When you experience a menstrual cycle, spotting is not usually considered unusual or an automatic cause for concern. If it’s accompanied by other symptoms or happening on a regular basis, it’s definitely worth seeking medical advice. But for many, it’s a regular part of their cycle.  

After menopause, the perception of any bleeding changes dramatically. Any vaginal bleeding after menopause is considered abnormal vaginal bleeding and should be investigated.

Postmenopausal Bleeding: A High-Level Overview

During perimenopause (the stage before menopause), your menstrual cycle gradually comes to an end. The average length of perimenopause is 3-5 years, and during that time, your menstrual period can become irregular, and there can be irregular bleeding between periods.

Just as periods start out irregularly when you go through the changes of puberty, so they become irregular as you go through the changes of perimenopause.

Because of this gradual change, many individuals are unsure when perimenopause ends, and menopause begins. In medical terms, menopause is confirmed 12 months after your last menstrual period. 

Bleeding after this point is called postmenopausal bleeding (PMB), and it is considered abnormal bleeding.

Don’t Freak Out. But *Do* See a Doctor…

If you Google "vaginal bleeding after menopause" or “causes of light spotting after menopause,” the search results are likely to send you into a panic. 

Please don’t panic! There are many explanations for spotting after menopause. So, why the urgency to see a doctor?  

One serious reason for menopausal bleeding is endometrial cancer, which cannot be screened for and means it can go undetected if symptoms are ignored.

So, even though postmenopausal bleeding can occur for a variety of reasons—not just cancer—understanding that it can allow for early detection of endometrial cancer means it’s always worth investigating.

Causes of Vaginal Bleeding Postmenopause

As mentioned, there can be a number of reasons for postmenopausal bleeding and while we urge you to work with your doctor to determine the underlying cause of postmenopausal bleeding, it might be helpful to know some of the most common explanations:

You’re Still in Perimenopause

One obvious reason you might experience spotting after menopause is that you’re not yet actually in menopause. The perimenopause stage lasts, on average, 3-5 years. But for some women, this stage may last only a few months or continue for up to 10 years.

"During perimenopause, the ovaries begin to make less estrogen. Some months, the ovaries may release an egg. Other months, they do not release an egg. In your 40s, your menstrual periods may be shorter or longer, and the days between may increase or decrease.

Your bleeding may change too—it may be heavier or lighter. You also may skip periods," according to the American College of Obstetricians and Gynecologists. 

Considering periods become irregular at this stage, it can be easy to mistake the stage you’re in for menopause. It’s worth tracking your periods and irregular bleeding after menopause so you and your doctor can understand what stage you’re in.

If you’ve gone 12 months since your last period, you’re considered to be in menopause.

Vaginal Atrophy (Thinning Tissue in the Vagina)

Vaginal or endometrial atrophy occurs in some women after menopause. The body produces less estrogen after menopause, which can lead to the thinning, drying, and inflammation of the vaginal walls.

According to the Mayo Clinic, “Because the condition causes both vaginal and urinary symptoms, doctors use the term ‘genitourinary syndrome of menopause (GSM)’ to describe vaginal atrophy and its accompanying symptoms.” You may also notice brown spotting or other bleeding relating to the dryness caused by the reduction in estrogen.

Symptoms of GSM

 In addition to bleeding, symptoms of GSM include:

• Vaginal dryness, burning, and itching
• A burning sensation when urinating
• Frequent urinary tract infections (UTIs)
• Urinary incontinence
• Decreased vaginal lubrication during sex and increased discomfort during sex

Endometrial Atrophy or Endometrial Hyperplasia

The endometrium is the tissue that makes up the uterine lining. Fluctuating or irregular hormone levels during menopause can affect the tissue of the uterus in 2 possible ways:

1. Thinning of the endometrium (atrophy): Low estrogen levels can cause the tissue of the endometrium (or lining of the uterus) to thin, which can result in some abnormal uterine bleeding.
2. Thickening of the endometrium (endometrial hyperplasia): When the uterine lining becomes thickened, most often due to increased estrogen and decreased levels of the hormone progesterone, it is called endometrial hyperplasia which can result in abnormal uterine bleeding.

Polyps

Polyps are usually benign, noncancerous growths in the uterus (a.k.a. endometrial polyps), cervical canal, or on your cervix. While polyps are not usually harmful, but they often bleed and cause spotting between your cycle or after menopause.

Many people aren’t even aware they have them, so it’s always good to have this checked out by a medical professional.

Infection

Sexually transmitted infections (STIs) can be the reason for spotting or light bleeding. 

Most infections are treatable. But infections can become more serious if ignored, so it’s worth getting routinely tested for STIs.

Strenuous Exercise

While exercise is essential for good all-around health, strenuous exercise after menopause can trigger bleeding (or perhaps brown discharge). This usually happens while you are close to transitioning into menopause from perimenopause.

Generally, this is not something to be concerned about. But if it happens for the first time, it’s good to seek reassurance from your doctor.

Hormone Replacement Therapy (HRT)

Hormone replacement therapy (such as estrogen and progesterone therapy) therapy) is a form of hormone therapy used to treat symptoms associated with perimenopause and menopause, including:

• Hot flashes
• Vaginal atrophy
• Skin and hair changes
• Vaginal dryness
• Joint pain
• Low libido 
• Bone loss

These symptoms are related to decreased levels of estrogen and progesterone that occur during menopause. HRT medications are available in different formulations, including oral tablets, patches, vaginal suppositories, and creams. 

Side effects of HRT medications include unusual bleeding, though this is considered a less common side effect. More information about HRT can be found at the Mayo Clinic.

Other Medications

In addition to HRT, a side effect of other medications can include unusual bleeding. For example, blood thinners may cause unusual postmenopausal bleeding.

If you are on any medications and have post menopausal bleeding be sure to share your complete medication list with your healthcare provider so they can review your medications to see if this is a possible medication risk.

Cervical or Uterine Cancer

According to the Dana-Farber Cancer Institute, spotting in postmenopausal women can, in some cases, be an early sign of cervical or uterine cancer and should always be investigated further.

“Any postmenopausal bleeding should warrant a visit to a gynecologist,” says Ursula Matulonis, MD, chief of the Division of Gynecologic Oncology at Dana-Farber Cancer Institute.

"If the bleeding is related to cancer, a conversation with your doctor can lead to an earlier diagnosis and better prognosis," according to the institute. "Even if the bleeding is not related to cancer, talking with your doctor can help him or her determine the cause and the best treatment for you."

Time to See a Doctor? What to Expect…

In general, any bleeding post menopause is worth a trip to your health care provider. Even if the spotting is minor, it’s worth eliminating the risk that it could be an early indicator of cancer, such as endometrial cancer. 

Rule Out Endometrial Cancer

It’s worth noting that age is a factor too. According to the American Cancer Society, endometrial cancer most often affects postmenopausal women—60 is the average age at diagnosis.

So, what can you expect when you see your doctor or healthcare provider?

To diagnose and treat any cause of abnormal perimenopausal bleeding or bleeding after menopause, your doctor will likely:

• Review your personal and family health history
• Perform a physical exam including a pelvic exam, which may include the following tests:
• Endometrial biopsy
• Pelvic ultrasound

Treatment of Postmenopausal Bleeding

Your treatment could include hormone therapy, which could be administered through pills, creams, or patches. 

Or it could involve other procedures (including surgery), like:

• Hysteroscopy: During hysteroscopy, instruments inserted through the hysteroscope (a device your doctor uses to see inside your uterus) can be used to remove polyps in your uterus. 
• D&C (dilation and curettage): A surgery in which your cervix is opened (or dilated). Your doctor will then use a surgical instrument called a curette to remove excess tissue in the uterus.
• Hysterectomy: This is a major surgery to remove the uterus. Your doctor or healthcare provider may also recommend the removal of your ovaries, fallopian tubes, cervix, or nearby lymph nodes at the same time as your uterus.

It’s important to understand that postmenopausal bleeding or spotting is never considered normal. You should see your healthcare provider if this is happening to you. However, please do not panic or jump to the worst possible conclusions. As we’ve seen, these symptoms can have many possible sources, and not all are serious causes.

Sources:

https://my.clevelandclinic.org/health/diseases/21549-postmenopausal-bleeding

https://www.healthline.com/health/womens-health/spotting-before-periods 

https://www.acog.org/womens-health/faqs/perimenopausal-bleeding-and-bleeding-after-menopause

https://www.mayoclinic.org/diseases-conditions/vaginal-atrophy/symptoms-causes/syc-20352288 

https://www.mayoclinic.org/diseases-conditions/menopause/in-depth/hormone-therapy/art-20046372 

https://blog.dana-farber.org/insight/2018/11/spotting-periods-sign-cancer/ 

https://www.cancer.org/cancer/types/endometrial-cancer.html 

—

We hope you found this post informative—but remember: we’re not doctors and this post is not medical advice! While all posts are fact-checked and well researched, we always recommend you chat with your doctor about any questions or concerns you might have regarding a medical condition. 

We’re here to support and educate, but never with the aim of disregarding professional medical advice you’ve been given. Phew, now that that’s out of the way, you can go on living unapologetically free.

But, even still, sugar can surprise you! Did you know there’s also a link between high blood sugar and hot flashes? Well, you’re about to learn all about it…

What Are Hot Flashes and Night Sweats?

Hot flashes and night sweats are common symptoms experienced by individuals, primarily women, during perimenopause and menopause. They are characterized by sudden feelings of intense heat and a rapid increase in body temperature, often accompanied by sweating. These episodes can vary in duration and frequency and may disrupt sleep patterns and daily activities.

Hot flashes typically begin as a sudden sensation of heat that spreads across the face and upper body. This warmth may be accompanied by flushing of the skin, redness, and perspiration. Some people may also experience a rapid heartbeat, chills, or a feeling of anxiety or unease. The intensity and frequency of hot flashes can vary from person to person.

Night sweats, as the name suggests, are episodes of excessive sweating during sleep. They are essentially hot flashes that occur at night and can lead to drenched pajamas, bedding, and disrupted sleep. Night sweats can be particularly upsetting, as they can interfere with sleep quality and result in fatigue and daytime drowsiness.

Both hot flashes and night sweats are associated with hormonal changes that occur during perimenopause. Fluctuations in estrogen levels, along with changes in other hormones, are believed to disrupt the body's temperature regulation system, leading to the sudden onset of hot flashes and night sweats. While menopause is the most common cause, these symptoms can also be experienced by men and women undergoing certain medical treatments or experiencing hormonal imbalances for other reasons.

Does Eating Sugar Cause Hot Flashes?

According to one 2012 study in the Journal of Clinical Endocrinology & Metabolism, women with higher blood sugar levels had more frequent hot flashes. However, it’s worth noting that the exact cause of hot flashes during perimenopause is not fully understood and the role of sugar/glucose levels may not paint a full picture for every case.

Hot flash triggers will vary from person to person. Other common triggers include: 

• Spicy foods
• Hot beverages
• Alcohol, caffeine
• Smoking

However, if you notice a correlation between eating sugary foods and hot flashes, you can certainly try moderating or decreasing your sugar intake (there would be other positive health benefits too! We’ll go into that later.)

The common explanation for hot flashes is fluctuating hormone levels. Perimenopause is characterized by hormonal fluctuations, particularly a decline in estrogen levels. These hormonal changes are believed to disrupt the body's thermoregulatory system, which is responsible for maintaining a stable body temperature.

The hypothalamus, a region in the brain, plays a crucial role in regulating body temperature. Estrogen is known to influence the hypothalamus, and the decline in estrogen levels during perimenopause can affect the hypothalamus's function. This disruption can lead to the hypothalamus perceiving an increase in body temperature when there isn't one, triggering a hot flash.

It's worth noting that while hot flashes are most commonly associated with perimenopause and menopause, they can also be caused by other factors such as certain medications, thyroid disorders, stress, anxiety, or certain lifestyle factors. If you are experiencing bothersome hot flashes, we advise consulting with a healthcare professional who can provide guidance, support, and potential treatment options tailored to your specific situation.

A Connection Between Blood Glucose Levels and Hot Flashes

According to a 2007 paper published in the Journal for Obstetrics Gynecology Neonatal Nursing, hot flash frequency decrease when blood glucose levels were in the higher normal range, but more hot flashes occur when blood glucose levels are low. 

Based on this, interventions that aim to stabilize blood glucose levels may be effective in reducing hot flashes during menopause. Strategies for managing diet, which are similar to those used for individuals with diabetes, such as having small frequent meals and selecting nutrient-rich foods for meals and snacks, could be helpful. 

Exercise's impact on blood glucose levels may also contribute to stabilizing blood glucose, but more research is needed in this area. Although further study is required, these findings offer initial evidence for the potential development of hot flash treatments focused on modifying the diet as an alternative or additional approach to hormone therapy.

How Can You Manage Your Sugar Levels?

Reducing or eliminating sugar intake is a complex dietary change to make. At first glance, you may think it amounts to reducing or eliminating desserts, sweet treats, and snacks. However, sugar has pervaded many more foodstuffs, often showing up on ingredient lists as maple syrup, coconut sugar, honey, date syrup, dextrose, barley malt, and agave are all sugars too. Dried fruits and juices are also loaded with sugar.

Of course, you can take a moderate approach and eliminate the obvious stuff like sugary drinks and desserts. But if you’re planning on taking a bigger stance against sugar, it’s probably worth chatting with a doctor or dietician, spending some time learning to read ingredient labels, and assessing what is realistic and sustainable for you and your diet and lifestyle. 

Let’s be blunt here: Sugar is tasty. There’s a reason we crave it. So it’s better to start with realistic goals that you can sustain than aim for puritanical extremes. (Of course, if you need to give up sugar for medical reasons, you may have less flexibility, but that would be a medical diet).

What Are Some Other Benefits of a Reduced Sugar Diet?

That said, eliminating sugar has benefits that reach beyond the possibility of reduced perimenopause/menopause symptoms. Here are some other potential benefits:

Weight Management

Sugar is a concentrated source of calories with little nutritional value. By cutting back on sugar, you can reduce your overall calorie intake, which can help with weight management and potentially lead to weight loss.

Improved Dental Health

Sugar is a major contributor to tooth decay and cavities. By reducing your sugar consumption, particularly sugary drinks, and snacks, you can help protect your teeth and maintain better oral health.

Balanced Blood Sugar Levels

Consuming excessive amounts of sugar, especially refined sugars and high-glycemic foods, can lead to spikes in blood sugar levels followed by crashes when blood glucose falls. By reducing sugar intake, you can help stabilize your blood sugar levels and avoid energy crashes and mood swings.

Reduced Risk of Chronic Diseases

High sugar consumption has been linked to an increased risk of chronic health conditions, including obesity, type 2 diabetes, heart disease, and certain types of cancer. By reducing sugar intake, you can potentially lower your risk of developing these conditions.

Some Other Suggestions for Managing Hot Flashes

While it's not possible to completely eliminate hot flashes, there are several strategies you can try to reduce their severity or frequency. Here are some suggestions:

Dress in Layers

Wear lightweight, breathable clothing made from natural fibers such as cotton or linen. Dressing in layers allows you to remove clothing as needed when a hot flash occurs.

Manage Your Stress Levels

Stress can trigger or worsen hot flashes. Practice stress-reduction techniques such as deep breathing exercises, meditation, yoga, or engaging in activities you enjoy.

Stay Cool

Keep your environment cool by using fans, air conditioning, or keeping windows open. Use a portable fan or carry a handheld fan to use during hot flashes.

Avoid Food & Drink Triggers

Identify any triggers that worsen your hot flashes and try to avoid them. Common triggers include spicy foods, hot beverages, alcohol, caffeine, and smoking. As we’ve discussed here, sugar may also be on this list!

Stay Hydrated

Drink plenty of water throughout the day to stay hydrated. Some women find that sipping cold water during a hot flash can help alleviate the sensation of heat.

Maintain a Healthy Weight

Some studies suggest that maintaining a healthy weight can help reduce the severity of hot flashes. Regular exercise and a balanced diet can contribute to overall well-being during perimenopause.

Discuss Hormone Therapy With Your Healthcare Provider

If your hot flashes are severe and significantly affect your quality of life, you can discuss hormone replacement therapy options with your healthcare provider. Hormone therapy involves taking medications that contain estrogen or a combination of estrogen and progestin to help alleviate menopausal symptoms. However, hormone therapy may not be suitable for everyone, so it's important to discuss the potential risks and benefits with your healthcare provider.

We hope you found this post informative — but remember: we’re not doctors and this post is not medical advice! While all posts are fact-checked and well researched, we always recommend you chat with your doctor about any questions or concerns you might have regarding a medical condition. We’re here to support and educate, but never with the aim of disregarding professional medical advice you’ve been given. Phew, now that that’s out of the way, you can go on living unapologetically free.

In general, hot flashes are characterized by a sudden sensation of intense and overwhelming heat.

But there can be more to it than that. Let’s take a look…

Signs Commonly Associated With Hot Flashes

Here are some signs commonly associated with hot flashes:

Sudden Sensation of Intense Heat

A hot flash typically begins with a sudden feeling of warmth or heat that spreads over the face, neck, and upper body.

Flushed Skin

The skin may become red and flushed during a hot flash. Some individuals experience blotchy skin or a reddened appearance, particularly on the chest, neck, and face.

Sweating

Profuse sweating often accompanies a hot flash. It can range from mild perspiration to drenching sweat.

Rapid Heartbeat

Many women may notice an increased heart rate or palpitations during a hot flash.

A Feeling of Being Chilled

Following a hot flash, some individuals may experience a brief period of feeling cold or chilled as the body temperature drops.

Anxiety or Irritability

Hot flashes can sometimes be accompanied by feelings of anxiety, irritability, or restlessness.

Night Sweats

Hot flashes that occur during sleep are referred to as night sweats. They can disrupt sleep, leading to fatigue and daytime sleepiness.

Duration and Frequency

Hot flashes typically last for a few minutes but can vary in duration. They may occur sporadically or multiple times throughout the day.

Why Do Hot Flashes Happen During Perimenopause?

During perimenopause, which is the transitional phase before menopause, hot flashes commonly occur. The exact cause of hot flashes during perimenopause is not fully understood, but it is believed that hot flashes occur because of hormonal changes in the body. Here’s how it’s thought to break down:

Fluctuating Hormone Levels

Perimenopause is characterized by hormonal fluctuations, particularly a decline in estrogen levels. It is believed that these hormonal changes disrupt the body's thermoregulatory system, which is responsible for maintaining a stable body temperature.

Hypothalamus involvement

The hypothalamus, a region in the brain, plays a crucial role in regulating body temperature. Estrogen is known to influence the hypothalamus, and the decline in estrogen levels during perimenopause can affect the hypothalamus's function. This disruption can lead to the hypothalamus perceiving an increase in body temperature when there isn't one, triggering a hot flash.

Vasomotor instability

Hot flashes are thought to be a result of vasomotor instability, which refers to the dilation and constriction of blood vessels. When a hot flash occurs, blood vessels near the skin's surface dilate, causing flushing and increased blood flow to the skin. This sudden dilation of blood vessels leads to the characteristic sensation of heat and sweating associated with hot flashes.

It's worth noting that while hot flashes are most commonly associated with perimenopause and menopause, they can also be caused by other factors such as certain medications, thyroid disorders, stress, anxiety, or certain lifestyle factors. No two women will experience hot flashes the same way. If you are experiencing bothersome hot flashes, it's advisable to consult with a healthcare professional who can provide guidance, support, and potential treatment options tailored to your specific situation.

