, vaginal dryness, and decreased libido, among others, as a result of declining estrogen and progesterone levels. These symptoms can significantly impact a woman's quality of life, with varying severity and duration among individuals 1. Some common symptoms of perimenopause include:
- Irregular menstrual cycles with varying flow
- Hot flashes and night sweats
- Sleep disturbances
- Mood changes such as irritability, anxiety, and mood swings
- Vaginal dryness and decreased libido
- Fatigue, memory and concentration problems
- Weight gain, particularly around the abdomen
- Thinning hair and dry skin
- Urinary issues like increased frequency or urgency According to the American Cancer Society/American Society of Clinical Oncology breast cancer survivorship care guideline, vasomotor symptoms such as hot flushes can be mitigated with SNRIs, selective serotonin reuptake inhibitors (SSRIs), gabapentin, lifestyle modifications, and/or environmental modifications 1. Lifestyle interventions, including rhythmic breathing, vitamins, exercise, and avoiding spicy foods, caffeine, and alcohol, have had variable results, while environmental modifications like cool rooms and dressing in layers can also be helpful 1. It is essential to note that symptoms can vary widely in severity and duration among women, and management strategies may include lifestyle modifications, hormone therapy, or other medications, depending on the severity and impact of symptoms 1.
From the FDA Drug Label
When the estrogen levels begin dropping, some women develop very uncomfortable symptoms, such as feelings of warmth in the face, neck, and chest, or sudden strong feelings of heat and sweating (“hot flashes” or “hot flushes”). The symptoms of perimenopause (pre-menopause) include:
- Feelings of warmth in the face, neck, and chest
- Sudden strong feelings of heat and sweating (hot flashes or hot flushes) 2 Note that these symptoms are associated with the drop in estrogen levels that occurs during perimenopause.
From the Research
Symptoms of Perimenopause
The symptoms of perimenopause, also known as pre-menopause, can vary from woman to woman. Some common symptoms include:
- Vasomotor symptoms, such as hot flashes and night sweats 3, 4, 5
- Genitourinary symptoms, such as vulvovaginal irritation and dryness, dyspareunia, and urinary problems 3, 4
- Changes in sexual function, mood, and sleep 3, 4, 6
- Cognitive changes and low sexual desire 3
- Bone loss, increase in abdominal fat, and adverse changes in metabolic health 3
- Depressed mood and increased anxiety 6
- Vaginal dryness and dyspareunia 4, 6
Onset and Duration of Symptoms
The onset and duration of perimenopausal symptoms can vary. Some women may experience symptoms for a short period, while others may experience them for a decade or more 6. The symptoms can also interact with one another, such as depressed women experiencing worse hot flashes and sleep disturbances 6.
Treatment Options
Treatment options for perimenopausal symptoms include:
- Hormone therapy, which can be effective for vasomotor symptoms and genitourinary symptoms 3, 4, 7
- Non-hormonal medications, such as selective serotonin reuptake inhibitors and gabapentin, for vasomotor symptoms 4
- Lifestyle modifications, such as cognitive behavior therapy and clinical hypnosis, for short-term reduction of vasomotor symptoms and associated sleep disturbances 4
- Hormone-free vaginal moisturizers and other non-pharmacologic treatments for genitourinary syndrome of menopause 4