Symptoms of Perimenopause
Perimenopause is characterized by vasomotor symptoms, menstrual irregularities, genitourinary symptoms, sleep disturbances, mood changes, and physical discomfort that significantly impact quality of life. These symptoms occur as women transition toward menopause, which is defined as no menses for 1 year in the absence of other causes 1.
Common Perimenopausal Symptoms
Vasomotor Symptoms
- Hot flashes and night sweats (experienced by 46-73% of women) 1, 2
- Can persist for 1-2 years in most women, but may last a decade or more in some 3
- Often disrupt sleep and daily activities 2
Menstrual Changes
- Irregular menstrual cycles 4
- Variable menstrual flow 4
- Longer intervals between periods as perimenopause progresses 2
Genitourinary Symptoms
- Vaginal dryness 1
- Dyspareunia (painful intercourse) 1
- Urinary complaints (urgency, recurrent infections) 2
- Vaginal irritation and pruritis 2
Sexual Function Changes
Mood and Cognitive Changes
- Mood disturbances (irritability, anxiety) 1, 2
- Depression 1, 2
- Sleep disturbances (often exacerbated by night sweats) 1, 2
- Cognitive changes 5
Physical Symptoms
- Arthralgias and myalgias (joint and muscle pain) 1, 2
- Fatigue 1, 2
- Weight changes, particularly increase in abdominal fat 5
Diagnostic Considerations
It's important to note that perimenopause is diagnosed clinically based on symptoms and menstrual pattern changes, not solely on laboratory values 2. Key considerations include:
- FSH levels can be unreliable during the transition period 2
- Other causes of similar symptoms should be ruled out (e.g., thyroid disease, diabetes) 2
- Standardized assessment tools like the Greene Scale or MENQOL can help evaluate symptom severity 1
Impact on Quality of Life
Perimenopausal symptoms can have a profound impact on quality of life 1. The symptoms are sufficiently bothersome that approximately 90% of women seek healthcare provider advice on how to cope 3. Symptoms may interact with each other, creating a cycle of discomfort - for example, depressed women tend to experience worse hot flashes and poorer sleep 3.
Special Considerations
- Bone health: Women with perimenopausal symptoms may have lower bone mineral density and higher rates of bone loss 4
- Fertility: Despite irregular cycles, women in perimenopause may still be fertile and should use contraception if pregnancy is not desired 1
- Duration: While most symptoms are temporary, vaginal symptoms typically will not resolve without treatment 3
Understanding these symptoms helps in early recognition of perimenopause, allowing for timely management strategies to improve quality of life during this transition period.