Steps You Can Take to Manage, Prevent and Treat Hot Flashes

While it's not possible to completely eliminate hot flashes, there are several strategies you can try to reduce their severity or frequency, as well as some options for treating hot flashes. Here are some suggestions:

Dress in Layers

Wear lightweight, breathable clothing made from natural fibers such as cotton or linen. Dressing in layers allows you to remove clothing as needed when a hot flash occurs.

Manage Your Stress Levels

Stress can trigger or worsen hot flashes. Practice stress-reduction techniques such as deep breathing exercises, meditation, yoga, or engaging in activities you enjoy.

Keep Your Environment Cool

Keep your environment cool by using fans, air conditioning, or opening windows. Use a portable fan or carry a handheld fan to use during hot flashes.

Avoid Food & Drink That Trigger Hot Flashes

Identify any triggers that seem to worsen your hot flashes and try to avoid them. Common triggers include spicy foods, hot beverages, alcohol, caffeine, and smoking.

Stay Hydrated

Drink plenty of water throughout the day to stay hydrated. Some women find that sipping cold water during a hot flash can help alleviate the sensation of heat.

Maintain a Healthy Weight

Some studies suggest that maintaining a healthy weight can help reduce the severity of hot flashes. Regular exercise and a balanced diet can contribute to overall well-being during perimenopause.

Explore Alternative Therapies

Some women find relief from hot flashes through alternative therapies such as acupuncture, mindfulness-based stress reduction, or herbal supplements like black cohosh. However, the effectiveness of these therapies varies from person to person, so it's important to consult with a qualified healthcare professional before trying them.

Discuss Hormone Therapy With Your Doctor

If your hot flashes are severe and significantly affect your quality of life, you can discuss hormone therapy options with your healthcare provider. Hormone therapy involves taking medications that contain estrogen or a combination of estrogen and progestin to help alleviate menopausal symptoms. However, hormone therapy may not be suitable for everyone, so it's important to discuss the potential risks and benefits with your healthcare provider.

Remember, what works for one person may not work for another, so it may take some trial and error to find the strategies that work best for you. If your hot flashes are persistent, severe, or significantly impact your daily life, it's advisable to seek guidance from a healthcare professional for further evaluation and management options.

Discuss SSRIs With Your Doctor

Selective serotonin reuptake inhibitors (SSRIs) are a class of medications primarily used to treat depression and anxiety. However, certain SSRIs have been found to be effective in treating symptoms of perimenopause—including reducing the frequency and severity of hot flashes, particularly in women who cannot or do not want to use hormone therapy. 

If you are considering using an SSRI for the management of hot flashes, it's important to discuss the potential benefits, risks, and side effects with your healthcare provider. They can evaluate your specific situation, medical history, and any other medications you may be taking to determine if an SSRI is an appropriate option for you.

Severe Hot Flashes? When to See a Doctor

While hot flashes are a common symptom during perimenopause and menopause, there are instances when it is recommended to seek medical attention for severe or concerning hot flashes. Here are some situations in which you should consider seeing a doctor:

Interference With Your Daily Life

If hot flashes are significantly affecting your quality of life, disrupting your sleep, or interfering with your ability to perform everyday activities, it's important to seek medical help. Your doctor can evaluate your symptoms and provide appropriate treatment options to manage the severity of hot flashes.

Other Concerning Symptoms

If you experience additional symptoms along with hot flashes that are concerning or unusual, it's important to consult a healthcare professional. These symptoms may include excessive bleeding, pain, vaginal discharge, or any other symptoms that are causing you distress.

Onset Before Age 40

If you start experiencing hot flashes before the age of 40, it could indicate a different underlying medical condition. Consulting a doctor can help identify the cause and determine the appropriate treatment.

Risk Factors or Medical History

If you have a personal or family history of certain medical conditions, such as breast cancer or blood clots, or if you have specific risk factors, it's advisable to discuss your symptoms with a healthcare professional. They can evaluate your individual situation and provide appropriate guidance.

Persistence or Worsening of Symptoms

If your hot flashes persist or worsen over time rather than improving or becoming less frequent, it's worth seeking medical attention. A doctor can assess your condition and help determine the underlying cause or explore alternative treatment options.

Don’t depend on Dr. Google! Remember, a healthcare professional is always the best resource to evaluate your specific situation and provide personalized advice. They can help determine the underlying cause of your severe hot flashes and recommend appropriate treatment options to alleviate your symptoms and improve your quality of life.

We hope you found this post informative — but remember: we’re not doctors and this post is not medical advice! While all posts are fact-checked and well researched, we always recommend you chat with your doctor about any questions or concerns you might have regarding a medical condition. We’re here to support and educate, but never with the aim of disregarding professional medical advice you’ve been given. Phew, now that that’s out of the way, you can go on living unapologetically free.

While the exact cause of hot flashes is not fully understood, the leading theory suggests that they are triggered by hormonal changes in the body.

When Do Most People Start Experiencing Hot Flashes?

Hot flashes can begin before menopause during a phase known as perimenopause, which is the transitional period leading up to menopause. 

Perimenopause can start in a woman's 40s or even earlier, and during this phase, hormonal fluctuations can lead to irregular periods, changes in menstrual flow, and symptoms like hot flashes and night sweats.

Hot flashes can continue during menopause, which is a natural stage in a woman's life when her menstrual periods cease permanently. Menopause typically occurs between the ages of 45 and 55, with the average age of onset being around 51. 

However, it's important to note that menopause is a highly individual experience, and hot flashes vary widely among women.

Night Sweats & Other Common Symptoms of Perimenopause

It's important to note that not all women will experience all of these symptoms, and some women may not experience any at all. Additionally, the severity and duration of symptoms can vary widely from woman to woman. Here are some of the other symptoms of perimenopause:

Night Sweats

Night sweats, also known as nocturnal hyperhidrosis, are episodes of excessive sweating that occur during sleep. They are similar to hot flashes but specifically happen at night. Indeed many think of them as nighttime hot flashes. Night sweats can be super annoying, as they can disrupt sleep, soaking through bedding and nightclothes, and leading to discomfort and fatigue. 

Skipped or Irregular Periods

During perimenopause, menstrual cycles may change drastically due to fluctuating hormone levels. Some women may experience irregular or less frequent periods, while others may experience spotting or heavier bleeding. It's important to track these changes to better understand the stage you're in and to seek medical advice if needed. Excessive bleeding may be a symptom of something else, such as anemia.

Other Symptoms

The list of other menopausal symptoms is quite long. The good news is not all perimenopausal women experience these symptoms. And they may be less intense for some. The list includes:

• Nausea: Fluctuating estrogen levels can result in feelings of nausea.
• Mood swings & anxiety: Any fluctuation in hormones can have a knock-on effect on your mood. Many report feeling more anxious or having sudden flashes of rage.
• Weight gain: Sudden changes in weight or digestion can also point to perimenopause. If your diet, nutrition, and exercise levels are fairly stable and you find yourself experiencing weight gain, that may be a symptom of perimenopause.
• Vaginal dryness: Vaginal or endometrial atrophy occurs in some women after menopause. The body produces less estrogen after menopause, which can lead to the thinning, drying, and inflammation of the vaginal walls. During perimenopause this process can begin, resulting in dryness.
• Changes in sexual desire or satisfaction: Some women report changes in sexual desire and arousal due to fluctuating hormones.
• Insomnia and sleep troubles: Apart from night sweats, general sleep can become unpredictable during perimenopause and beyond. It can also be hard to fall asleep, with some experiencing insomnia.
• Bone loss: With declining estrogen levels, your bone density may decrease as you start to lose bone more quickly than you replace it. For some, this can increase the risk of osteoporosis — a disease that causes fragile bones in women.
• Bladder problems: Low estrogen levels may also make you more vulnerable to urinary or vaginal infections. Loss of tissue strength may contribute to urinary incontinence.
• Memory problems or difficulty concentrating: Memory problems or difficulty concentrating are common symptoms caused by hormonal changes. Other factors like stress, sleep disturbances, and mental health conditions can contribute to these symptoms. 
• Joint and muscle pain: Estrogen plays an important role in maintaining joint and bone health. As estrogen levels decline during perimenopause, women may experience a loss of bone density and joint cartilage, leading to joint and muscle pain
• Headaches or migraines: The exact cause of headaches during menopause is not fully understood, but hormonal changes are believed to play a role. As levels of estrogen and progesterone fluctuate during menopause, some women may experience changes in blood vessels that can lead to headaches. Other factors, such as stress, lack of sleep, and certain foods or drinks, can also trigger headaches during menopause.
• Changes in skin and hair, such as dryness or thinning: Estrogen plays a key role in maintaining skin and hair health. It promotes collagen production, which helps keep skin elastic and firm, and also helps maintain healthy hair follicles. As estrogen levels decline during menopause, collagen production decreases, and hair follicles may become less active, leading to thinner, less elastic skin and hair.

If you're experiencing symptoms that are interfering with your daily life, talk to your healthcare provider about your options for managing them. Most of these symptoms will subside in postmenopausal women.

Take Our Perimenopause Quiz

The symptoms of menopause and perimenopause - including cold flashes - are numerous. But they can also be easily confused with other things going on in our bodies. Perimenopausal women may also wonder:

• Am I just stressed (work, world events, family life, etc.)
• Am I just run down?
• Maybe I’m coming down with the flu/cold/COVID?
• Maybe my body is just a little out of whack?

This means it can be difficult to say decisively if one is experiencing perimenopause or something else. To help you navigate these uncertainties, we’ve devised a little quiz. Check it out here…

Can Hot Flashes Be Caused By Something Other Than Perimenopause/Menopause?

During menopause, a woman's estrogen levels decline, which can affect the hypothalamus, a part of the brain that regulates body temperature. The hypothalamus may become more sensitive to small changes in temperature and send signals to the body to cool down. As a result, blood vessels near the skin's surface dilate, leading to a sudden sensation of heat and flushing of the skin.

Other potential factors that can contribute to hot flashes include:

• Hormonal imbalances: Fluctuations in hormones, such as estrogen and progesterone, can disrupt the body's temperature regulation system.
• Genetics: Some studies suggest that there may be a genetic predisposition to experiencing hot flashes.
• Lifestyle and environmental factors: Certain triggers, such as stress, spicy foods, caffeine, alcohol, and hot environments, can exacerbate hot flashes.
• Medications and medical conditions: Some medications, like certain antidepressants and opioids, can cause hot flashes as a side effect. Certain medical conditions, such as thyroid problems, diabetes, and certain cancers, can also be associated with hot flashes.

It's important to note that while hot flashes are typically associated with menopause, they can occur in other situations as well. For example, some women may experience hot flashes during perimenopause, the transitional phase leading up to menopause. Also: Certain medical treatments, such as hormone therapy for prostate cancer or breast cancer, can induce hot flashes in men or women, respectively.

If you experience bothersome hot flashes that impact your quality of life, we recommend consulting with a healthcare professional. 

9 Tips for Managing Hot Flashes During Perimenopause and Menopause

Managing hot flashes during perimenopause and menopause can involve a combination of lifestyle changes, self-care strategies, and, in some cases, medical interventions. Here are some tips that may help treat hot flashes:

1. Dress in Layers

Wear lightweight, breathable clothing and dress in layers so you can easily remove or add clothing as needed when a hot flash occurs. Leakproof underwear and clothing can also help absorb excess sweat and moisture.

2. Keep Cool

Use fans or air conditioning to keep your environment cool. Keep a portable fan or hand-held fan with you to use when needed.

3. Manage Stress

Hot flashes happen more often when you're stressed, so incorporating stress management techniques into your daily routine can be helpful. Try relaxation exercises, deep breathing, meditation, or activities like yoga or tai chi.

Practicing relaxation techniques like deep breathing exercises, guided imagery, or progressive muscle relaxation may help reduce the frequency and severity of hot flashes.

4. Stay Hydrated

Drink plenty of cool fluids to stay hydrated. Cold water or herbal iced teas can be refreshing during hot flashes.

5. Consider Your Diet

Some women find hot flashes occur more when they consume certain food or beverages. Common triggers include spicy foods, caffeine, alcohol, and hot beverages. Keep a diary to track your symptoms and identify any specific triggers.

6. Maintain a Healthy Weight

Some research suggests that being overweight or obese may increase the frequency and intensity of hot flashes. Maintaining a healthy weight through regular exercise and a balanced diet may help reduce hot flashes.

7. Quit Smoking

Smoking has been associated with increased hot flashes. Quitting smoking can have multiple health benefits, including a potential reduction in hot flashes.

8. Consider Herbal Remedies

Some herbal supplements, such as black cohosh, evening primrose oil, and red clover, have been suggested to alleviate menopausal symptoms, including hot flashes. However, it's important to consult with a healthcare professional before trying any herbal remedies, as they may interact with other medications or have potential side effects.

9. Discuss Medical interventions With Your Doctor

In cases where hot flashes are significantly impacting the quality of life, hormone therapy (HT) may be an option for treating hot flashes. HT involves taking estrogen alone or a combination of estrogen and progesterone to help balance hormone levels. 

However, hormone therapy is not suitable for everyone, and the decision should be made in consultation with a healthcare provider, considering individual health history and risk factors.

Remember that every individual is unique, and what works for one person may not work for another. It's important to discuss options with your doctor and experiment with different strategies to find what works best for you.

Did You Know: Cold Flashes Are Also a Thing!

They may be less common than hot flashes, but at the other end of the spectrum, some women report experiencing cold flashes. 

Cold flashes often happen at night and might be underreported because sometimes we just think a room is chilly or there’s a draught. We’ll tend to reach for an extra blanket or a robe. Or we may think the temperature outdoors has dropped suddenly around sunset and attribute our sense of cold to that and simply raise the thermostat a bit.

They may be perceived as less disruptive than hot flashes (though of course, it can be hard to sleep if you’re shivering and can’t seem to get warm, so they’re not exactly a breeze either.) Tips for managing cold flashes include:

• Add layers: Reach for an extra blanket, and pull on a pair of socks. If you find you’re susceptible to cold flashes, carry an extra layer (sweater, jacket) even on warm nights.
• Get moving: You may also find that movement helps to increase blood flow. So go for a walk or do some gentle stretching. 
• Change damp clothing or nightwear: If your cold flashes tend to follow night sweats or hot flashes, make sure you’re not sitting or lying around in damp clothing. Have a change of clothes or nightwear handy to prevent this.
• A warm shower or bath: Whenever I have that deep-in-my-bones chill, a hot shower usually works wonders (beware of intense heat that might scald this skin.) It may seem counter-intuitive (and a little masochistic), but I also find a final blast of cold water helps my temperature regulate. 
• Snuggle your hot water bottle: A hot water bottle against your feet may also help chase away those chills. 

Do Hot Flashes Stop After Menopause?

Hot flashes typically diminish and eventually stop after menopause. Menopause is defined as the absence of menstrual periods for 12 consecutive months. As women go through menopause, the hormonal fluctuations that trigger hot flashes become less frequent and eventually stabilize.

However, it's important to note that the duration and intensity of hot flashes can vary among individuals. For some women, hot flashes may continue for a few years after menopause, while others may experience them for a shorter or longer duration. Factors such as genetics, overall health, and lifestyle can also influence the duration and severity of hot flashes.

If severe hot flashes persist or significantly impact your daily life and you find yourself unable to treat hot flashes, we recommend consulting your healthcare professional. They can assess your specific situation, provide guidance, and discuss potential treatment options or lifestyle modifications to manage the symptoms effectively.

We hope you found this post informative — but remember: we’re not doctors and this post is not medical advice! While all posts are fact-checked and well researched, we always recommend you chat with your doctor about any questions or concerns you might have regarding a medical condition. We’re here to support and educate, but never with the aim of disregarding professional medical advice you’ve been given. Phew, now that that’s out of the way, you can go on living unapologetically free.

Menopause is the end of that transition—when you’ve gone 12 months without a period and are no longer ovulating or capable of reproducing. Therefore, strictly speaking, it’s not possible to become pregnant when you’re menopausal.

However, during perimenopause, you are still ovulating and you can become pregnant. And because ovulation starts to become more erratic (often resulting in missed periods or an irregular cycle), it is possible to confuse perimenopause and pregnancy—and it is possible to become pregnant when you are in perimenopause.

Menopause Versus Perimenopause: Can You Get Pregnant During These Stages?

The terms ‘perimenopause’ and ‘menopause’ have distinct medical meanings. Perimenopause means ‘around menopause’ and describes the years leading up to menopause. This is a time of transition. Fluctuating hormone levels lead to a wide array of symptoms, which can impact women with varying degrees of severity.

As previously mentioned, menopause is the end of that transition stage. By menopause, you are no longer ovulating and have gone a full 12 months without a period. While the symptoms of perimenopause can continue for some women even when they’re in menopause, generally things begin to level out, and those erratic hormonal fluctuations (and their associated symptoms) ease.

All this said, sometimes in everyday conversation, menopause and perimenopause are lumped together and both stages are labeled simply “menopause.” This can lead to some confusion about these stages and what’s possible. To make it clear:

• Perimenopause: The stage in a woman's life leading up to menopause when the menstrual cycle gradually winds down. While ovulation is still happening (and therefore pregnancy is still possible), women are generally less fertile during perimenopause and cycles are more erratic. However, missed periods can cause confusion about the possibility of pregnancy. If you do not wish to become pregnant, birth control is recommended.
• Menopause: The moment when you’ve gone 12 full months without a period and are therefore considered to be no longer fertile or ovulating. Pregnancy is no longer possible and birth control is not required (though contraceptives are still recommended for the prevention of STIs).

Symptoms of Perimenopause vs Pregnancy Symptoms

There are many common symptoms between perimenopause and pregnancy. 

Changes in your cycle can indicate various events, including pregnancy, perimenopause or others health issues. Therefore, it's always worth investigating if you miss a period.

In your 40s, missed periods may be due to perimenopause. So how do you distinguish between pregnancy, perimenopause, or other conditions? 

The Easy Answer: Take a Pregnancy Test

Apart from seeing your doctor (which you should do), you can buy an at-home pregnancy test from any pharmacist. If you’re on the fence about whether you’re pregnant or if there’s something else going on (e.g. perimenopause), a pregnancy test will help clear things up.

The Better Answer: See Your Doctor

If you suspect you could be pregnant, it’s always worth a trip to the doctor. A doctor can confirm your pregnancy through a blood test or urine test. If you are pregnant, they will also provide you with important information about prenatal care, nutrition, and overall health during pregnancy. 

Additionally, a doctor can check for any underlying health conditions that may affect your pregnancy and provide guidance on how to manage them. It's important to seek medical care early in pregnancy to ensure the best possible outcome for both you and your baby.

Symptoms Common to Both Pregnancy and Perimenopause Include Weight Gain , Mood Swings and Missed Periods

There’s a huge overlap between pregnancy symptoms and perimenopause or menopause symptoms. Symptoms that are common to both include:

• Missed (or late) menstrual periods
• Bloating
• Changes to libido
• Fatigue and poor sleep
• Headaches
• Hot flashes and night sweats
• Incontinence
• Mood changes
• Weight gain

Unique Pregnancy Symptoms

While the two are easily confused because they share such a long list of similar symptoms, there are also some symptoms that are considered unique to pregnancy (i.e. not common with perimenopause.) These pregnancy symptoms include:

Food and Taste Sensitivity

When you’re pregnant your taste buds can change. Foods that were previously your favorites might become repugnant to you. You might also find yourself craving unusual foods or unusual combinations of foods.

