Discover the five worst perimenopause symptoms: hot flashes, irregular cycles, vaginal dryness, sleep disturbances, and mood changes. Plus practical strategies and medical treatments to help you find relief and manage your transition with confidence!
What Are the Worst Perimenopause Symptoms? For many people, symptoms like hot flashes, irregular cycles, and vaginal dryness are among the worst perimenopause symptoms. Read on to find out what causes these (and more) symptoms, plus how to treat your symptoms and get relief.
As you reach the end of your reproductive years, you enter a period of major biological shift called perimenopause. Perimenopause, or the transition into menopause, generally begins in your late 30s or early-to-mid 40s. Is that earlier than you thought? That’s partially why it can be so hard to connect your symptoms to hormonal change.
During perimenopause, hormones like estrogen and progesterone fluctuate unpredictably while declining steeply over time. This can lead to a broad range of physical and emotional symptoms.
What are the worst perimenopause symptoms? Everyone’s experience is different, but for a lot of people, the most common perimenopause symptoms also tend to be the most horrible .
Let’s take a look at five of the worst perimenopause symptoms, plus how to get symptom relief and manage your experience.
1. Hot flashes (vasomotor symptoms)
Hot flashes are one of the most well-known symptoms of perimenopause and definitely among the worst! Up to 4 out of 5 people report experiencing perimenopause hot flashes (also called vasomotor symptoms).
Hot flashes are sudden, intense bursts of heat in the head, face, neck, chest, and/or upper back. Heat can be accompanied by:
Sweating Flushing in the face and neck Blotches on the chest and arms Accelerated heartbeat Hot flashes are driven by hormone level changes. Lower estrogen, in particular, may make you more sensitive to changes in body temperature, so that even the slightest differences cause a big internal reaction. The result? You’re burning up and wondering why no one else in the room is sweating.
How to get relief from hot flashes
For relief from hot flashes:
Wear light clothing, with easily removable layers Keep portable cooling devices close at hand Avoid common triggers, like spicy foods, alcohol, caffeine, and hot beverages When hot flashes are among your worst perimenopause symptoms, your doctor may also prescribe certain medications to help stabilize hormone fluctuations and manage the heat.
Commonly prescribed options include:
Combined hormone replacement therapies (HRT) Certain antidepressants
2. Irregular cycles
Irregular menstrual cycles and irregular periods are another tell-tale sign of the menopausal transition. For many people, they’re also one of the worst perimenopause symptoms.
Your cycle is regulated by hormones. When hormones fluctuate during perimenopause, they no longer function in tandem, which means that they can’t support your cycle as before.
During perimenopause, you’ll likely experience:
Shorter or longer cycles Missed periods (amenorrhea) Heavy bleeding (menorrhagia) Spotting between periods These cycle symptoms generally continue until you reach your final period and official menopause , which marks 12 months without a period
How to manage irregular cycles
Being as prepared as possible can help you manage this difficult perimenopause symptom:
Plan for unexpected bleeding : Keep period supplies with you (panty liners, tampons, a menstrual cup, or whatever you’re most comfortable with)Minimize surprises : Track your cycle with a perimenopause kitThe Oova perimenopause and fertility kit is a highly accurate and hassle-free way to monitor your cycle and period at home, even with the most irregular cycles. Oova measures your unique hormone levels to help you understand what’s going on in your body day in and day out.
If you’re trying to get pregnant during perimenopause , monitoring your cycle with hormone tracking helps optimize your chances of conceiving.
3. Vaginal dryness and discomfort
If you’re perimenopausal and you’re experiencing vaginal symptoms, the odds are good that the two are connected and hormones are likely the culprit.
Estrogen is essential to vaginal health. Over time, decreasing estrogen can cause the vaginal walls to grow thin and cervical mucus secretions to decrease. This is referred to as vaginal atrophy, which is next up on our list of the worst perimenopause symptoms.
