8 Unexpected Signs Of Perimenopause

When most people think about perimenopause and menopause, issues like hot flashes, weight gain and period irregularity likely come to mind.

While those symptoms do happen, recent data found that the most commonly reported signs of perimenopause were much different than those we had come to associate with the condition. Instead, think mental health struggles and digestive problems ― just to name a few.

The study, led by researchers from the period-tracker Flo and the Mayo Clinic, examined data from 17,494 people in 158 countries who self-reported their perimenopause symptoms over five months via a survey in the Flo app. Study authors defined perimenopause as the roughly six years before (and 12 months after) a woman’s final period, but noted perimenopause can last for up to 10 years. By comparison, menopause is the end of someone’s reproductive years and begins once someone has gone 12 months without a period.

“I think what’s interesting is how cool it is to have a digital platform with such great reach to be able to survey over 17,000 women from 158 countries,” said Dr. Sarah Richina, an OB-GYN and director of the Women’s Midlife Health Center at the University of Pittsburgh Medical Center. Richina was not affiliated with the study.

The study had limitations, though. The majority (93%) of respondents were upper middle income or high income, 59% were English speaking and 48% were white. This could mean the results weren’t the same for other groups of people.

For study participants who were 35 years and older, the most commonly-reported perimenopause symptoms were fatigue, physical and mental exhaustion, irritability, depression, sleep troubles, digestive problems and anxiety.

“What Flo found on their study is very much consistent with what I see in the office every day,” said Dr. Sameena Rahman, who is an OB-GYN. Rahman is not affiliated with the study but is the medical adviser for Flo.

“Sometimes it’s not the hot flashes, it’s not the night sweats, it’s not the typical symptoms that you think about in this transition,” Rahman said. “It really is this feeling of anxiety that people develop, this mental health distress.”

Sleep disturbances were also common.

“And when your sleep is off, that really does just continue to cause other problems,” Rahman explained.

If you’re not sleeping well, you are likely dealing with more brain fog, mental exhaustion and even increased feelings of anxiety and depression.

“So much overlap with sleep and mood and physical function. It’s all interrelated,” Richina said.

Bloating and constipation are also symptoms Richina sees in her practice.

“We know some of that’s hormonally related,” Richina said.

Perimenopause can begin up to 10 years before menopause, noted Richina. While the average age of menopause in the U.S. is 51, it can also begin as early as 45 or even younger. So, symptoms can feasibly start in someone’s mid-30s or early-40s.

Many women blame emotions on family demands or work stress, and while that certainly could be part of mood changes, it likely isn’t the entire story if you are in the perimenopausal phase of life.

“It’s your erratic hormones that are really perpetuating this,” Rahman said.

You may be raising kids, caring for aging parents and managing challenges as your career starts to peak. This can make it really hard to tell whether you’re dealing with mood-related perimenopause issues or if that stress and depression have to do with personal circumstances — or both.

According to Richina, it can be helpful to keep a diary of your symptoms relative to your menstrual cycle. Do you tend to get more anxious the week before your period? Are your sleep issues more frequent the days before your period? Determining a pattern can be helpful when addressing and potentially treating the issues, she noted.

There’s no “one-size-fits-all” treatment when it comes to perimenopause and menopause, Rahman said. But there are certain treatments available, such as hormone therapy and talk therapy. Be sure to talk to your doctor about your symptoms.

It’s also important to address the main drivers of your health, both experts said.

“You want to see how we can get your sleep better, see how we can get your nutritional status better — we want to make sure you’re getting adequate protein, adequate fiber,” Rahman said. “Make sure that you’re strength training and getting some cardiovascular workouts,” as well as managing stress.

“I think a lot of it is back to basics. What worked through your 20s and 30s doesn’t always work. You can’t just get by on no sleep and no breakfast,” Richina said. “There’s not a quick fix either. It’s a natural transition we go through, but it is during a very busy time in our lives.”

Treatment tends to be a “full body approach,” according to Rahman. “And trying to make sure that their top symptoms that are most distressing to them are being treated.”