Increased Urination

It is considered normal to pee more frequently during a healthy pregnancy. This is due to the hormonal changes in the body in early pregnancy (later, it can be caused by the pressure of your uterus upon your bladder.) When pregnant, your body also produces more fluid than at other times, which can also lead to frequent urination.

Nausea

So-called “morning sickness” can actually happen at any time of the day within 1 month of getting pregnant. It may or may not be accompanied by vomiting.

Swollen and Sensitive Breasts

Early in your pregnancy, hormonal changes can make your breasts more tender. They may even appear swollen. Breast tenderness usually subsides after a few weeks.

The Most Common Symptoms of Perimenopause

Fluctuating hormones can cause both physical and emotional reactions (mood symptoms.) There’s quite a range of symptoms perimenopausal women experience, and their severity and duration can vary wildly from person to person. Many women experience these more common menopause symptoms.

Missed or Irregular Periods

During perimenopause, you may notice changes to your menstrual cycles. Some of these changes can be extreme opposites of each other, from lighter periods to heavier periods. This is caused by the extreme fluctuation of your hormone levels. 

Hot Flashes / Night Sweats

Hot flashes (aka hot flushes) are characterized by a sudden feeling of warmth or heat that spreads throughout the body, often accompanied by sweating, rapid heartbeat, and flushing of the skin.

Night sweats are episodes of excessive sweating during the night that can drench the bedding and clothing, leading to discomfort and interrupted sleep.

… And So Many Other Symptoms

There’s still a long list of other menopausal symptoms is quite long. The good news is not all perimenopausal women experience these symptoms. And they may be less intense for some. The list includes:

• Nausea: Fluctuating estrogen levels can result in feelings of nausea.
• Weight gain: Sudden changes in weight or digestion can also point to perimenopause.
• Vaginal dryness: Vaginal or endometrial atrophy occurs in some women after menopause. The body produces less estrogen after menopause, which can lead to the thinning, drying, and inflammation of the vaginal walls. 
• Changes in sexual desire or satisfaction: Some women report changes in sexual desire and arousal due to fluctuating hormones.
• Insomnia and sleep troubles: Apart from night sweats, general sleep can become unpredictable during perimenopause and beyond.
• Mood swings & anxiety: Any fluctuation in hormones can have a knock-on effect on your mood. Many report feeling more anxious or having sudden flashes of rage.
• Bone loss: With declining estrogen levels, your bone density may decrease as you start to lose bone more quickly than you replace it. For some, this can lead to an increased risk of osteoporosis — a disease that causes fragile bones in women.
• Bladder problems: Low estrogen levels may also make you more vulnerable to urinary or vaginal infections. Loss of tissue strength may contribute to urinary incontinence.
• Memory problems or difficulty concentrating: Memory problems or difficulty concentrating are common symptoms caused by hormonal changes. Other factors like stress, sleep disturbances, and mental health conditions can contribute to these symptoms. 
• Joint and muscle pain: Estrogen plays an important role in maintaining joint and bone health. As estrogen levels decline during perimenopause, women may experience a loss of bone density and joint cartilage, leading to joint and muscle pain
• Headaches or migraines: The exact cause of headaches during menopause is not fully understood, but hormonal changes are believed to play a role. Other factors, such as stress, lack of sleep, and certain foods or drinks, can also trigger headaches during menopause.
• Changes in skin and hair, such as dryness or thinning: As estrogen levels decline during menopause, collagen production decreases, and hair follicles may become less active, leading to thinner, less elastic skin and hair.

If you're experiencing symptoms that are interfering with your daily life, talk to your healthcare provider about your options for managing them. Most of these symptoms will subside in postmenopausal women.

The symptoms of perimenopause are numerous. But they can also be easily confused with other things going on in our bodies. This means it can be difficult to say decisively if one is experiencing perimenopause or something else. And the situation can be even more confusing if you’re typically prone to an irregular menstrual cycle. It might be hard to spot the differences.

To help you navigate these uncertainties, we’ve devised a little quiz. Check it out here…

We hope you found this post informative — but remember: we’re not doctors and this post is not medical advice! While all posts are fact-checked and well researched, we always recommend you chat with your doctor about any questions or concerns you might have regarding a medical condition. We’re here to support and educate, but never with the aim of disregarding professional medical advice you’ve been given. Phew, now that that’s out of the way, you can go on living unapologetically free.

Often in everyday conversation, ‘menopause’ is used as an umbrella term to describe both perimenopause and menopause. And while ‘true menopause’ is pretty easy to identify (12 months without a period), the symptoms that accompany perimenopause can be broad and vary in severity from woman to woman. This can mean it’s difficult to know whether you’re in perimenopause or if there’s something else going on.

Considering Common Menopausal/Perimenopausal Symptoms

To help, we’ve devised this quiz which will cover many of the common menopausal symptoms. It’s pretty simple: If you answer with more ‘sometimes’ or ‘oftens’ than ‘nevers’, there’s a good chance you’re in perimenopause. Don’t expect to check the box on every symptom. Like PMS or pregnancy, some women experience a lot of symptoms and some women experience little or none. 

Always consider what else might be going on in your life too. Some of these symptoms may be caused by stress or being generally run down. And think about your own ‘normal’ baseline—you may experience some of these things regularly. In that case, think about whether you’re noticing more incidents of late.

Finally: This is a menopause quiz you found on the internet. As such, this is not the same as a medical consultation with a healthcare provider. If you have uncertainty or concerns about changes in your body, we do recommend a doctor’s visit. However, the answers you provide in this quiz might be helpful in preparation for that conversation.

1. How Old Are You?

According to Mount Sinai, perimenopause has two stages:

1. Early perimenopause: This can begin in your 30s but most often starts between the ages of 40 and 44.
2. Late perimenopause: Usually occurs in your late 40s or early 50s

Of course, these are average ages. Your body is unique and may defy these averages, but if you’re in or around these ages and experiencing other symptoms, you may be experiencing perimenopause.

2. Changes to Your Period

Compared to your ‘normal’ experience of menstruation, are you experiencing any of the following:

• Irregular periods (closer together, further apart, or completely missed)
• Never
• Sometimes
• Often
• Heavier-than-usual periods (including bleeding through clothes/sleepwear)
• Never
• Sometimes
• Often
• Worsening or constant PMS
• Never
• Sometimes
• Often

If you’ve answered ‘sometimes’ or ‘often’ to these questions, you may be experiencing perimenopause. But there can be other explanations too. For further confirmation, keep going!

3. Other Perimenopause Symptoms

While your age and changes to your period are the main indicators of perimenopause, many women experience a host of other common symptoms, including hot flashes. Compared to your normal experience, are you experiencing any of the following?

• Hot flashes/hot flushes
• Never
• Sometimes
• Often
• Night sweats
• Never
• Sometimes
• Often
• Breast tenderness
• Never
• Sometimes
• Often
• Racing heartbeat
• Never
• Sometimes
• Often
• Joint pain, stiffness, or muscle tension
• Never
• Sometimes
• Often
• Headaches, vertigo, or dizzy spells?
• Never
• Sometimes
• Often

Again, if you answered ‘sometimes’ or ‘often’ to some or all of these questions, you may be experiencing perimenopause. Keep going for more indicators that you might be experiencing perimenopause.

4. How’s Your Sleep?

While many of us struggle to get a good night’s sleep (work, kids, stress, amirite?) if you notice changes to your sleep, you may have an explanation in perimenopause:

• Fatigue: Do you feel tired more often than normal?
• Never
• Sometimes
• Often
• Insomnia: Are you having a hard time falling asleep or waking up more often during the night?
• Never
• Sometimes
• Often
• Poor sleep: Do you just never feel properly rested?
• Never
• Sometimes
• Often

It’s important to note that sleep alone may not point to perimenopause, but if you’re checking more ‘sometimes’ or ‘oftens’ than ‘nevers’ as you go through this quiz, perimenopause might be your answer.

5. Stress, Emotions & Memory

Most women know all too well the effect hormonal changes can have on our moods. Some of us already experience quite the shift in moods throughout our monthly cycle. Again, you’re looking for changes that deviate from your norm. Maybe the symptoms are worse, or maybe they’re more frequent. 

Have you noticed an unexplained increase in:

• Mood swings (depression, sudden fits of rage)
• Never
• Sometimes
• Often
• Anxiety (do you feel anxious?)
• Never
• Sometimes
• Often
• Brain fog / feeling fuzzy or confused
• Never
• Sometimes
• Often
• Increased forgetfulness or changes to your memory 
• Never
• Sometimes
• Often

6. Weight & Digestion

Sudden changes in weight or digestion can also point to perimenopause. Remember if you have a clear alternative explanation for these things, they may not be connected to perimenopause. For example, if you’re busy at work so you’ve stopped exercising as much and find yourself skipping meals and then carb-loading (hello, it’s me!), some weight gain is pretty understandable.

However, if your diet, nutrition, and exercise levels are fairly stable and you find yourself experiencing the following (along with checking some boxes in other categories), your answers are certainly pointing to perimenopause:

• Unexplained weight gain or difficulty losing weight
• Never
• Sometimes
• Often
• Water retention or bloating
• Never
• Sometimes
• Often
• Other digestive issues (gas, diarrhea, constipation, nausea, or heartburn)
• Never
• Sometimes
• Often

7. Sex Life

“The change” can also bring changes to your sex life and libido. Have you newly experienced the following:

• Vaginal dryness or pain during sex
• Never
• Sometimes
• Often
• A change in your sex drive/libido (lower desire for sex)
• Never
• Sometimes
• Often

8. Skin & Hair

One last area to reflect on is your skin and hair. Again, we all have our own issues with our skin and hair. But, generally, we know the range of what’s ‘normal’ for us. Reflecting on what you usually experience, are you noticing:

• Dry or itchy skin
• Never
• Sometimes
• Often
• Thinning hair
• Never
• Sometimes
• Often

What Is Perimenopause?

Perimenopause means “around menopause.”

The time before menopause is known as perimenopause. During perimenopause, your menstrual cycles and periods gradually come to an end as a result of fluctuating hormones.  This stage can last anywhere between 1 and 10 years. The average length of perimenopause is four years and, during that time, your period can become irregular and there can be irregular bleeding between periods.

According to the Mayo Clinic, “You may notice signs of progression toward menopause, such as menstrual irregularity, sometime in your 40s. But some women notice changes as early as their mid-30s.” Other common symptoms include hot flashes and night sweats. If these symptoms interfere with your day-to-day activities, talk to your doctor about options for menopause relief.

What Is Menopause?

Although the words perimenopause and menopause are often used interchangeably, menopause is more of a “destination point’ than a journey: Once you’ve gone 12 consecutive months since your last period, you’re considered in menopause.

Typically, perimenopause symptoms start to diminish after a woman has been in menopause for a year or more. However, every woman's experience of perimenopause and menopause is unique, and some women may continue to experience symptoms after menopause.

In women who have had their uterus removed (but their ovaries left intact), it may be difficult to identify menopause since they would not have had periods after a hysterectomy (removal of the uterus.)  You can also have your hormone levels tested, specifically follicle-stimulating hormone (FSH) and estradiol levels, which can help determine if you are in menopause.

If you had a hysterectomy with your ovaries removed, you would have gone through what is referred to as ‘surgical menopause’ which is a more abrupt end to the reproductive years than going through perimenopause. As such the symptoms that accompany surgical menopause can be more severe than those going through natural perimenopause and menopause.

We hope you found this post informative — but remember: we’re not doctors and this post is not medical advice! While all posts are fact-checked and well researched, we always recommend you chat with your doctor about any questions or concerns you might have regarding a medical condition. We’re here to support and educate, but never with the aim of disregarding professional medical advice you’ve been given. Phew, now that that’s out of the way, you can go on living unapologetically free.

Menopause can also impact your skin and hair. This is all down to hormonal changes. It may seem contradictory but you may see less of some hair (underarms, for example) but also have to cope with a sudden crop of coarse, dark hard on your chin and upper lip.

What the hell is happening? Let’s get into to:

Menopause Facial Hair Growth: It’s All in the Hormones

During perimenopause (the years in the lead-up to menopause, when the bulk of symptoms occurs) and menopause (medically defined as when you have gone 12 months without a period), your estrogen levels fluctuate and decline. This results in the gradual cessation of ovulation and periods. Perimenopause can last many years, so the changes (and symptoms) may seem more in flux, gradually unfurling new experiences.

Dropping estrogen levels can impact many parts of our bodies beyond our menstrual cycle. Symptoms of perimenopause can range from inner ear issues to stress and anxiety. 

But it’s not just estrogen that changes: As estrogen levels drop, the overall balance of your hormones changes. Levels of testosterone, which is typically thought of as the “male” hormone and is present in women’s bodies too, do not change. So as estrogen drops, testosterone levels stay the same. And this means your overall hormonal balance changes.

What Do Hormone Levels Have to Do With Excess Hair Growth?

Remember puberty? It was the surge in hormones that kicked your body into development. As estrogen levels rose, you developed breasts and began menses (monthly periods.) You may have become moodier. You also started to grow armpit hair and pubic hair. 

As those estrogen levels decline, you may notice that hair growth in those areas slows down. This can be a small mercy for those of us who shave or wax those areas. 

However, with the decline of estrogen, testosterone plays a more dominant role. The hair associated with testosterone is coarser and darker. As estrogen declines, you might notice growth slow on the softer, finer hair (aka vellus hair) associated with estrogen and puberty. But you may also notice the arrival of ‘testosterone-fuelled” coarse hair (aka terminal hair.) 

These coarser hairs will typically appear on the chin and upper lip. You may also notice one rogue eyebrow hair that seems thicker and wirier than the others. The good news is you’re not alone. The bad news is that the appearance of these hairs can feel like a devastating blow to your femininity and attractiveness at a time when your body and emotions are already in great turmoil. Hang in there!

What to Do About Unwanted Facial Hair Growth

There’s nothing wrong with growing facial hair - it’s all just part of the human experience! You should not feel medical concerns about facial hair growth—it is a natural part of the process.

That said, if it bothers you can do something about it. There are lots of old wife’s tales about hair removal—that it will grow back thicker, or that more hair will grow. These are not true. If you’ve got one (or two, or three) of those coarse and wiry hairs, you can deal with them.

You probably already have a preferred hair removal process for other body parts (eyebrows, underarms, legs, etc.) You can use that method for those rogue chin and upper lip hairs. Note: Hair removal methods that are not permanent may result in ingrown hairs on regrowth.

Popular methods of dealing with menopausal facial hair include:

Plucking or Tweezing Unwanted Facial Hair

Since these hairs tend to be more isolated (as opposed to dense growth), a more pinpointed approach works well. Tweezing or plucking the hair will pull it out by the root, so will mean there’s no ‘stubble’ and it will take longer to grow back.

While plucking can cause some pain and inflammation, you may be familiar with this method and the feeling if you already pluck your eyebrows. Generally grab the hair firmly, closer to the root, and give one firm tug in the direction of growth and the hair should release. If you have very sensitive skin, a cold flannel or an ice roller will help soothe the skin afterward.

Waxing or Threading for Unwanted Facial Hair Growth

If waxing or threading is your preferred method of hair removal, you can try it on those rogue, wiry hairs. Whether you do it at home or go to a salon, everybody knows that waxing can be pretty painful, especially on more sensitive body parts. But if you’re already a pro at getting waxed, you’ll be used to that feeling.

It’s worth noting that waxing and threading generally target larger areas than plucking, so consider if you have one stray hair and whether this might be the best approach. Also, waxing and threading are both temporary methods of hair removal, so you will have to repeat the process, depending on regrowth.

Electrolysis for Unwanted Hair Growth

Electrolysis is a targeted hair removal technique for unwanted hair growth (like tweezing) but unlike tweezing or plucking it is a permanent method for removing unwanted facial hair (and hair in other body areas.)

Electrolysis involves the insertion of a probe into the hair follicles to deliver electric currents that destroy the hair root. This makes it unsuitable for large areas of growth, but perfect for targeting individual rogue hairs. Electrolysis may be more expensive and will require a visit to a salon or dermatologist, but you will have no regrowth of the same hair after electrolysis.

Electrolysis is generally not considered too painful. You may experience a slight tingling and more sensitive skin types may experience redness or mild swelling after the treatment.

Laser Hair Removal (May Only Work on Dark Hair)

Laser removal is another permanent method of hair removal for those extra chin hairs, though it may take several sessions to have full effect. Laser hair removal is the process of hair removal through exposure to pulses of laser light that destroy the hair follicle. Because it works with light, it is only effective on dark hairs (not blonde or gray hair.)

Laser facial hair removal is generally not considered very painful. There may be a slight “zapping” feel and you may experience a feeling of heat too. Some liken it to a gentle snap of a rubber band against the skin. Laser hair removal is suitable for large and small body parts, but it should not be used around the eyes. It is usually administered by a professional salon, but there are an increasing number of at-home (IPL or intense pulsed light) devices on the market too.

Other Ways Menopause May Impact Hair and Skin (Beyond Facial Hair)

Excessive hair growth is just one of the ways perimenopause and menopause can impact your hair and skin. In addition to an increase in facial hair growth, you may also experience:

Dryness and Itchiness

The skin may become drier as a result of hormone fluctuations and you may have to step up your body and facial moisturizing game. Generally, the skincare regime that worked for you before perimenopause may not be what your skin needs now. 

Talking with your aesthetician, dermatologist, or skincare specialist about the types of products that might support your changing skin is a good idea. They may recommend serums and creams as opposed to lighter lotions. They might also point you to gentler cleansers so you’re not stripping the skin as much. 

Sagging Skin

When estrogen levels drop, your body produces less collagen. Collagen is what gives your skin that plumpness and tightness. You might notice your skin starts to sag or become more hollowed. It is common to notice sagging skin on the neck or hollowness around the eyes/cheeks. Facial massage may stimulate the skin and help restore plumpness.

Age Spots / Dark Spots 

If you have a history of sunburn or sun damage, you may notice age spots begin to appear around perimenopause. These are not usually a cause for concern medically, though some people dislike their appearance. Several topical products promise to address dark spots. 

There are also treatments (Including micro-needling, laser treatments, and peels) that will promise to address these. They will all have varying levels of efficacy. It is important to continue to wear sun protection daily and some of these treatments that target dark spots can also make you more susceptible to future dark spots, so definitely commit to that daily sunscreen routine.

Post-Menopause Acne Breakouts

You might think that acne is now a thing of the past. Unfortunately for some, that is not the case. Hormonal imbalances can cause outbreaks (similar to the kinds of outbreaks you may have experienced around your period.) The same rules apply as with any outbreak: Avoid picking or popping acne and try gentle salicylic acids to break down the acne. (Remember that menopausal skin can also suffer from dryness, so avoid very harsh cleaners.) A dermatologist or skincare professional will be able to recommend further products or treatments to try.

Thinning Scalp Hair

During and after menopause, women’s hair may become finer because the hair follicles shrink. Hair grows more slowly and falls out more easily in these cases. You may notice more hair coming out when you brush or style your hair, or when you wash it. Or you may notice bald patches appear on the scalp. Again, the cause is hormonal: Estrogen and progesterone levels fall during perimenopause, and this allows the effects of the androgens (male hormones) to be felt more keenly. If you experience hair loss, chat with your doctor. They may recommend supplements, medications, or treatments to minimize the effect.