Vaginal atrophy can cause discomfort, pain, and distress. Perimenopause vaginal symptoms include:
Dryness Irritation Burning Itching Pain during sex (dyspareunia) Recurrent urinary tract infections (UTIs) Overactive bladder How to get relief from vaginal dryness and discomfort
If you’re dealing with painful or uncomfortable perimenopause vaginal symptoms, you don’t have to suffer in silence. Treatment can help ease vaginal symptoms and find relief. Today, more and more clinicians are trained in treating menopause symptoms and can help you figure out a treatment plan that’s right for you.
Common treatments include:
Over-the-counter vaginal moisturizers and lubricants Prescription-strength topical treatments Estrogen-only HRT administered locally via a vaginal ring, tablet, cream, or gel
4. Sleep disturbances
Perimenopause can also cause sleep disturbances, including:
Difficulty falling asleep Waking up frequently at night Waking up too early and being unable to fall back asleep Sleeping lightly and fitfully Feeling unrested in the morning Insomnia What causes perimenopause sleep disturbances? Contributing factors include hormone fluctuations, which can negatively impact sleep quality, and night sweats (nighttime hot flashes), which can interrupt sleep. Plus, other perimenopause symptoms can make falling and staying asleep hard, like headaches or joint pain and muscle aches .
Many people count sleep disturbances as some of the worst perimenopause symptoms - and we get it! When perimenopause prevents you from getting quality sleep, you can experience a cascade of negative impacts like fatigue, irritability, forgetfulness, exhaustion, and even strain in your personal or work life.
How to manage sleep disturbances
Practicing good sleep hygiene can help you manage perimenopause sleep disturbances:
Stick to a regular sleep schedule Develop a relaxing bedtime routine Create a cozy sleep environment (cool, dark, and quiet!) Avoid drinking fluids close to bedtime Exercise regularly Home remedies like the above sleep hygiene hacks are typically the first and main management technique for perimenopause sleep disturbances. However, additional medical options like prescription sleep medication, cognitive behavioral therapy, or HRT may be appropriate in certain cases. Your doctor can help you decide what’s right for you.
5. Mood and cognitive symptoms
Perimenopause doesn’t just impact your body physically, it can also impact your mood and mental health.
If your emotions feel out of control, you experience rapid mood swings, or your mental state feels different from before, perimenopause and hormones could be to blame. Low estrogen, in particular, may impact mood regulation by altering levels of neurotransmitters and brain chemicals.
Mood symptoms can be some of the worst perimenopause symptoms. They include:
Feelings of sadness and tearfulness Anxiety Feelings of depression Rage and irritabilityLow patience Brain fog and difficulty concentratingIncreased stress How to cope with mood symptoms
If you’re dealing with mood changes during perimenopause, know that your experience is normal and your emotions are valid. Allow yourself to feel without guilt and work through emotions as they arise.
For many, therapy is a great strategy for understanding emotions, finding coping strategies, and embracing the life changes that perimenopause brings.
Alongside therapy, other ways to cope with mood and cognitive symptoms include:
Regular exercise Self-care Balanced diet Participation in activities and hobbies that bring you joy Be sure to talk to your doctor if you’re experiencing stranger than normal mood symptoms that disrupt your life. Clinicians commonly prescribe HRT for perimenopausal and menopausal women who experience hormone-related mood changes and these can often be more effective in managing symptoms than SSRIs or other pharmaceuticals prescribed for mental health issues more broadly.
The worst perimenopause symptoms: The bottom line
Hot flashes, irregular cycles, vaginal symptoms, sleep disturbances, and mood and cognitive symptoms are among the worst perimenopause symptoms. They’re also among the most common, which means you’re not alone in your experience! The good news is, lifestyle and medical strategies can help you find relief from these and other perimenopause symptoms. Talk to your doctor about how to ease your perimenopause experience and make your journey to menopause and the years beyond as smooth as possible.
