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5 surprising symptoms of perimenopause

Mature woman

HFG founding editor Niki Bezzant takes us through five of the more surprising symptoms of perimenopause.

Most women (and men, we hope by now) will be aware of the classic symptoms of menopause, or perimenopause, which is the name for the, sometimes, turbulent time before a woman’s periods stop. (You’re officially menopausal once you’ve reached one year without a period).

There are the hot flushes; the night sweats; the weight gain, cycle changes and sleep issues. But did you know there are more than 40 symptoms of perimenopause? And not all of them are things we’d automatically associate with hormonal change.

It’s not surprising – women are wired for oestrogen, and we have oestrogen receptors all over our bodies, contributing to crucial bodily processes. When oestrogen starts to fluctuate, all sorts of weird and wonderful things can start to happen. Here are a few perimenopause symptoms you might not know about.

1 Joint pain

Women are twice as likely as men to develop osteoarthritis, and this can often start to happen in perimenopause.

As well, women can often experience more pain in joints – especially knees, elbows, shoulders and hands – because of the decline in oestrogen that happens at this time.

Oestrogen reduces inflammation and helps keep joints lubricated and functioning, so it makes sense that as oestrogen declines, pain increases.

What you can do about it:

Keep your joints strong and mobile with regular weight-bearing exercise. Anti-inflammatory medication might be recommended, and there’s some evidence hormone replacement therapy (HRT) may help relieve joint pain, too.

There are some supplements that claim to offer relief; these can be worth trying, but if you don’t feel an effect within a month or so, move on.

2 Brain fog

This is a big one. You know, that moment when you forget the name of the thing/person/place you know super well; it was right on the tip of your tongue and now it’s just… gone?

Brain fog, and a feeling of not being able to multi-task or concentrate as well as you once could, is very common among women at perimenopause.
Brain fog can be caused or compounded by lack of sleep and, of course, it can be linked to other external issues in our daily lives.

But there’s a definite hormonal component here, too. Experts don’t really know what is going on, but it’s thought it’s related to oestrogen fluctuation, again.

What you can do about it:

There’s not much we can do about this one except know: it will improve once you’re through perimenopause and the hormone fluctuations are starting to calm down.

Sorting out sleep can help, too, which may be why HRT use tends to show benefits for brain fog.

3 Depression and anxiety

A 2006 study, following women aged between 36 and 44 who hadn’t had depression before, found that as they hit perimenopause, they were twice as likely to have ‘clinically significant depressive symptoms compared with younger women.

Women who also reported hot flushes and night sweats were even more likely to feel depressed.

Anxiety and panic disorders are also common at this time. Again, this is related to the oestrogen receptors in our brains messing with our moods.

What you can do about it:

Talk to your doctor about the range of treatments that are available, including anti-depressant medications; HRT and complementary therapies.

There’s also evidence exercise can really help, along with following a Mediterranean pattern of eating.

4 Dry eyes

We know that declining oestrogen level during perimenopause causes the skin to become thinner and less elastic.

It also affects our mucous membranes, including the eyes. The lacrimal glands keep our eyes moist; they produce lacrimal fluid which lays like a film on the eye and protects it.

The hormonal changes during perimenopause may cause the lacrimal glands to produce less fluid, drying out the eyes.

What you can do about it:

Try lubricating eye drops, and make sure you stay well hydrated by keeping up your fluid intake. Avoid air-conditioned rooms and try to rest – and blink – your eyes regularly.

5 Headaches

Women who’ve previously suffered from headaches at different stages in their menstrual cycle, or who’ve been prone to migraines, can suffer from more headaches as hormones fluctuate during perimenopause.

Like many things related to perimenopause, it’s not completely understood why this is. But it does seem to ease once women are through the menopause transition.

What you can do about it:

Talk to your doctor about treatments – there are medications that may help, and for some women, HRT will ease headaches too.

Regular exercise can be useful in preventing headaches, so try to get 30 minutes at least three times a week. And some foods can trigger headaches – so try keeping a food diary, and noting any links.

First published: Mar 2021

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