As you go through the changes of perimenopause and menopause, you may have to let go of long-held standards of beauty and create a kinder, more accepting space for yourself. But you can also take steps to care for your skin, hair, and body in this new phase. Be open to trying new products and supplements (with medical supervision/approval) that may help you manage and minimize some of the signs of perimenopause and menopause in your skin. 

At the same time, try to be kind to yourself and appreciate that your body has got you this far. Find new role models, style, and beauty inspiration on social and surround yourself with images and individuals who inspire you—aging can be beautiful and inspiring too!

We hope you found this post informative — but remember: we’re not doctors and this post is not medical advice! While all posts are fact-checked and well researched, we always recommend you chat with your doctor about any questions or concerns you might have regarding a medical condition. We’re here to support and educate, but never with the aim of disregarding professional medical advice you’ve been given. Phew, now that that’s out of the way, you can go on living unapologetically free.

One of the changes you might notice is changes to your vaginal discharge. You may see a decrease in vaginal discharge (resulting in dryness) or changes in the color or consistency of discharge. Many of these changes are not cause for concern. Some are worth a trip to your doctor.

In this article, we’ll dig into what perimenopause is, why it impacts vaginal discharge, and the different kinds of discharge you may experience during perimenopause—including watery vaginal discharge.

What Is Perimenopause?

Perimenopause refers to the transitional phase leading up to menopause, during which a woman's body winds down its reproductive stage. Perimenopause typically happens to women in their 40s but can begin as early as the mid-30s or as late as the 50s.

During perimenopause, the ovaries produce less estrogen, which can cause changes in the menstrual cycle, such as irregular periods. Some women also experience other symptoms such as hot flashes, night sweats, mood changes, vaginal dryness, decreased libido, and difficulty sleeping.

Perimenopause At a Hormonal Level

During perimenopause, the ovaries produce less estrogen, driving a lot of the symptoms women experience during perimenopause. But estrogen is not the only hormone fluctuating: The levels of other hormones, such as progesterone and follicle-stimulating hormone (FSH), also play a role in the perimenopausal experience.

As estrogen levels decline during perimenopause, the menstrual cycle may become irregular, and periods may become heavier or lighter. Fluctuating levels of estrogen can also cause other symptoms, such as hot flashes, night sweats, and vaginal dryness.

Other hormones in play include:

• Progesterone also starts to decline during perimenopause. This can contribute to mood changes, anxiety, and sleep disturbances.
• As estrogen levels decline, the pituitary gland produces more follicle-stimulating hormone (FSH). This increase in FSH may cause symptoms such as hot flashes and night sweats.

What Is Healthy Vaginal Discharge?

Vaginal discharge is fluid that is produced by glands inside a woman’s vagina and cervix. Discharge is considered normal and healthy. It helps keep the vagina clean and healthy, maintaining a healthy pH balance.

The quantity and consistency of vaginal discharge a woman experiences can vary over her life and even within her monthly menstrual cycle. Changes can depend on factors such as age, hormonal changes, the stage of their menstrual cycle, sexual activity, and pregnancy. Discharge can also be impacted by infections and therefore can be a symptom of an STI or yeast infection.

While there can be a range in ‘healthy’ discharge, vaginal discharge is usually clear or white and may have a slightly slippery or sticky texture. It may also have a mild odor that is not unpleasant.

How Perimenopause May Change Your Vaginal Discharge

Vaginal Atrophy

Vaginal atrophy (aka atrophic vaginitis) is a condition where the tissues of the vaginal walls become thinner, drier, and less elastic. It may happen to women during perimenopause or after surgical removal of the ovaries. 

Symptoms of vaginal atrophy include vaginal dryness, itching, or burning. Some women may also experience an increased frequency or urgency to pee urinary tract infections (UTIs), or discomfort or pain when peeing.

Watery Vaginal Discharge

During perimenopause, women may experience changes in their vaginal discharge due to hormonal fluctuations. Some women may notice that their vaginal discharge becomes watery, thinner, or more transparent. Watery discharge is due to changes in the vagina’s acidity or pH level following a decline in estrogen levels.

As a result of the vaginal walls becoming less acidic, harmful bacteria can grow more easily. This may lead to infections and other health problems. Therefore, it’s important to monitor your vaginal discharge and pay particular attention if the discharge is foul-smelling or accompanied by itching or irritation.

Less Vaginal Discharge / Vaginal Dryness

During perimenopause, many women experience vaginal dryness or decreased vaginal lubrication, which is caused by a decline in estrogen levels. Estrogen is the hormone responsible for maintaining the health and elasticity of vaginal tissues, as well as regulating the production of natural lubrication.

As estrogen levels decline during perimenopause, the tissues in the vaginal area may become thinner, less elastic, and less lubricated. This can lead to discomfort, irritation, and pain during sexual intercourse, as well as an increased risk of vaginal infections.

To manage vaginal dryness during perimenopause, you can use over-the-counter lubricants to alleviate discomfort and improve sexual function. 

Discharge or Light Bladder Leaks?

Some women experience light bladder leaks during perimenopause due to weakened pelvic floor muscles. If you are not aware of urine leakage, you may confuse moistness from urine leaking with discharge. The giveaway will usually be the ammonia-like smell of urine (discharge should not have a strong or bad smell.)

Leakproof Underwear Can Help!

If you’re experiencing watery discharge or light bladder leaks, you might try leakproof underwear. You may think leakproof underwear is just for periods—not the case! Indeed, they can absorb blood, sweat, or urine. This can make them a perimenopausal woman’s best friend! Whether you’re experiencing hot flashes, light bladder leaks, irregular periods, or watery vaginal discharge, leakproof underwear will keep you clean and fresh! Shop the Knix collection here!

Vaginal Discharge Concerns: When to See Your Doctor

While healthy vaginal discharge is a normal bodily function, there are times when it can serve as a signal of something not quite right. So always pay attention to changes in your vaginal discharge and talk to your doctor about any changes. 

If you experience any of the following in particular, it’s worth a conversation with your healthcare provider:

• Vaginal discharge accompanied by other symptoms such as itching, burning, or pain
• Unusual bleeding or spotting between periods, or after sex
• Pain or discomfort during sex
• Inflammation of the vulva
• Yellow or green discharge can be a sign of an STI
• Thick, white, or cottage cheese-like discharge may indicate yeast infections
• Pelvic pain or discomfort, especially if it is severe or accompanied by fever or nausea
• Signs of a possible sexually transmitted infection (STI), like sores or blisters around the genital area

It is important to note that vaginal discharge is a normal bodily function, but any changes or unusual symptoms should be addressed promptly to rule out any underlying health issues or infections. Your doctor can perform a physical exam, collect a sample of your discharge for laboratory testing, and recommend appropriate treatment based on the cause of your symptoms.

Other Symptoms of Perimenopause

Fluctuating hormones can cause both physical and emotional reactions (mood symptoms.) There’s quite a range of menopausal symptoms here, and their severity and duration can vary wildly from person to person. Here are some of the more common menopause symptoms.

Missed or Irregular Periods

During perimenopause, you may notice changes to your menstrual cycles. Some of these changes can be extreme opposites of each other, from lighter periods to heavier periods. This is caused by the extreme fluctuation of your hormone levels. 

Hot Flashes / Night Sweats

Hot flashes (aka hot flushes) are characterized by a sudden feeling of warmth or heat that spreads throughout the body, often accompanied by sweating, rapid heartbeat, and flushing of the skin.

Night sweats are episodes of excessive sweating during the night that can drench the bedding and clothing, leading to discomfort and interrupted sleep.

… And So Many Other Symptoms

There’s still a long list of other menopausal symptoms is quite long. The good news is not all perimenopausal women experience these symptoms. And they may be less intense for some. The list includes:

• Nausea: Fluctuating estrogen levels can result in feelings of nausea.
• Weight gain: Sudden changes in weight or digestion can also point to perimenopause. If your diet, nutrition, and exercise levels are fairly stable and you find yourself experiencing weight gain, that may be a symptom of perimenopause.
• Vaginal dryness: Vaginal or endometrial atrophy occurs in some women after menopause. The body produces less estrogen after menopause, which can lead to the thinning, drying, and inflammation of the vaginal walls. During perimenopause this process can begin, resulting in dryness.
• Changes in sexual desire or satisfaction: Some women report changes in sexual desire and arousal due to fluctuating hormones.
• Insomnia and sleep troubles: Apart from night sweats, general sleep can become unpredictable during perimenopause and beyond. It can also be hard to fall asleep, with some experiencing insomnia.
• Mood swings & anxiety: Any fluctuation in hormones can have a knock-on effect on your mood. Many report feeling more anxious or having sudden flashes of rage.
• Bone loss: With declining estrogen levels, your bone density may decrease as you start to lose bone more quickly than you replace it. For some, this can lead to an increased risk of osteoporosis — a disease that causes fragile bones in women.
• Bladder problems: Low estrogen levels may also make you more vulnerable to urinary or vaginal infections. Loss of tissue strength may contribute to urinary incontinence.
• Memory problems or difficulty concentrating: Memory problems or difficulty concentrating are common symptoms caused by hormonal changes. Other factors like stress, sleep disturbances, and mental health conditions can contribute to these symptoms. 
• Joint and muscle pain: Estrogen plays an important role in maintaining joint and bone health. As estrogen levels decline during perimenopause, women may experience a loss of bone density and joint cartilage, leading to joint and muscle pain
• Headaches or migraines: The exact cause of headaches during menopause is not fully understood, but hormonal changes are believed to play a role. As levels of estrogen and progesterone fluctuate during menopause, some women may experience changes in blood vessels that can lead to headaches. Other factors, such as stress, lack of sleep, and certain foods or drinks, can also trigger headaches during menopause.
• Changes in skin and hair, such as dryness or thinning: Estrogen plays a key role in maintaining skin and hair health. It promotes collagen production, which helps keep skin elastic and firm, and also helps maintain healthy hair follicles. As estrogen levels decline during menopause, collagen production decreases, and hair follicles may become less active, leading to thinner, less elastic skin and hair.

If you're experiencing symptoms that are interfering with your daily life, talk to your healthcare provider about your options for managing them. Most of these symptoms will subside in postmenopausal women.

Take Our Perimenopause Quiz

The symptoms of perimenopause are numerous. But they can also be easily confused with other things going on in our bodies. Perimenopausal women may also wonder:

• Am I just stressed (work, world events, family life, etc.)
• Am I just run down?
• Maybe I’m coming down with the flu/cold/COVID?
• Maybe my body is just a little out of whack?
• Have I let my healthy habits slide a bit?
• Perhaps I’m just PMS-ing!
• Am I pregnant?

This means it can be difficult to say decisively if one is experiencing perimenopause or something else. And the situation can be even more confusing if you’re typically prone to an irregular menstrual cycle. It might be hard to spot the differences.

To help you navigate these uncertainties, we’ve devised a little quiz. Check it out here…

We hope you found this post informative — but remember: we’re not doctors and this post is not medical advice! While all posts are fact-checked and well researched, we always recommend you chat with your doctor about any questions or concerns you might have regarding a medical condition. We’re here to support and educate, but never with the aim of disregarding professional medical advice you’ve been given. Phew, now that that’s out of the way, you can go on living unapologetically free.

A cold flash is exactly what it sounds like - that to-the-bones kind of chill that sweaters, blankets, or cranked heat can’t seem to chase away. They can happen on the heels of a hot flash or in isolation. And they can last mere moments to about 20 minutes.

Why We Don’t Hear As Much About Cold Flashes

Cold flashes may be more common than you think. 

They often happen at night and might be underreported because sometimes we just think a room is chilly or there’s a draught. We’ll tend to reach for an extra blanket or a robe. Or we may think the temperature outdoors has dropped suddenly around sunset and attribute our sense of cold to that and simply raise the thermostat a bit.

We may even attribute it to hunger or put the kettle on for a warming cup of tea and simply never connect the dots that it could be a perimenopausal symptom.

Finally, they may be perceived as less disruptive than hot flashes (though of course, it can be hard to sleep if you’re shivering and can’t seem to get warm, so they’re not exactly a breeze either.) 

Overall, though, they probably are less common than hot flashes, even considering the fact they’re likely underreported.

What Are Hot Flashes / Night Sweats?

In contrast to cold flashes, a hot flash (aka hot flushes) is characterized by a sudden feeling of warmth or intense heat rising throughout the body, often accompanied by sweating, rapid heartbeat, and flushing of the skin.

What can trigger hot flashes? A variety of things, including hormonal changes, stress, alcohol consumption, spicy foods, and caffeine. They can vary in duration and intensity, with some women experiencing only mild hot flashes that last for a few seconds, while others may have more severe hot flashes that last for several minutes or longer.

Night sweats are episodes of excessive sweating during the night that can drench the bedding and clothing, leading to discomfort and interrupted sleep.

Hot Flashes and Cold Flashes: What They Have in Common

So they’re at opposite ends of the heat spectrum but hot flashes and cold flashes in perimenopausal and menopausal women share a common cause: It’s all about the hypothalamus.

The hypothalamus is a small but important area of the brain located just above the brain stem. It plays a crucial role in maintaining the body's internal balance, or homeostasis, by regulating various bodily functions including body temperature, hunger, thirst, sleep, and more... 

But here’s the kicker: Guess which hormone plays a crucial role in keeping the hypothalamus in tip-top condition? You got it: Estrogen.

And we all know that during our perimenopausal and menopausal years, there’s a decrease in estrogen levels. (Actually, estrogen also fluctuates over the course of your monthly cycle, which is also why your temperature can rise and fall during your cycle.) So, the decrease in estrogen can lead to body temperature instability.

The menopausal fluctuation of estrogen can cause your temperature regulation to become a bit whacky, resulting in sudden surges of heat and cold; aka hot/cold flashes. 

Cold flashes may also be caused by anxiety or a panic attack, as the body releases adrenaline (and other stress hormones), which can impair your body's ability to regulate its temperature.

So What Can You Do to Manage Cold Flash Symptoms?

As it’s happening, these are the things you can do to manage cold flashes. You probably have the right instincts here: 

• Add layers: Reach for an extra blanket, and pull on a pair of socks. If you find you’re susceptible to cold flashes, carry an extra layer (sweater, jacket) even on warm nights.
• Get moving: You may also find that movement helps to increase blood flow. So go for a walk or do some gentle stretching. 
• Change damp clothing or nightwear: If your cold flashes tend to follow night sweats or hot flashes, make sure you’re not sitting or lying around in damp clothing. Have a change of clothes or nightwear handy to prevent this.
• A warm shower or bath: Whenever I have that deep-in-my-bones chill, a hot shower usually works wonders (beware of intense heat that might scald this skin.) It may seem counter-intuitive (and a little masochistic), but I also find a final blast of cold water helps my temperature regulate. 
• Snuggle your hot water bottle: A hot water bottle against your feet may also help chase away those chills.

While the above tactics can help you regulate body temperature in the moment, there are lifestyle changes you can make that may mitigate the occurrence of cold flashes. 

Meditation

Meditation can help you manage the emotional symptoms of menopause, including feelings of panic  (or panic attack) and anxiety. By practicing mindfulness meditation, menopausal women can learn to observe their thoughts and emotions without judgment or reactivity.

Meditation can help you notice when anxiety starts to build, you can learn to pause and respond in a more intentional and constructive way, rather than simply reacting in the moment. And because a cold flash can be caused by anxiety or panic attacks, learning to regulate those feelings can minimize the occurrence of cold flashes.

Regular meditation can help to reduce stress and promote feelings of calm and relaxation, which can have a positive impact on overall well-being.

Avoid or Minimize Spicy Foods, Alcohol, and Caffeine

The same foods that can cause changes to your body temperature on a regular day, can set off a hot or cold flash. Taking care of how much caffeine, spicy foods, and alcohol you consume (and the time of day you consume those things) can offset your chances of experiencing both hot and cold flashes.

This doesn’t mean you have to cut those things out altogether (though that’s fine too) but cultivating some awareness of your physical reactions may help you make wise choices about what you choose to eat and drink.

When to See Your Doctor About a Cold Flash

If cold flashes (or any other perimenopausal symptoms are disrupting your lifestyle (including your sleep), it can start a chain reaction or vicious cycle of symptoms. E.g. hot and cold flashes can disrupt sleep, lack of sleep can cause anxiety, anxiety can cause hot or cold flashes…

Ideally, you’re seeing your doctor for an annual checkup and having conversations about the stage of life you’re in, what’s considered medically ‘normal’, how to optimize your health, and other medical options for more extreme physical symptoms. If you're experiencing a lot of perimenopause symptoms, definitely bring it up at your next checkup.

Hormone Replacement Therapy to Treat Menopause Symptoms

Hormone replacement therapy (HRT) is a medication to replace the estrogen that your body starts to lose during perimenopause. Hormone therapy can be used to treat severe hot/cold flashes and other menopause symptoms. It can also prevent bone loss and prevent fractures in women after menopause.  

However, hormone therapy has associated risks too, including a risk of heart disease, stroke, and breast cancer. Overall, HRT is neither all good nor all bad. Whether it’s right for you will depend on a number of factors, including your medical history, general health, and the severity of your symptoms. It’s advisable to work with your healthcare provider to determine if hormone replacement therapy is right for you.

Selective Serotonin Reuptake Inhibitors

Selective serotonin reuptake inhibitors (SSRIs) are a class of medications that are commonly used as antidepressants. They work by increasing the levels of the neurotransmitter serotonin in the brain, which can improve mood, reduce anxiety, and alleviate symptoms of depression. 

SSRIs can also be used to alleviate some of the symptoms of menopause, such as hot flashes and mood changes. SSRIs can also improve mood and reduce symptoms of anxiety and irritability that are commonly associated with menopause, which may trigger a cold or hot flash. However, as with any medication, it is important to discuss the risks and benefits with a healthcare provider before starting treatment.

Take Our Perimenopause Quiz

The symptoms of menopause and perimenopause - including cold flashes - are numerous. But they can also be easily confused with other things going on in our bodies. Perimenopausal women may also wonder:

• Am I just stressed (work, world events, family life, etc.)
• Am I just run down?
• Maybe I’m coming down with the flu/cold/COVID?
• Maybe my body is just a little out of whack?

This means it can be difficult to say decisively if one is experiencing perimenopause or something else. To help you navigate these uncertainties, we’ve devised a little quiz. Check it out here…

We hope you found this post informative — but remember: we’re not doctors and this post is not medical advice! While all posts are fact-checked and well researched, we always recommend you chat with your doctor about any questions or concerns you might have regarding a medical condition. We’re here to support and educate, but never with the aim of disregarding professional medical advice you’ve been given. Phew, now that that’s out of the way, you can go on living unapologetically free.

During perimenopause, a woman's hormone levels begin to fluctuate, which can cause irregular menstrual periods and symptoms such as hot flashes, night sweats, mood swings, and difficulty sleeping. Those mood swings can include unexplained fits of rage.

Now, let’s be careful here: Women (of any age or any reproductive phase) are not unhinged emotional creatures. Just because you feel something doesn’t mean you have to let it impact your behavior. And you’re no less capable or qualified of doing things your male peers do just because your body is going through changes.

So let’s avoid the ‘hysterical’ or ‘unhinged’ connotations of perimenopause rage and seek to better understand why you may be susceptible to stronger feelings, and provide some tools for managing them.

What Are Perimenopause and Menopause?

Menopause is a natural part of a woman's life cycle. It usually happens between the ages of 45 and 55 and is marked by the absence of menstrual periods for 12 consecutive months. As a result, a woman's body stops producing eggs, and hormone levels, especially estrogen, decrease.

Now, before menopause, there's a transition period called perimenopause that can start as early as a woman's 30s or 40s. During perimenopause, hormone levels can start to fluctuate, which can lead to symptoms like irregular menstrual periods, hot flashes, night sweats, mood swings, and difficulty sleeping. This transition can last for a few months to several years, so it's important to be aware of these changes and to take care of yourself during this time.

Why You Might Feel Rage During Perimenopause

Feeling rage is a normal reaction to perimenopause and menopause. But why? Two main reasons:

1. An Emotional Reaction to Changes and Symptoms You Can’t Control

Perimenopause can be a challenging time in a woman's life. You may be dealing with physical symptoms like hot flashes and insomnia, as well as emotional issues like anxiety and depression. These factors can contribute to feelings of frustration and anger, which can manifest as rage.

It is also a life stage that marks the end of reproductive years and this can be a poignant time for some. While aging and menopause are being more openly discussed and embraced these days, there may still be some negative baggage associated with entering this life stage for some. 

Feelings of grief and rage are a natural part of any mourning process. And whether you’re mourning an actual loss (your ability to reproduce) or a perceived loss (your youth, vitality, even feelings of attractiveness) it is natural to feel rage as part of that process.

2. A Result of Fluctuating Hormones

During perimenopause, your hormone levels, particularly estrogen, and progesterone, can fluctuate significantly. These hormonal changes can affect the levels of neurotransmitters in the brain, which can lead to mood swings, irritability, and even rage.

It's important for women to recognize that these emotions are a normal part of the hormonal changes that come with perimenopause, and to seek support and guidance from healthcare providers, therapists, or support groups as needed. By managing symptoms and taking care of their mental health, women can navigate this transition with greater ease and well-being.

Tools for Managing Rage and Mood Swings

The good news is that by the time you’re going through perimenopause and menopause, you probably have learned ways of coping with stress in your life. We all go through turbulent times; breakups, bereavement, losing one’s job, moving home, and money worries. And we all develop mechanisms for coping with the things life throws at us. It could be a physical sport, a creative habit, long walks on the beach, or even housecleaning.

But perimenopausal rage may still throw you for a loop. It’s never too late to develop new coping mechanisms or find new ways of supporting your emotional well-being. This is a new life stage, after all—and what worked in the past may not necessarily work for you now. 

If you’re looking for ways to process and manage your feelings of rage or anxiety during perimenopause, here are some suggestions:

Try Meditation

Meditation can be a helpful tool for managing the emotional symptoms of menopause, including feelings of anger or rage. By practicing mindfulness meditation, menopausal women can learn to observe their thoughts and emotions without judgment or reactivity.

Meditation can help you cultivate greater awareness and self-regulation of your emotions if you experience mood swings. By noticing when anger starts to build, you can learn to pause and respond more intentionally and constructively, rather than simply reacting at the moment.

Research has shown that mindfulness meditation can be effective in reducing symptoms of anxiety and depression, which are common during menopause. Regular meditation can help to reduce stress and promote feelings of calm and relaxation, which can have a positive impact on overall well-being.

Add Strength Training to Your Exercise Regime

At a time when it may feel like your body is betraying you, it might help you heal your relationship with your body if you take control back. Strength training is important as you age because you begin to lose bone density, which can increase the risk of osteoporosis and fractures.

But more than that: There’s something super empowering and badass about seeing your strength improve. Besides the physical benefits, strength training can help you rebuild your relationship with your body (your body is truly amazing, at every age!)

Learn Your Triggers and Practice Communication

We all have our pet peeves. It could be that perpetually late friend or the coworker who mansplains what you just said back to you. The more aware you are of those things that (justifiably or not!) set you off the more able you will be to minimize or avoid situations altogether.

It’s also an opportunity to practice providing feedback. After all, one of the benefits of age is the ability to confidently but respectfully communicate your needs—especially to close friends and partners. If handled lovingly, you might even improve your relationships!

Find a Therapist or Support Group

If you’ve never been in therapy, it can be a daunting process. But most people who’ve had therapy will agree it’s something everybody can benefit from. 

Still carrying around baggage from childhood, old relationships, or past injustices? These are all things that can percolate during moments of rage. Or perhaps you’re finding yourself angry about your sense of loss, or even angry about the fact you feel so angry all the time! It can become a big knotty mess and sometimes you need help to unravel it. 

Don’t be afraid to seek help or intimidated about what it “means” to need help. It really only means that you’re a self-aware person who wants to live her best possible life. 

Give Yourself “Me Time”

Sometimes we all just need to “breathe and reboot.” It’s totally fine and healthy to need some me-time. There’s no pressure to do super Goop-y things either. If it’s a day in bed, or rewatching old episodes of Gilmore Girls that’s fine too. No shame, no blame, no guilt. Give yourself the gift of no-strings-attached time off. 

Talk to Your Doctor

Any time something is persistently problematic or it interferes with your ability to function day-to-day, it’s worth chatting with your doctor. Ideally, you’re seeing your doctor for an annual checkup and having conversations about the stage of life you’re in, what’s considered medically ‘normal’, how to optimize your health, and other medical options for more extreme physical symptoms. If you're experiencing a lot of perimenopause rage or suspect you have mood disorders, definitely bring it up at your next checkup.

Hormone Replacement Therapy to Treat Menopause Symptoms

Hormone replacement therapy (HRT) is a medication to replace the estrogen that your body starts to lose during perimenopause. Hormone therapy can be used to treat severe hot flashes and other menopause symptoms. It can also prevent bone loss and prevent fractures in women after menopause. 

However, hormone therapy has associated risks too, including a risk of heart disease, stroke, and breast cancer. Overall, HRT is neither all good nor all bad. Whether it’s right for you will depend on several factors, including your medical history, general health, and the severity of your symptoms. It’s advisable to work with your healthcare provider to determine if hormone replacement therapy is right for you.

Selective Serotonin Reuptake Inhibitors

Selective serotonin reuptake inhibitors (SSRIs) are a class of medications that are commonly used as antidepressants. They work by increasing the levels of the neurotransmitter serotonin in the brain, which can improve mood, reduce anxiety, and alleviate symptoms of depression. 

SSRIs can also be used to alleviate some of the symptoms of menopause, such as hot flashes and mood changes. SSRIs can also improve mood and reduce symptoms of anxiety and irritability that are commonly associated with menopause. However, as with any medication, it is important to discuss the risks and benefits with a healthcare provider before starting treatment.

Other Menopausal Symptoms You Might Experience

Fluctuating hormones can cause both physical and emotional reactions (mood symptoms.) There’s quite a range of menopausal symptoms here, and their severity and duration can vary wildly from person to person. Here are some of the more common menopause symptoms.

Missed or Irregular Periods

During perimenopause, you may notice changes to your menstrual cycles. Some of these changes can be extreme opposites of each other, from lighter periods to heavier periods. This is caused by the extreme fluctuation of your hormone levels. 

Less Frequent or Irregular Periods

Because you will start ovulating less as you approach menopause, your entire menstrual cycle may not run like clockwork anymore. This can mean less frequent periods, including skipped months. These infrequencies will increase as perimenopause progresses. This is part of the reason why doctors wait a full 12 months before confirming that you have passed into menopause.

Spotting or Lighter Periods

You might also experience very light menstrual periods or spotting between periods. Considering periods become irregular at this stage, it can be easy to mistake the stage you’re in for menopause. It’s worth tracking your periods and any irregular bleeding in a journal or app so you and your doctor can understand what stage you’re in.

Longer Periods or Heavy Bleeding

As periods become infrequent, sometimes the lining of the uterus has more time to become thicker. This means that when your uterus sheds its lining, there will be a longer and heavier period. If periods become excessively heavy, you may be at risk of anemia, or it might be a symptom of something else. So monitor your cycle and determine if you need to seek medical advice. 

Hot Flashes / Night Sweats

Hot flashes (aka hot flushes) are characterized by a sudden feeling of warmth or heat that spreads throughout the body, often accompanied by sweating, rapid heartbeat, and flushing of the skin.

What can trigger hot flashes? A variety of things, including hormonal changes, stress, alcohol consumption, spicy foods, and caffeine. They can vary in duration and intensity, with some women experiencing only mild hot flashes that last for a few seconds, while others may have more severe hot flashes that last for several minutes or longer.

Night sweats are episodes of excessive sweating during the night that can drench the bedding and clothing, leading to discomfort and interrupted sleep.

Mood Swings

Mood swings (in addition or apart from feelings of rage) and mood disorders are common symptoms of menopause and perimenopause due to the hormonal changes that occur during this time. Specifically, fluctuations in estrogen and progesterone levels can impact the levels of neurotransmitters in the brain, which can affect mood, emotions, and behavior even leading to depressive symptoms/perimenopausal depression.

… And So Many Other Symptoms

There’s still a long list of other menopausal symptoms is quite long. The good news is not all perimenopausal women experience these symptoms. And they may be less intense for some. The list includes:

• Nausea: Fluctuating estrogen levels can result in feelings of nausea.
• Weight gain: Sudden changes in weight or digestion can also point to perimenopause. If your diet, nutrition, and exercise levels are fairly stable and you find yourself experiencing weight gain, that may be a symptom of perimenopause.
• Vaginal dryness: Vaginal or endometrial atrophy occurs in some women after menopause. The body produces less estrogen after menopause, which can lead to the thinning, drying, and inflammation of the vaginal walls. During perimenopause this process can begin, resulting in dryness.
• Changes in sexual desire or satisfaction: Some women report changes in sexual desire and arousal due to fluctuating hormones.
• Insomnia and sleep troubles: Apart from night sweats, general sleep can become unpredictable during perimenopause and beyond. It can also be hard to fall asleep, with some experiencing insomnia.
• Bone loss: With declining estrogen levels, your bone density may decrease as you start to lose bone more quickly than you replace it. For some, this can lead to an increased risk of osteoporosis — a disease that causes fragile bones in women.
• Bladder problems: Low estrogen levels may also make you more vulnerable to urinary or vaginal infections. Loss of tissue strength may contribute to urinary incontinence.
• Memory problems or difficulty concentrating: Memory problems or difficulty concentrating are common symptoms caused by hormonal changes. Other factors like stress, sleep disturbances, and mental health conditions can contribute to these symptoms. 
• Joint and muscle pain: Estrogen plays an important role in maintaining joint and bone health. As estrogen levels decline during perimenopause, women may experience a loss of bone density and joint cartilage, leading to joint and muscle pain
• Headaches or migraines: The exact cause of headaches during menopause is not fully understood, but hormonal changes are believed to play a role. As levels of estrogen and progesterone fluctuate during menopause, some women may experience changes in blood vessels that can lead to headaches. Other factors, such as stress, lack of sleep, and certain foods or drinks, can also trigger headaches during menopause.
• Changes in skin and hair, such as dryness or thinning: Estrogen plays a key role in maintaining skin and hair health. It promotes collagen production, which helps keep skin elastic and firm, and also helps maintain healthy hair follicles. As estrogen levels decline during menopause, collagen production decreases, and hair follicles may become less active, leading to thinner, less elastic skin and hair.

If you're experiencing symptoms that are interfering with your daily life, talk to your healthcare provider about your options for managing them. Most of these symptoms will subside in postmenopausal women.

Take Our Perimenopause Quiz

The symptoms of perimenopause are numerous. But they can also be easily confused with other things going on in our bodies. Perimenopausal women may also wonder:

• Am I just stressed (work, world events, family life, etc.)
• Am I just run down?
• Maybe I’m coming down with the flu/cold/COVID?
• Maybe my body is just a little out of whack?
• Have I let my healthy habits slide a bit?
• Perhaps I’m just PMS-ing!
• Am I pregnant?

This means it can be difficult to say decisively if one is experiencing perimenopause or something else. And the situation can be even more confusing if you’re typically prone to an irregular menstrual cycle. It might be hard to spot the differences.

To help you navigate these uncertainties, we’ve devised a little quiz. Check it out here…

We hope you found this post informative — but remember: we’re not doctors and this post is not medical advice! While all posts are fact-checked and well researched, we always recommend you chat with your doctor about any questions or concerns you might have regarding a medical condition. We’re here to support and educate, but never with the aim of disregarding professional medical advice you’ve been given. Phew, now that that’s out of the way, you can go on living unapologetically free.

The reason you may experience dizziness during menopause (or more correctly perimenopause) is because of fluctuating hormones, specifically falling estrogen levels. Dizziness can also be caused by fatigue since menopausal changes include sleep disruption.

But let’s take a look at dizziness and other menopausal symptoms that might occur. First, though, let’s explain what is happening in your body during perimenopause and menopause.

Perimenopause and Menopause: What Are They? 

Menopause is a natural biological process that marks the end of a woman's reproductive years. It typically occurs between the ages of 45 and 55 and is defined as the absence of menstrual periods for 12 consecutive months. During menopause, a woman's body stops producing eggs and her hormone levels, particularly estrogen, decrease.

Perimenopause is the time leading up to menopause, which can start as early as a woman's 30s or 40s. During perimenopause, a woman's hormone levels begin to fluctuate, which can cause irregular menstrual periods and symptoms such as hot flashes, night sweats, mood swings, and difficulty sleeping. This transition can last anywhere from a few months to several years.

While menopause and perimenopause can be challenging for some women, they are a natural part of the aging process and there are many treatments and lifestyle changes that can help alleviate symptoms.

What Can Cause Menopause Dizziness?

Dizziness is a common symptom some women may experience during menopause or perimenopause. Some possible reasons for experiencing dizziness during this time may include:

Metabolism / Blood Sugar Levels

Changes in blood sugar levels can lead to lightheadedness or trigger dizziness.

Dehydration

If you’re sweating excessively (night sweats or hot flashes) you may become dehydrated and this may cause feelings of dizziness.

Headaches

Headaches and migraines during menopause can sometimes cause dizziness due to how they affect blood flow and blood vessels in the head. 

Extreme Anxiety or Stress Levels

Extreme stress or emotional distress can manifest in many physical symptoms. Sometimes it can lead you to hold your breath or to breathe more rapidly (hyperventilation.) Both may result in feelings of wooziness.

Benign Paroxysmal Positional Vertigo (BBPV)

The inner ear is responsible for our sense of balance, and hormonal fluctuations during menopause can affect the function of the inner ear, leading to symptoms such as dizzy spells, vertigo, and problems with balance. Inner ear problems, such as vestibular migraines or benign paroxysmal positional vertigo (BPPV), can cause dizziness and balance issues.

Anemia Caused By Heavier Periods

As periods become infrequent, sometimes the lining of the uterus has more time to become thicker. This means that when your uterus sheds its lining, there will be a longer and heavier period. If periods become excessively heavy, you may be at risk of anemia (low iron levels), which can cause dizziness and lightheadedness.

Low Blood Pressure or Other Cardiovascular Conditions

Estrogen helps to keep blood vessels flexible and healthy, regulates cholesterol levels, and reduces inflammation in the body. As estrogen levels decline during menopause, these protective effects diminish, which can increase the risk of CVD. Cardiovascular conditions, such as arrhythmias or low blood pressure, can cause dizziness and fainting.

Medications, Including Hormone Replacement Therapy (HRT)

Medications, including hormone replacement therapy (HRT), can have side effects that include dizziness.

If you're experiencing dizziness during menopause or perimenopause, it's important to talk to your healthcare provider to determine the underlying cause and discuss treatment options.

Other Causes of Dizziness Not Necessarily a Menopause Symptom

Menopausal symptoms are a tangled web and it can be difficult to tease apart what might be happening due directly to menopause and what might simply be concurrent with menopause. While some of the items on this list are also associated with menopause, they can also happen outside of menopause and still make you feel dizzy:

• Low blood pressure or hypotension
• Inner ear disorders such as labyrinthitis or benign paroxysmal positional vertigo (BPPV)
• Ear infection
• Dehydration
• Migraine symptoms
• Anxiety or panic disorders
• Medication side effects
• Neurological disorders such as Parkinson's disease or multiple sclerosis
• Cardiovascular problems such as heart disease or arrhythmia
• Anemia or other blood disorders
• Low blood sugar levels
• Cold, flu, or other viruses or infection
• Hyperventilation syndrome

Always Discuss Dizziness (and Other Menopause Symptoms) With Your Healthcare Provider

Dizzy spells you cannot easily explain (skipped meals or an excessively hot day) are worth a trip to the doctor. As we’ve seen, dizziness and fainting can be symptoms of menopause and perimenopause, but there may be other explanations for why you feel dizzy beyond menopause dizziness.

Considering the risks associated with dizziness (falling, hitting your head, etc.) it’s worth making sure you’re taking every precaution. And if your dizziness is not related to menopause (and even sometimes if it is!) there may be readily available treatments to help.

If feeling dizzy is accompanied by chest pain, please seek immediate medical attention.

Other Symptoms of Menopause

It's important to note that not all women will experience all of these symptoms, and some women may not experience any at all. Additionally, the severity and duration of symptoms can vary widely from woman to woman. Here are some of the other symptoms of perimenopause:

Skipped or Irregular Periods

During perimenopause, menstrual cycles may change drastically due to fluctuating hormone levels. Some women may experience irregular or less frequent periods, while others may experience spotting or heavier bleeding. It's important to track these changes to better understand the stage you're in and to seek medical advice if needed. Excessive bleeding may be a symptom of something else, such as anemia.

Hot Flashes / Night Sweats

Hot flashes (aka hot flushes) are characterized by a sudden feeling of warmth or heat that spreads throughout the body, often accompanied by sweating, rapid heartbeat, and flushing of the skin.

What can trigger hot flashes? A variety of things, including hormonal changes, stress, alcohol consumption, spicy foods, and caffeine. They can vary in duration and intensity, with some women experiencing only mild hot flashes that last for a few seconds, while others may have more severe hot flashes that last for several minutes or longer.

Night sweats are episodes of excessive sweating during the night that can drench the bedding and clothing, leading to discomfort and interrupted sleep.

Other Symptoms

Sorry to be a bearer of potentially bad news, but the list of other menopausal symptoms is quite long. The good news is not all perimenopausal women experience these symptoms. And they may be less intense for some. The list includes:

• Nausea: Fluctuating estrogen levels can result in feelings of nausea.
• Mood swings & anxiety: Any fluctuation in hormones can have a knock-on effect on your mood. Many report feeling more anxious or having sudden flashes of rage.
• Weight gain: Sudden changes in weight or digestion can also point to perimenopause. If your diet, nutrition, and exercise levels are fairly stable and you find yourself experiencing weight gain, that may be a symptom of perimenopause.
• Vaginal dryness: Vaginal or endometrial atrophy occurs in some women after menopause. The body produces less estrogen after menopause, which can lead to the thinning, drying, and inflammation of the vaginal walls. During perimenopause this process can begin, resulting in dryness.
• Changes in sexual desire or satisfaction: Some women report changes in sexual desire and arousal due to fluctuating hormones.
• Insomnia and sleep troubles: Apart from night sweats, general sleep can become unpredictable during perimenopause and beyond. It can also be hard to fall asleep, with some experiencing insomnia.
• Bone loss: With declining estrogen levels, your bone density may decrease as you start to lose bone more quickly than you replace it. For some, this can increase the risk of osteoporosis — a disease that causes fragile bones in women.
• Bladder problems: Low estrogen levels may also make you more vulnerable to urinary or vaginal infections. Loss of tissue strength may contribute to urinary incontinence.
• Memory problems or difficulty concentrating: Memory problems or difficulty concentrating are common symptoms caused by hormonal changes. Other factors like stress, sleep disturbances, and mental health conditions can contribute to these symptoms. 
• Joint and muscle pain: Estrogen plays an important role in maintaining joint and bone health. As estrogen levels decline during perimenopause, women may experience a loss of bone density and joint cartilage, leading to joint and muscle pain
• Headaches or migraines: The exact cause of headaches during menopause is not fully understood, but hormonal changes are believed to play a role. As levels of estrogen and progesterone fluctuate during menopause, some women may experience changes in blood vessels that can lead to headaches. Other factors, such as stress, lack of sleep, and certain foods or drinks, can also trigger headaches during menopause.
• Changes in skin and hair, such as dryness or thinning: Estrogen plays a key role in maintaining skin and hair health. It promotes collagen production, which helps keep skin elastic and firm, and also helps maintain healthy hair follicles. As estrogen levels decline during menopause, collagen production decreases, and hair follicles may become less active, leading to thinner, less elastic skin and hair.

If you're experiencing symptoms that are interfering with your daily life, talk to your healthcare provider about your options for managing them. Most of these symptoms will subside in postmenopausal women.

Wondering If You’re in Perimenopause? Take Our Quiz

The symptoms of perimenopause are numerous, and they can also be easily confused with other things going on in our bodies. In real-life situations where you’re juggling all the world throws at you, they can easily become confusing. Perimenopausal women may also wonder:

• Am I just stressed (work, world events, family life, etc.)
• Am I just run down?
• Maybe I’m coming down with the flu/cold/COVID?
• Maybe my body is just a little out of whack?
• Have I let my healthy habits slide a bit?
• Perhaps I’m just PMS-ing!
• Am I pregnant?

This means it can be difficult to say decisively if one is experiencing perimenopause or something else. And the situation can be even more confusing if you’re typically prone to an irregular menstrual cycle. It might be hard to spot the differences.

To help you navigate these uncertainties, we’ve devised a little quiz. Check it out here…

Considering Hormone Replacement Therapy to Help Manage Your Menopausal Symptoms?

Hormone replacement therapy (HRT) is a treatment option that can be used to alleviate symptoms of menopause and perimenopause including hot flashes, vaginal dryness, mood changes, and sleep disturbances.

Hormone therapy involves taking medication that contains either estrogen alone or a combination of estrogen and progesterone. These hormones are taken orally or through a patch, gel, or spray, and work to replace the hormones that are no longer being produced in the body.

HRT can be effective in reducing the frequency and severity of hot flashes, night sweats, and vaginal dryness. It may also help to improve mood and sleep quality. Additionally, hormone therapy can help to prevent bone loss and reduce the risk of osteoporosis.

However, like all medications, HRT has potential risks and side effects. It may increase the risk of blood clots, stroke, breast cancer, and other health conditions, especially when taken for a prolonged time. Therefore, it's important to discuss the potential benefits and risks of HRT with your healthcare provider to determine if it's a suitable option for you.

We hope you found this post informative — but remember: we’re not doctors and this post is not medical advice! While all posts are fact-checked and well researched, we always recommend you chat with your doctor about any questions or concerns you might have regarding a medical condition. We’re here to support and educate, but never with the aim of disregarding professional medical advice you’ve been given. Phew, now that that’s out of the way, you can go on living unapologetically free.

The same hormonal changes (estrogen levels dropping) that happen during early pregnancy also happen during perimenopause—the stage of transition before menopause. So it is common to also experience nausea during this transition before you enter menopause properly.

After menopause (when you have gone without a period for more than 12 months), your body should be regulating again, so nausea should subside and your body should settle into a new pattern.

Let’s better understand menopause and perimenopause first!

What Is Menopause?

Many people use the term “menopause” for the entire transition from reproductive years to non-menstruating years. But medically speaking, you’ve entered menopause only when you’ve gone without a period for more than 12 months (you are no longer ovulating at all and therefore cannot become pregnant.)

So menopause is more the “After” state than the “Transition” state. And a lot of the symptoms we associate with the winding down of our reproductive years (including nausea) will have settled when we’re finally, fully menopausal.

What Is Perimenopause?

Perimenopause means “around menopause.” The time before menopause is known as perimenopause and it can last anywhere between 1 and 10 years. 

According to the Mayo Clinic, “You may notice signs of progression toward menopause, such as menstrual irregularity, sometime in your 40s. But some women notice changes as early as their mid-30s.”

The transition from reproductive years to menopause can be a very gradual one. It can span years and be a time of great fluctuation in your feeling of well-being. Your periods do not stop abruptly, but you may start to experience missed periods, late periods, or even heavier periods as they wind down.

Your hormone levels are governing all of these changes, and we all know the impact hormones can have on our bodies. But just like PMS, pregnancy, and other times of massive drops or surges in hormones, these changes do not impact every person in the same way. 

From a hormonal standpoint, perimenopause is characterized by irregular estrogen and progesterone levels. For some, the symptoms of perimenopause can be extreme. For others, they will be mild. This can make it difficult to know when one is in perimenopause. A lot of these symptoms can have other explanations too (including PMS, pregnancy, or just general health/well-being!)

If perimenopause sounds like a rollercoaster, it certainly can be. But let’s explore the symptoms and better understand what nausea can be a problem during perimenopause.

Perimenopause Symptoms / Menopause Symptoms

Let’s look in more detail at some of the major symptoms of perimenopause/menopausal symptoms.

Changes to Your Period

During perimenopause, you may notice changes to your menstrual cycles. Some of these changes can be extreme opposites of each other, from lighter periods to heavier periods. This is caused by the extreme fluctuation of your hormone levels. 

Some women may experience all of these changes, while others will just experience some. Below are some of the possibilities. If it reads like perimenopause is a bit of a rollercoaster ride, that’s not surprising—many women feel that way!

Less Frequent or Irregular Periods

Because you will start ovulating less as you approach menopause, your entire menstrual cycle may not run like clockwork anymore. This can mean less frequent periods, including skipped months. These infrequencies will increase as perimenopause progresses. This is part of the reason why doctors wait a full 12 months before confirming that you have passed into menopause.

Spotting or Lighter Periods

You might also experience very light menstrual periods or spotting between periods. Considering periods become irregular at this stage, it can be easy to mistake the stage you’re in for menopause. It’s worth tracking your periods and any irregular bleeding in a journal or app so you and your doctor can understand what stage you’re in.

Longer Periods or Heavy Bleeding

As periods become infrequent, sometimes the lining of the uterus has more time to become thicker. This means that when your uterus sheds its lining, there will be a longer and heavier period. If periods become excessively heavy, you may be at risk of anemia, or it might be a symptom of something else. So monitor your cycle and determine if you need to seek medical advice. 

Hot Flashes and Night Sweats

Hot flashes are commonly associated with menopause. According to the Mayo Clinic, “The cause of hot flashes isn't known, but it's likely related to several factors. These include changes in reproductive hormones and your body's thermostat (hypothalamus), which becomes more sensitive to slight changes in body temperature.”

Night sweats are hot flashes that occur while sleeping. They can have the added complication of disrupting sleep and causing insomnia.

Nausea, Mood Swings, Weight Gain and So Much More…

Sorry to be a bearer of potentially bad news, but the list of other menopausal symptoms is quite long. The good news is not all perimenopausal women experience these symptoms. And they may be less intense for some. The list includes:

• Nausea: Fluctuating estrogen levels can result in feelings of nausea.
• Mood swings & anxiety: Any fluctuation in hormones can have a knock-on effect on your mood. Many report feeling more anxious or having sudden flashes of rage.
• Weight gain: Sudden changes in weight or digestion can also point to perimenopause. If your diet, nutrition, and exercise levels are fairly stable and you find yourself experiencing weight gain, that may be a symptom of perimenopause.
• Vaginal dryness: Vaginal or endometrial atrophy occurs in some women after menopause. The body produces less estrogen after menopause, which can lead to the thinning, drying, and inflammation of the vaginal walls. During perimenopause this process can begin, resulting in dryness.
• Changes in sexual desire or satisfaction: Some women report changes in sexual desire and arousal due to fluctuating hormones.
• Sleep troubles: Apart from night sweats, general sleep can become unpredictable during perimenopause and beyond. It can also be hard to fall asleep, with some experiencing insomnia.
• Bone loss: With declining estrogen levels, your bone density may decrease as you start to lose bone more quickly than you replace it. For some, this can increase the risk of osteoporosis — a disease that causes fragile bones in women.
• Bladder problems: Low estrogen levels may also make you more vulnerable to urinary or vaginal infections. Loss of tissue strength may contribute to urinary incontinence.

Menopausal Symptoms: Nausea and its “Sister Symptoms”

Some symptoms like to strike all at once, unleashing a double- or even triple-whammy of awfulness on your day and making your nausea worse. Menopause nausea in particular can often be accompanied by the following.

Headaches

Severe headaches can also manifest with (of course) head pain, but also photo-sensitivity (sensitivity to light) and feelings of nausea. If you have a headache, it’s not unusual to also feel queasy and lose your appetite. If you can, lie down in the dark.

Digestive Issues (Bloating, Constipation, Diarrhea)

Menopause-related nausea can also be accompanied by a whole host of digestive issues. Digestive issues can also make your tummy feel sensitive and nauseous. 

Dizziness

Dizziness can be a symptom of many things, including anemia (which may occur if you have heavier periods), but it can also accompany nausea and general feelings of wooziness.

Wondering if You’re in Perimenopause? Take Our Quiz

The symptoms of perimenopause are numerous, and they can also be easily confused with other things going on in our bodies. In real-life situations where you’re juggling all the world throws at you, they can easily become confusing. Perimenopausal women may also wonder:

• Am I just stressed (work, world events, family life, etc.)
• Am I just run down?
• Maybe I’m coming down with the flu/cold/COVID?
• Maybe my body is just a little out of whack?
• Have I let my healthy habits slide a bit?
• Perhaps I’m just PMS-ing!
• Am I pregnant?

This means it can be difficult to say decisively if one is experiencing perimenopause or something else. And the situation can be even more confusing if you’re typically prone to an irregular menstrual cycle. It might be hard to spot the differences.

To help you navigate these uncertainties, we’ve devised a little quiz. Check it out here…

Real Talk: Some Ways to Manage Perimenopausal Symptoms

Nothing replaces real medical advice from a trained professional. And although perimenopause is having a “moment” on social media, be careful hopping on bandwagons of taking supplements or changing your diet based on social media or opinion pieces. It is always worth talking to your doctor about making these kinds of changes, and even what preventative measures you might start pursuing in the run-up to perimenopause that might alleviate the severity of symptoms.

That said, there are some consumer products that might be helpful to add to your arsenal as you navigate these changes:

Leakproof Underwear to Help Manage Sweat or Light Bladder Leaks

If you’re experiencing night sweats and hot flashes, irregular bleeding, or light bladder leaks, your confidence might take a real dip. Leakproof underwear can help manage those symptoms as you go through these erratic experiences. Knix leakproof underwear is a solid choice.

Ginger to Soothe Your Tummy

Fresh ginger or ginger chews (or even flat ginger ale or ginger tea) can help soothe an upset tummy. Having some ginger chews around (in your purse or your pantry) can help you overcome those feelings of nausea.

Cooler Bedding to Help You Have a Restful Sleep

If you’re experiencing night sweats, consider changing your bedding. Linen sheets can help keep you cool. You might want to swap your duvet for a warm-weather weight so you don’t get too hot at night.

There are also some things you might consider decreasing or eliminating altogether (with medical supervision, where required), including:

Reduce Your Intake of Spicy Foods

Spicy foods can make you feel hot and exacerbate hot flashes and feelings of nausea. If hot flashes are really affecting you, you might want to limit your spice intake or take care of the time of day you eat. 

Reduce Your Alcohol Intake

Alcohol consumption can have a negative impact on our sleep and digestion so if you’re battling perimenopause symptoms, cutting back on your alcohol intake may help. 

Stop Smoking

It’s never a bad idea to quit smoking and perimenopause symptoms can sometimes be more severe for smokers (smokers are also more likely to experience early menopause too - source). If you’re considering quitting, talk to your doctor as there may be side effects as you come off cigarettes. They can also offer support and advice about how to quit successfully.

In general, it’s never a bad idea to follow a healthy balanced diet (lots of fresh fruits, vegetables, and a good amount of healthy protein). It’s also good to get balanced consistent exercise that builds strength as well as works your heart.  Being healthy will help mitigate menopause symptoms. 

Finally, to alleviate symptoms of nausea, consider fewer, small meals (big meals, especially close to bedtime can exacerbate feelings of bloatedness and nausea.

When to See a Doctor

Any time something is persistently problematic or it interferes with your ability to function day-to-day, it’s worth chatting with your doctor. Ideally, you’re seeing your doctor for an annual checkup and having conversations about the stage of life you’re in, what’s considered medically ‘normal’, how to optimize your health, and other medical options for more extreme physical symptoms. If you're experiencing nausea, definitely bring it up at your next checkup.

Hormone Replacement Therapy to Treat Menopause Symptoms

Hormone replacement therapy is medication to replace the estrogen that your body starts to lose during perimenopause. Hormone replacement therapy (HRT) can be used to treat severe hot flashes and other menopause symptoms. It can also prevent bone loss and prevent fractures in women after menopause. 

However, HRT has associated risks too, including a risk of heart disease, stroke, and breast cancer. Overall, HRT is neither all good nor all bad. Whether it’s right for you will depend on a number of factors, including your medical history, general health, and the severity of your symptoms. It’s advisable to work with your healthcare provider to determine if hormone replacement therapy is right for you.

In These Cases, Don’t Wait… 

There are particular times when you should go out of your way to make a trip to the doctor (i.e. not just wait for your next check-up). These include:

• Heavy periods with a lot of clotting (especially clots larger than a quarter)
• Spotting between periods accompanied by abdominal pain or cramping
• Pain or a burning sensation when peeing
• Unusual vaginal discharge and/or redness and itchiness

Even if you know you’re in perimenopause, if any of your symptoms become worrying, go to your doctor. Hopefully, they’ll give you peace of mind. But it’s also possible other things are going on and the sooner you have those looked into, the better.

We hope you found this post informative — but remember: we’re not doctors and this post is not medical advice! While all posts are fact-checked and well researched, we always recommend you chat with your doctor about any questions or concerns you might have regarding a medical condition. We’re here to support and educate, but never with the aim of disregarding professional medical advice you’ve been given. Phew, now that that’s out of the way, you can go on living unapologetically free.

• Hot flashes/night sweats
• Stiff and achy joints
• Lack of focus
• Weight gain
• Mood swings

When listed here, these symptoms paint a picture of a perimenopausal woman. But in real-life situations where you’re juggling all the world throws at you, they can easily become confusing. You may also wonder:

• Am I just stressed (work, world events, family life, etc.)
• Am I just run down?
• Maybe I’m coming down with the flu/cold/COVID?
• Maybe my body is just a little out of whack?
• Have I let my healthy habits slide a bit?
• Perhaps I’m just PMS-ing!
• Am I pregnant?

This means it can be difficult to say decisively if one is experiencing perimenopause or something else. And the situation can be even more confusing if you’re typically prone to an irregular menstrual cycle. It might be hard to spot the differences.

To help you navigate these uncertainties, we’ve devised a little quiz. 

Please note that taking this free quiz is NOT a replacement for medical diagnosis or advice. 

Perimenopause Quiz: Are You Experiencing Perimenopause (Or Is it Something Else?)

1. How Old Are You?

According to Mount Sinai, perimenopause has two stages:

1. Early perimenopause: This can begin in your 30s but most often starts between the ages of 40 and 44.
2. Late perimenopause: Usually occurs in your late 40s or early 50s

Of course, these are average ages. Your body is unique and may defy these averages, but if you’re in or around these ages and experiencing other symptoms, you may be experiencing perimenopause.

2. Changes to Your Period

Compared to your ‘normal’ experience of menstruation, are you experiencing any of the following:

• Irregular periods (closer together, further apart, or completely missed)
• Never
• Sometimes
• Often
• Heavier-than-usual periods (including bleeding through clothes/sleepwear)
• Never
• Sometimes
• Often
• Worsening or constant PMS
• Never
• Sometimes
• Often

If you’ve answered ‘sometimes’ or ‘often’ to these questions, you may be experiencing perimenopause. But there can be other explanations too. For further confirmation, keep going!

3. Other Perimenopause Symptoms

While your age and changes to your period are the main indicators of perimenopause, many women experience a host of other symptoms. Compared to your normal experience, are you experiencing any of the following?

• Hot flashes/hot flushes
• Never
• Sometimes
• Often
• Night sweats
• Never
• Sometimes
• Often
• Breast tenderness
• Never
• Sometimes
• Often
• Racing heartbeat
• Never
• Sometimes
• Often
• Joint pain, stiffness, or muscle tension
• Never
• Sometimes
• Often
• Headaches, vertigo, or dizzy spells?
• Never
• Sometimes
• Often

Again, if you answered ‘sometimes’ or ‘often’ to some or all of these questions, you may be experiencing perimenopause. Keep going for more indicators that you might be experiencing perimenopause.

4. How’s Your Sleep?

While many of us struggle to get a good night’s sleep (work, kids, stress, amirite?) if you notice changes to your sleep, you may have an explanation in perimenopause:

• Fatigue: Do you feel tired more often than normal?
• Never
• Sometimes
• Often
• Insomnia: Are you having a hard time falling asleep or waking up more often during the night?
• Never
• Sometimes
• Often
• Poor sleep: Do you just never feel properly rested?
• Never
• Sometimes
• Often

It’s important to note that sleep alone may not point to perimenopause, but if you’re checking more ‘sometimes’ or ‘oftens’ than ‘nevers’ as you go through this quiz, perimenopause might be your answer.

5. Stress, Emotions & Memory

We women know all too well the effect hormonal changes can have on our moods. Some of us already experience quite the shift in moods over the course of our monthly cycle. Again, you’re looking for changes that deviate from your norm. Maybe the symptoms are worse, or maybe they’re more frequent. 

Have you noticed an unexplained increase in:

• Mood swings (depression, sudden fits of rage)
• Never
• Sometimes
• Often
• Anxiety (do you feel anxious?)
• Never
• Sometimes
• Often
• Brain fog / feeling fuzzy or confused
• Never
• Sometimes
• Often
• Increased forgetfulness or changes to your memory 
• Never
• Sometimes
• Often

6. Weight & Digestion

Sudden changes in weight or digestion can also point to perimenopause. Remember if you have a clear alternative explanation for these things, they may not be connected to perimenopause. For example, if you’re busy at work so you’ve stopped exercising as much and find yourself skipping meals and then carb-loading (hello, it’s me!), some weight gain is pretty understandable.

However, if your diet, nutrition, and exercise levels are fairly stable and you find yourself experiencing the following (along with checking some boxes in other categories), your answers are certainly pointing to perimenopause:

• Unexplained weight gain or difficulty losing weight
• Never
• Sometimes
• Often
• Water retention or bloating
• Never
• Sometimes
• Often
• Other digestive issues (gas, diarrhea, constipation, nausea, or heartburn)
• Never
• Sometimes
• Often

7. Sex Life

“The change” can also bring changes to your sex life. Have you newly experienced the following:

• Vaginal dryness or pain during sex
• Never
• Sometimes
• Often
• A change in your sex drive (lower desire for sex)
• Never
• Sometimes
• Often

8. Skin & Hair

One last area to reflect on is your skin and hair. Again, we all have our own issues with our skin and hair. But, generally, we know the range of what’s ‘normal’ for us. Reflecting on what you usually experience, are you noticing:

• Dry or itchy skin
• Never
• Sometimes
• Often
• Thinning hair
• Never
• Sometimes
• Often

How to Understand Your Answers

If you have a bunch of ‘nevers’ and a few ‘sometimes,’ there’s probably no real reason to believe you’re experiencing perimenopause. This, of course, could mean you’re just lucky to experience fewer symptoms. 

However, if you have more ‘sometimes’ and ‘oftens’ and you’re the expected age and you’re noticing changes to your period, you may have good reason to believe that you’re experiencing perimenopause.

Regardless of whether it’s perimenopause or something else entirely if you’re experiencing these changes you should visit the doctor as they could be symptoms of other treatable concerns.

If you find yourself on the fence about whether you’re experiencing something “sometimes’ or ‘often,’ consider starting to keep a journal tracking your well-being. You will be able to see patterns emerge and whether the frequency or intensity of certain symptoms is increasing over time.

Unique Situations Where This Quiz Might Not Be Straightforward

Wouldn’t life be grand if our bodies were as simple to read as an internet article? Unfortunately, it’s seldom the case. We’re all unique and it can make it difficult to judge what’s going on based on a checklist. Good news: There are medical professionals who can help! They’ll take the guesswork out of what’s going on.

In particular, online quizzes may prove difficult for more unique situations, like:

Hysterectomy

A hysterectomy is the surgical removal of the uterus. Depending on your unique situation, your surgeon may also recommend the removal of the ovaries, this would mean you stop ovulating and therefore become menopausal as a result of this surgery.

However, a hysterectomy can also leave the ovaries intact, which means you continue to ovulate every month. But since you don’t have a uterus after the surgery, you won’t have periods. For women who have had a hysterectomy but kept their ovaries, it may be harder to detect perimenopause, since they’re not observing any changes to the monthly menstruation.

Nevertheless, the other symptoms can still manifest. 

High-Stress Times

It’s easier to observe changes in the body when things in life are stable. If you’re going through a stressful time (bereavement, work stress, divorce or separation, even moving home,) your body may manifest symptoms that are easy to confuse with perimenopause.

No matter what the cause, stress is not good for us. So try to make some time for relaxation. Keep your diet as healthy as possible and try to make some time for exercise, even if it’s less than you usually do. 

If your stress levels continue to be high and manifest in physical symptoms that cause concern, it’s also worth visiting the doctor. 

Other Medical Concerns, Like a History of Hormonal Imbalance

If you have a medical history that includes a thyroid condition, PCOS, insulin resistance, diabetes, or other diseases and conditions that may manifest symptoms on this list, it may be difficult to pinpoint what’s what. 

It’s never a bad idea to talk to your doctor about how to understand your symptoms

Medications, Including HRT and Hormonal Birth Control

Any hormonal medications, including hormone replacement therapy and the hormonal birth control pill, can create symptoms that might confuse you as you approach perimenopause. 

If symptoms are severe, don’t wait to talk to your doctor. But if you’re on the fence, consider keeping a daily log so that you can go to your doctor and confidently relay the frequency and intensity of your symptoms, whether they are worsening over time.

What Is Perimenopause?

Perimenopause means “around menopause.”

The time before menopause is known as perimenopause. During perimenopause, your menstrual cycles and periods gradually come to an end.  It can last anywhere between 1 and 10 years. The average length of perimenopause is four years and, during that time, your period can become irregular and there can be irregular bleeding between periods.

This is a transitional time for the body (like puberty) and refers to the time your body is making a transition from fertility to menopause, which marks the end of your reproductive years. Perimenopause is sometimes called the menopausal transition.

According to the Mayo Clinic, “You may notice signs of progression toward menopause, such as menstrual irregularity, sometime in your 40s. But some women notice changes as early as their mid-30s.”

From a hormonal standpoint, perimenopause is characterized by irregular estrogen and progesterone levels. These changes to your hormone levels can cause many symptoms, which if severe, you might want to seek medical advice. Among those symptoms are changes in your menstrual period.

Once you’ve gone 12 months since your last period, you’re considered in menopause.

Symptoms of Perimenopause

The quiz above covered the main symptoms of perimenopause, but some symptoms may escape your notice. Others might just need a little more explanation, including:

Irregular or Skipped Periods

Because you will start ovulating less as you approach menopause, your entire menstrual cycle may not run like clockwork anymore. This can mean less frequent periods, including skipped months.

These infrequencies will increase as perimenopause progresses. This is part of the reason why doctors wait a full 12 months before confirming that you have passed into menopause.

Hot Flashes and Night Sweats

Hot flashes are commonly associated with menopause. According to the Mayo Clinic, “The cause of hot flashes isn't known, but it's likely related to several factors. These include changes in reproductive hormones and in your body's thermostat (hypothalamus), which becomes more sensitive to slight changes in body temperature.”

Night sweats are hot flashes that occur while sleeping. They can have the added complication of disrupting sleep and causing insomnia.

Vaginal Dryness

Vaginal or endometrial atrophy occurs in some women after menopause. The body produces less estrogen after menopause, which can lead to the thinning, drying, and inflammation of the vaginal walls. During perimenopause this process can begin, resulting in dryness.

Bladder Problems

Low estrogen levels may also make you more vulnerable to urinary or vaginal infections. Loss of tissue strength may contribute to urinary incontinence.

Bone Loss

The hormone estrogen can protect your bones. With declining estrogen levels, your bone density may decrease as you start to lose bone more quickly than you replace it. For some, this can increase the risk of osteoporosis — a disease that causes fragile bones in women.

When to Talk to Your Doctor

If you’re finding these changes difficult to tolerate or you’re feeling uncertain about what’s happening, it’s definitely worth chatting with your doctor.

The majority of women would prefer to manage these changes through lifestyle and your doctor will certainly recommend ways to adjust your lifestyle to manage the symptoms of perimenopause.

These changes might include:

• Healthy diet: Of course, a healthy diet has many benefits for your body but some of the symptoms of perimenopause and menopause are more severe when you don’t maintain a healthy lifestyle. Dairy products and dark leafy greens are rich in Vitamin D and Calcium, which can help with other symptoms. 
• Regular exercise, including strength training: Staying fit and flexible can mitigate some of the symptoms associated with this time of life. Strength training in particular can help maintain strong bones, which can help offset the decrease in estrogen and its effect on bone density for women.
• Stop smoking: Smoking can increase the risk of many diseases, including cardiovascular disease. 
• Less alcohol: Alcohol consumption can worsen the effects of hot flashes or night sweats, so abstaining or drinking less can help bring relief to those symptoms.
• Vaginal lubricants: These can help with vaginal dryness.
• Leakproof underwear: If you’re experiencing irregular cycles, spotting between periods, or bladder control issues, leakproof underwear can provide you with extra reassurance and confidence.
• Supplements: According to the American College of Obstetricians and Gynaecologists, “Plants and herbs that have been used to relieve menopause symptoms include soy, black cohosh, and Chinese herbal remedies. Only a few of these substances have been studied for safety and effectiveness”. Always talk to your doctor about taking new supplements, including over-the-counter supplements.

If your symptoms are more severe and making lifestyle changes does not impact them, you and your doctor can explore other courses of action. These might include hormone replacement therapy (HRT) and even surgical options, including hysterectomy.

We hope you found this post informative — but remember: we’re not doctors and this post is not medical advice! While all posts are fact-checked and well researched, we always recommend you chat with your doctor about any questions or concerns you might have regarding a medical condition. We’re here to support and educate, but never with the aim of disregarding professional medical advice you’ve been given. Phew, now that that’s out of the way, you can go on living unapologetically free.

This is connected with the profound hormonal changes that are happening in your body, but also with aging more generally. Let’s get into it...

Can Menopause Cause Urinary Incontinence?

Menopause is a critical stage in a woman’s life. It marks the end of reproductive years. You are officially deemed to be in menopause (vs. perimenopause) when you’ve gone 12 months without a menstrual period.

Like most events in a women’s reproductive cycle, changes in hormone levels play a crucial role in menopause. In particular, estrogen levels drop. Low estrogen levels may also make you more vulnerable to urinary or vaginal infections. Loss of tissue strength may contribute to urinary incontinence.

6 Causes of Bladder Leaks During Menopause

There are many changes connected to menopause that can cause urinary incontinence. And, of course, there may be events that occurred earlier in life (such as pregnancy, childbirth, surgery) that also contribute to incontinence that does not manifest until menopause. These changes start during perimenopause.

Let’s look at some of the main causes of bladder leaks during menopause:

1. Weak Pelvic Floor Muscles

The pelvic floor muscles span the bottom of the pelvis and support the pelvic organs—bladder, bowel, and uterus (or womb). 

As we age, our pelvic muscles start to relax. Weak pelvic floor muscles can also be exacerbated by past events, like pregnancy, childbirth, and certain abdominal surgeries (e.g., hysterectomy.)

Often those past traumas begin to manifest at menopause—if they haven’t earlier—as your pelvic muscles naturally weaken at menopause. When they weaken, they can create problems with bladder and bowel control.

2. Estrogen Depletion

When your ovaries stop producing estrogen, you get a break from the monthly menstrual cycle you’ve likely lived with since puberty.

However, this isn’t the only impact a drop in estrogen has for women at menopause. While it might be nice to get a break from periods, your body may go through some turmoil as it adjusts, including:

• Hot flashes
• Vaginal atrophy
• Accelerated skin aging
• Vaginal dryness
• Bone loss

Bladder control issues also belong on this list for many women.

3. Pelvic Organ Prolapse

Pelvic floor disorders include prolapse: The descending or drooping of pelvic organs. It can impact the:

• Bladder
• Uterus
• Vagina
• Small bowel
• Rectum

About one-third of women are affected by prolapse at some point in their lives. Prolapse causes further strain to your pelvic muscles and may result in urinary or fecal incontinence, among other complications.

4. Thinning of the Lining of the Urethra

Another marked impact of the estrogen depletion that occurs during menopause is that your urethra (the short tube that connects the bladder to the outside of your body and through which urine leaves the body) becomes thinner.

The thinning of the urethra makes it easier for bacteria to enter the bladder. This can cause urinary tract infections (UTIs), which can also lead to urinary incontinence. For this reason, UTIs are more common as women age. 

5. Decreased Bladder Elasticity 

Another change during menopause is that the bladder can become less elastic. This means it cannot expand and contract to hold as much urine as it used to, which can result in more frequent trips to the washroom, nocturia (waking up during the night because you need to use the bathroom), and even urinary incontinence.

6. Weight Gain

Menopausal symptoms include weight gain. And while we’re never going to body-shame, excess weight can add to the pressure on your pelvis, exacerbating any stress that might cause a bladder control problem.

What Are the Different Types of Urinary Incontinence?

At a high level, there are 5 types of urinary incontinence that can impact women. While these bladder control problems can impact at any time and for many reasons, your chances of experiencing any form increase as you age. The types of bladder control problems most often directly associated with menopause are:

• Stress incontinence
• Urge incontinence
• Mixed incontinence

Other Causes of Urinary Incontinence During Menopause

In addition to the main types of urinary incontinence listed above, there are other reasons you may experience bladder control issues during menopause.

UTIs

As mentioned earlier, you become more susceptible to urinary tract infections as you age. Incontinence is one symptom of urinary tract infection. Another symptom is a stinging or burning sensation when you pee and a decreased or irregular flow of urine. If you experience this, you should visit your doctor. UTIs are treated with antibiotics for 3 to 7 days.

Ways to prevent UTIs include:

• Drink plenty of water
• Urinate before and after having sex
• Wipe from front to back after you pee
• Wear breathable, natural underwear and clothing, changing your underwear daily

Other Diseases

As you can see there are many possible and very different explanations for menopausal incontinence. Not to make matters even more complicated, but it can also be connected with the following:

• Diabetes
• Neurological disorders
• Anatomical abnormalities
• Stones (calculi)
• Bladder cancer
• Obstructive sleep apnea

This just underscores the importance of seeing your doctor (potentially for a pelvic exam) to uncover the real reason and the appropriate treatment if you’re experiencing involuntary urine leakage.

Certain Medications

Many women find that some medications irritate the bladder. If you suspect this is the case with a current prescription, work with your doctor or pharmacist to see if there are alternatives—or if the timing of taking medication can be altered to minimize its impact.

Treatments Options

Do Pelvic Floor Muscle Exercises

These exercises strengthen the pelvic floor muscles, which support the uterus, bladder, small intestine, and rectum. You don’t need to wait for menopause to begin. Kegel or pelvic floor exercises can be done any time, either sitting or lying down. You can even do them when you are eating, sitting at your desk, or when you are resting or binging your favorite show on Netflix!

If you’re unsure how to do Kegel exercises, your doctor or physiotherapist can help you. But basically it’s like pretending you have to urinate and then holding it. You relax and tighten the muscles that control urine flow. 

One way to learn the muscles you should activate is to pay attention when you pee: Start to pee and then stop. You should feel the muscles in your vagina (for women), bladder, and anus get tight and move up. These are the pelvic floor muscles. If you feel them tighten, you have done the pelvic floor muscle training right. Your thighs, buttock muscles, and abdomen should remain relaxed.

Adjust Food & Beverage Consumption

Certain foods and drinks irritate the bladder, including spicy and excessively sugary foods. You may also wish to cut back on caffeinated, carbonated beverages, and/or alcohol. If these simple changes have an effect, it will be a personal decision whether to make more permanent dietary changes. If you experience incontinence more often at bedtime, you can think about reducing your fluid intake closer to bedtime.

Try Bladder Training

Bladder training involves taking bathroom breaks at regularly timed intervals. By ensuring your bladder is emptied frequently, you minimize the chances of leakages (even if it's just a few drops). Over time, the duration of time between breaks can be increased. 

Discover Leakproof Underwear

These sorts of changes will likely take a while to show any effect. So, while you wait, you can also explore products to help you stay active and social. Leakproof underwear comes with different absorbency levels. 

Super absorbent Knix leakproof underwear is a solid choice. Products like these can be a game changer for those experiencing female urinary incontinence, allowing them to remain active and social while exploring treatment options.

Further Medical Treatment Options for Urinary Incontinence

We do advocate talking to your doctor if you experience urinary incontinence. Beyond the other symptoms mentioned above, there may be more involved treatment options and surgeries to help. Some options you might explore with them may include:

• Hormone replacement therapy (HRT)
• Vaginal pessary or urinary insert
• Botox
• Medications

Surgical options for urinary incontinence may include:

• Sling procedure
• Injectable bulking agents
• Retropubic colposuspension

While it’s no doubt scary to navigate all of these changes during menopause, hang in there. Assemble a support team, including your doctor, and know you’re not alone.

Written by Jane Flanagan — Updated on April 5, 2022.

We hope you found this post informative — but remember: we’re not doctors and this post is not medical advice! While all posts are fact-checked and well researched, we always recommend you chat with your doctor about any questions or concerns you might have regarding a medical condition. We’re here to support and educate, but never with the aim of disregarding professional medical advice you’ve been given. Phew, now that that’s out of the way, you can go on living unapologetically free.

What Is the Menopause and What Is Menopause Age?

Menopause is when a woman’s menstrual cycle stops permanently. Once in this stage, a woman can no longer become pregnant. The time leading up to this event is called perimenopause. During perimenopause, periods grow infrequent.

Menopause is confirmed 12 months after your last period. Bleeding after this point is called postmenopausal bleeding (PMB), and it is considered abnormal bleeding. This stage usually occurs between the ages of 45 and 55.

Postmenopausal Bleeding

If you Google "postmenopausal bleeding," the search results are likely to make you nervous. But please don’t panic. There are many explanations for vaginal bleeding after menopause. And despite what Dr. Google says, it does not automatically mean you have cancer.

According to this study published by JAMA Internal Medicine, “postmenopausal bleeding occurs in approximately 90% of women with endometrial cancer; however, only 9% of women with postmenopausal bleeding were diagnosed with endometrial cancer.”

So, why the urgency to see a doctor? Well, endometrial cancer cannot be screened for, which means it can go undetected if symptoms are ignored. Because of that, even though postmenopausal bleeding may occur for a variety of reasons, understanding that it can allow for early detection of endometrial cancer means it’s always worth investigating.

Are You Really in Menopause? What Is Perimenopause?

One possible explanation of a post-menopausal period is that you’re still in perimenopause.

During perimenopause, your menstrual cycles and periods gradually come to an end. The average length of perimenopause is 4 years, and during that time, your period can become irregular, and there can also be irregular bleeding between periods.

Just as periods maybe start out irregularly when you go through the changes of puberty, so they become irregular as you go through the changes of perimenopause. From a hormonal standpoint, perimenopause is characterized by irregular estrogen and progesterone levels. 

Because of this gradual change, many individuals are unsure when perimenopause ends. In medical terms, menopause is confirmed 12 months after a woman's last period.

Symptoms of Perimenopause Periods

During perimenopause, some may notice changes to the menstrual period. Some of these changes can be extreme opposites of each other, from lighter periods to heavier periods. This is caused by the extreme fluctuation of hormone levels.

Many women may experience all of the following changes; others will just experience just some. If it reads like perimenopause is a bit of a rollercoaster ride, that’s not surprising - many feel that way!

• Less frequent or irregular periods: Because you start ovulating less as you age, your entire menstrual cycle may not run like clockwork anymore. This can mean less frequent and irregular periods, including skipped months.
• Spotting or lighter periods: Due to fluctuating hormones, you might experience very light periods or spotting between periods. It’s worth tracking your periods and any irregular bleeding in a journal or app.
• Longer periods or heavy bleeding: As periods become infrequent, sometimes the lining of the uterus has more time to become thicker. This means that when your uterus sheds its lining, there will be a longer and heavier period. 

Other symptoms include:

• Hot flashes
• Vaginal atrophy
• Accelerated skin aging
• Vaginal dryness
• Bone loss
• Mood swings
• Changes to your sex life (in desire or satisfaction)
• Cardiovascular disease and high blood pressure

Note: Even as your menstrual cycle becomes less regular, it is important to know that you’re still ovulating (even if it’s infrequent). If you want to avoid pregnancy, use birth control.

Post-Menopausal Bleeding: What Could Cause It?

If you haven’t had a period for one year and you experience bleeding, there are a few different explanations.

While we strongly urge you to see a doctor to understand these symptoms, don’t panic. Not all explanations of vaginal bleeding after menopause are serious. But you will want to have the more serious explanations ruled out quickly.

Here are some of the most common explanations of vaginal bleeding after menopause:

Vaginal Atrophy (Thinning Tissue in the Vagina)

Vaginal or endometrial atrophy occurs in some women. The body produces less estrogen, leading to the thinning, drying, and inflammation of the vaginal walls.

According to the Mayo Clinic, “Because the condition causes both vaginal and urinary symptoms, doctors use the term "genitourinary syndrome of menopause (GSM)" to describe vaginal atrophy and its accompanying symptoms.” You may also notice brown spotting or other bleeding.

Endometrial Atrophy or Endometrial Hyperplasia

The endometrium is the tissue that lines your uterus. Fluctuating or irregular hormone levels can affect this tissue in two possible ways:

1. Thinning of the Endometrium (Endometrial Atrophy): According to the American College of Obstetricians and Gynaecologists, low estrogen levels can cause the tissue of the endometrium (or uterine lining) to thin, which can result in some bleeding.
2. Thickening of the Endometrium (Endometrial Hyperplasia): The uterine lining becomes thickened, most often due to increased estrogen and decreased progesterone. Endometrial hyperplasia can sometimes lead to endometrial cancer (also referred to as uterine cancer), though it may be prevented if detected early (source). Early indicators include unusual bleeding. Progestin is often used to treat endometrial hyperplasia.

Both the thinning and thickening of the endometrium can result in bleeding after menopause.

Polyps

Polyps are usually benign, noncancerous growths in the uterus, cervical canal, or on your cervix. While they are not usually harmful, they can grow quite large, which can cause discomfort. Women with polyps can experience bleeding, and because they can occur at any age, they may result in perimenopausal bleeding and bleeding after menopause.

Your doctor will advise whether you should seek to remove endometrial polyps. In general, they will seek to use the least invasive treatment before opting for surgical interventions.

Infection

Sexually Transmitted Diseases (STIs) and other infections like Pelvic Inflammatory Disease (PID) can all be explanations of spotting at any age, including perimenopausal bleeding and bleeding after menopause. 

Most infections are treatable. But infections can become more serious if ignored, so it’s worth getting routinely tested for STIs.

Strenuous Exercise

While exercise is essential for good all-round women's health, strenuous exercise can cause some bleeding (or perhaps brown spotting) in postmenopausal women. Generally, this is not something to be concerned about. But if it happens for the first time, it’s good to seek reassurance from your doctor.

Hormone Replacement Therapy (HRT)

Hormone Replacement Therapy is a form of hormone therapy used to treat symptoms associated with female menopause, including:

• Hot flashes
• Vaginal atrophy
• Accelerated skin aging
• Vaginal dryness
• Bone loss

Side effects of HRT medications include unusual bleeding, though this is considered a less common side effect. More information about HRT can be found at the Mayo Clinic.

Other Medications

In addition to HRT, a side effect of other medications can include unusual bleeding. For example, blood thinners may cause unusual postmenopausal spotting.

If you are on any medications you think might cause spotting, discuss this side effect with your doctor. She will help you determine if there’s any additional risk.

Endometrial Cancer, Cervical Cancer or Uterine Cancer

According to the Dana-Farber Cancer Institute, spotting in post-menopausal women can, in some cases, be an early sign of cancer and should always be investigated further.

“Any post-menopausal bleeding should warrant a visit to a gynecologist,” says Ursula Matulonis, MD, chief of the Division of Gynecologic Oncology at Dana-Farber Cancer Institute.

Seeing your doctor promptly will increase the chances that any cancer will be found early, which increases the chances of successful treatment. To determine if abnormal cells or cancerous cells are present, your doctor may take a normal biopsy to take a small sample of tissue. If positive, further tests will determine the extent (stage) of cancer.

Treatments for cervical or uterine cancer can vary (see the Mayo Clinic) but may include surgery, such as hysterectomy (removal of the uterus and cervix) or trachelectomy (removal of the cervix.)

Seeking Medical Advice for Vaginal Bleeding After Menopause: What to Expect…

In general, any bleeding post-menopause is worth a trip to your health care provider for some health information. Even if the spotting is minor, it’s worth eliminating the (slight) risk that it could be an early indicator of cancer. 

But don’t take this caution as a reason to panic. Odds are, there’s another explanation for your bleeding. And your health care provider may be able to help you address the symptoms.

Written by Jane Flanagan — Updated on March 25, 2022

We hope you found this post informative — but remember: we’re not doctors and this post is not medical advice! While all posts are fact-checked and well researched, we always recommend you chat with your doctor about any questions or concerns you might have regarding a medical condition. We’re here to support and educate, but never with the aim of disregarding professional medical advice you’ve been given. Phew, now that that’s out of the way, you can go on living unapologetically free.

In this article, we’ll explain why a “menopause period” is considered an oxymoron (i.e., the words contradict each other) and what else might be happening if you experience something like a period when you’re in menopause.

What Is Menopause?

Menopause is when a woman’s menstrual cycle stops permanently. Once in this stage, a woman can no longer become pregnant.

Some people refer to the time leading up to a woman’s last period as menopause, but this is actually called perimenopause. During perimenopause, menstruation grows infrequent and eventually, periods stop altogether.

Menopause is confirmed 12 months after your last period. Bleeding after this final menstrual period is called postmenopausal bleeding (PMB) and it is considered abnormal bleeding.

Bleeding After Menopause Isn’t Considered Normal

If you Google "vaginal bleeding after menopause," the search results are likely to send you into a panic.

Please don’t panic. There are many explanations for these menopausal symptoms. And despite what Dr. Google says, it does not automatically mean you have cancer.

According to a study published by JAMA Internal Medicine, “postmenopausal bleeding occurs in approximately 90% of women with endometrial cancer; however, only 9% of women with postmenopausal bleeding were diagnosed with endometrial cancer.”

So, why the urgency to see a doctor? 

Well, endometrial cancer cannot be screened for, which means it can go undetected if symptoms are ignored. 

So, even though postmenopausal bleeding can occur for a variety of reasons, understanding that it can allow for early detection of endometrial cancer (and early cancer treatment) means it’s always worth investigation.

Are You Really in Menopause? What Is Perimenopause

One possible explanation of a period in menopause is that you’re not yet in menopause, but still in perimenopause.

During perimenopause (the stage before menopause), your menstrual cycles and periods gradually come to an end. The average length of perimenopause is 4 years and, during that time, your period can become irregular and there can be bleeding between periods.

Just as periods may have started out irregularly when you went through the changes of puberty, so they become irregular as you go through the changes of perimenopause. From a hormonal standpoint, perimenopause is characterized by irregular estrogen and progesterone levels. 

Because of this gradual change, many individuals are unsure when perimenopause ends and menopause begins. In medical terms, menopause is confirmed 12 months after women have their last period.

Symptoms of Perimenopause Periods

During perimenopause, women may notice changes to your menstrual period. Some of these changes can be extreme opposites of each other, from lighter periods to heavier periods. This is caused by the extreme fluctuation of your hormone levels.

Many women may experience all of these perimenopausal symptoms, others will just experience some. If it reads like perimenopause is a bit of a rollercoaster ride, that’s not surprising—many feel that way!

Less Frequent or Irregular Periods

Because you will start ovulating less as you approach menopause, your entire menstrual cycle may not run like clockwork anymore. This can mean less frequent and irregular periods, including skipped months.

These infrequencies in menstrual periods will increase as perimenopause progresses. Unpredictable cycles are part of the reason why doctors wait a full 12 months after your last menstrual period before confirming that you have passed into menopause.

Spotting or Lighter Periods

"Estrogen levels generally decline during perimenopause, but they do so in an irregular fashion," according to the North American Menopause Society.

Due to fluctuating hormones (including estrogen levels), many women might experience very light periods or spotting between periods.  

Considering monthly cycles become irregular at this stage, it can be easy to mistake the stage you’re in for menopause. Skipping periods is common. It’s worth tracking your periods and any irregular bleeding in a journal or app. 

Longer Menstrual Period or Heavy Bleeding

As periods become infrequent, sometimes the lining of the uterus has more time to become thicker. This means that when your uterus sheds its lining, there will be a longer and heavier period. 

Menopausal Symptoms

Other perimenopause symptoms and menopause symptoms include:

• Hot flashes: "As many as 75% of North American women have hot flashes during perimenopause, and nearly a quarter of them experience enough discomfort to seek relief from their clinicians," according to the North American Menopause Society
• Vaginal atrophy (which can lead to vaginal dryness)
• Accelerated skin aging
• Vaginal dryness
• Bone loss
• Emotional symptoms such as mood swings and mood changes
• Night sweats and sleep problems

Note on birth control in menopausal transition: Even as your menstrual cycle becomes less regular it is important to know that you’re still ovulating (even if it’s infrequent).

If you're having sexual intercourse and want to avoid pregnancy, use birth control (e.g., barrier methods, birth control pills). According to the North American Menopause Society, “Even if you have a few months without a period, you can still get pregnant.”

Bleeding After Menopause: What Could Cause it?

If you are confirmed to be in menopause (i.e., you haven’t had a period for one year) and you experience bleeding there are a few different explanations.

While we strongly urge you to see a doctor to understand certain symptoms, don’t panic. Not all explanations are serious. But you will want to have the more serious explanations ruled out quickly.

Here are some of the most common explanations:

Vaginal Atrophy (Which Can Lead to Vaginal Dryness)

Vaginal atrophy—thinning tissue in the vagina—occurs in some women. The body produces less estrogen after menopause. These hormonal changes can lead to the thinning, drying, and inflammation of the vaginal walls.

According to the Mayo Clinic, “Because the condition causes both vaginal and urinary symptoms, doctors use the term ‘genitourinary syndrome of menopause (GSM)’ to describe vaginal atrophy and its accompanying symptoms.” You may also notice brown spotting or other bleeding.

Endometrial Atrophy or Endometrial Hyperplasia

The endometrium is tissue that lines your uterus. Fluctuating or irregular hormone levels during menopause can affect this tissue in 2 possible ways:

1. Thinning of the endometrium (atrophy): According to the American College of Obstetricians and Gynecologists, declining estrogen levels can cause the tissue of the endometrium (or uterine lining) to thin, which can result in some bleeding.
2. Thickening of the endometrium (hyperplasia): The uterine lining becomes thickened, most often due to increased estrogen and decreased progesterone. This condition can sometimes lead to cancer, though it may be prevented if detected early (source). Early indicators include unusual bleeding.

Polyps

Polyps are usually benign, noncancerous growths in the uterus, cervical canal, or on your cervix. While they are not usually harmful, they can grow quite large, which can cause discomfort. Women with polyps can experience bleeding. 

Infection

Sexually transmitted infections (STIs) and other infections like pelvic inflammatory disease (PID) can all be explanations of spotting in postmenopausal women. 

Most infections are treatable. But infections can become more serious if ignored, so it’s worth getting routinely tested for STIs.

Strenuous Exercise

While exercise is essential for good all-round health, strenuous exercise after menopause can cause some bleeding (or perhaps brown spotting). Generally, this is not something to be concerned about. But if it happens for the first time, it’s good to seek reassurance from your doctor.

Hormone Therapy

Hormone replacement therapy (HRT) is a form of hormone therapy used to relieve symptoms associated with menopause, including:

• Hot flashes
• Vaginal atrophy
• Accelerated skin aging
• Vaginal dryness
• Bone loss
• Mood swings
• Night sweats

Side effects of hormone therapy medications include unusual bleeding, though this is considered a less common side effect than hot flashes, for example. 

"Many side effects are temporary, so unless they are severe or include bleeding, give hormone therapy 3 months to see whether the discomfort resolves. Lowering the dose or switching to another type of estrogen or progestogen may help reduce side effects," according to the North American Menopause Society.

More information about HRT can be found on the Mayo Clinic.

Other Medications

In addition to hormone therapy, other symptoms of medications can include unusual bleeding. For example, blood thinners may cause unusual postmenopausal spotting.

If you have officially reached menopause and are on any medications you think might cause spotting, discuss your symptoms with your doctor. She will help you determine if there’s any increased risk.

Cervical or Uterine Cancer

According to the Dana-Farber Cancer Institute, spotting in postmenopausal women can, in some cases, be an early sign of cancer and should always be investigated further.

“Any post-menopausal bleeding should warrant a visit to a gynecologist,” says Ursula Matulonis, MD, chief of the Division of Gynecologic Oncology at Dana-Farber Cancer Institute.

Time to Seek Medical Advice: What to Expect…

In general, any bleeding post-menopause is worth a trip to your health care provider. Even if the symptoms are minor, it’s worth eliminating the (slight) risk that it could be an early indicator of cancer. 

But don’t take this caution as a reason to panic. Odds are, there’s another explanation for your bleeding. And your health-care provider may be able to help you address the symptoms.

Written by Jane Flanagan — Updated on March 1, 2022.

We hope you found this post informative — but remember: we’re not doctors and this post is not medical advice! While all posts are fact-checked and well researched, we always recommend you chat with your doctor about any questions or concerns you might have regarding a medical condition. We’re here to support and educate, but never with the aim of disregarding professional medical advice you’ve been given. Phew, now that that’s out of the way, you can go on living unapologetically free.

One of the biggest questions is what to expect from your monthly menstrual cycle. Many of us might expect a gradual wane, but the reality can be more turbulent than that.

Let’s try to explain...

What Is Perimenopause

The time before menopause is known as perimenopause. It can last anywhere between 1 and 10 years. Perimenopause means “around menopause.”

This is a transitional time for the body (like puberty) and refers to the time your body is making a transition from fertility to menopause, which marks the end of your reproductive years. Perimenopause is sometimes called the menopausal transition.

According to the Mayo Clinic, “You may notice signs of progression toward menopause, such as menstrual irregularity, sometime in your 40s. But some women notice changes as early as their mid-30s.”

From a hormonal standpoint, perimenopause is characterized by irregular estrogen and progesterone levels. These changes to your hormone levels can cause many symptoms. If you experience perimenopausal symptoms that are severe (such as mood swings or hot flashes), you might want to ask your healthcare provider for advice. Among those symptoms are changes in your menstrual period.

Perimenopausal Symptoms and Characteristics

When perimenopause occurs, a common symptom is changes to your periods. Some of these changes can be extreme opposites of each other, from lighter periods to heavier periods. This is caused by the extreme fluctuation of your hormone levels. 

Some women may experience all of these changes, others will just experience some perimenopausal symptoms. Below are some of the possibilities. If it reads like perimenopause is a bit of a rollercoaster ride, that’s not surprising—many feel that way!

Less Frequent or Irregular Periods

Because you will start ovulating less as you approach menopause, your entire cycle may not run like clockwork anymore. This can mean less frequent, irregular periods—including skipped months.

These perimenopause symptoms will increase as perimenopause progresses. This is part of the reason why a healthcare provider will wait a full 12 months before confirming that you have passed into menopause.

Spotting or Lighter Periods During Your Menstrual Cycle

Due to hormonal changes, perimenopausal symptoms include very light periods or spotting between periods.  

Considering irregular periods are common at this stage, it can be easy to mistake perimenopausal symptoms for menopause. It’s worth tracking your menstrual cycles and any irregular bleeding in a journal or app so you and your doctor can understand what stage you’re in. 

Longer Periods or Heavy Bleeding

As irregular periods become more common, sometimes the lining of the uterus has more time to become thicker. This means that when your uterus sheds its lining, there will be a longer and heavier period. 

If periods become excessively heavy, health risks could include anemia. But abnormal uterine bleeding might be a symptom of something else. So, monitor your cycle and determine if you need to talk to a healthcare provider. Learn more about heavy bleeding here.

Can You Still Get Pregnant?

Even as your menstrual cycles become less regular, it is important to know that you’re still ovulating (even if it’s infrequent). As long as you’re ovulating and having periods, you can become pregnant.

If you want to avoid pregnancy, use birth control until you've entered menopause (i.e., you’ve had no periods for 12 months).

Other Symptoms of Perimenopause

Other common symptoms of perimenopause include:

Hot Flashes

Hot flashes are commonly associated with menopause. According to the Mayo Clinic, “The cause of hot flashes isn't known, but it's likely related to several factors. These include changes in reproductive hormones and in your body's thermostat (hypothalamus), which becomes more sensitive to slight changes in body temperature.”

Night Sweats

Hot flashes that occur while sleeping are called night sweats. Nighttime hot flashes can have the added complication of causing sleep problems such as insomnia.

Vaginal Dryness

Vaginal or endometrial atrophy occurs in some women after menopause. The body produces less estrogen after menopause, which can lead to the thinning, drying, and inflammation of the vaginal walls. This process can begin during early perimenopause, resulting in dryness and a change in sexual function.

Changes in Sexual Desire or Satisfaction

Some women report changes in sexual desire and arousal due to fluctuating hormones.

Sleep Problems

Apart from night sweats, general sleep can become unpredictable during perimenopause and the menopausal transition.

Bone Loss

The hormone estrogen can protect your bones. With declining estrogen levels, your bone density may decrease as you start to lose bone more quickly than you replace it. For some, this can lead to an increased risk of osteoporosis—a disease that causes fragile bones in women—as you reach menopause. 

Bladder Problems

Low estrogen levels may also make you more vulnerable to urinary or vaginal infections. Loss of tissue strength may contribute to urinary incontinence.

Heart Disease

As estrogen levels drop during perimenopause, cholesterol levels can change, creating greater risk of cardiovascular disease, or CVD (especially when combined with other risk factors and family history). According to the US Cardiology Review, “CVD is traditionally thought of as being a problem of middle-aged men, but in fact CVD affects just as many women as men—if not more—albeit on average a decade later. This delay is thought to be due to the protective effects of estrogen that occur in the years before the menopause. As estrogen levels drop, often from the mid-40s onwards, the protective effect is lost and changes occur that lead to an increased risk of heart disease in the ensuing years.”

Symptom Relief

If you’re finding these changes difficult to tolerate or you’re feeling uncertain about what’s happening, it’s definitely worth chatting with a healthcare provider to discuss managing symptoms.

There are a range of treatments you can explore together. The majority of women would prefer to manage these changes through lifestyle, and your doctor will certainly recommend ways to adjust your lifestyle to mitigate the symptoms of perimenopause.

These changes might include:

• Healthy diet: Of course, a healthy diet has many benefits for your body, but some of the symptoms of perimenopause and menopause are more severe when you don’t maintain a healthy lifestyle. Dairy products and dark leafy greens are rich in vitamin D and calcium, which can help with other symptoms. 
• Regular exercise, including strength training: Staying fit and flexible can mitigate some of the symptoms associated with this time of life. Strength training in particular can help maintain strong bones, which can help offset the decrease in estrogen and its effect on bone density for women.
• Stop smoking: Smoking can increase the risk of many diseases, including cardiovascular disease. 
• Less alcohol: Alcohol consumption can worsen the effects of hot flashes or night sweats, so abstaining or drinking less can help bring relief to those symptoms.
• Vaginal lubricants: These can help with vaginal dryness.
• Leakproof underwear: If you’re experiencing irregular cycles, spotting between periods, or bladder control issues, leakproof underwear can provide you with extra reassurance and confidence.
• Supplements: According to the American College of Obstetricians and Gynecologists, “Plants and herbs that have been used for relief of menopause symptoms include soy, black cohosh, and Chinese herbal remedies. Only a few of these substances have been studied for safety and effectiveness.” Always talk to your doctor about taking new supplements, including over-the-counter supplements.

Written by Jane Flanagan — Updated on April 5, 2022.

We hope you found this post informative — but remember: we’re not doctors and this post is not medical advice! While all posts are fact-checked and well researched, we always recommend you chat with your doctor about any questions or concerns you might have regarding a medical condition. We’re here to support and educate, but never with the aim of disregarding professional medical advice you’ve been given. Phew, now that that’s out of the way, you can go on living unapologetically free.