10 Surprising Signs of Perimenopause: because it’s not always hot flashes!

Perimenopause is a hot topic these days and thank GOD! It’s spent far too long in the shadows, so it’s great that it’s getting the airtime it deserves. However, I often see the symptoms rattled off around the internet and think, but that wasn’t me. So, I wrote this article to share some of the less common, though no less important symptoms of peri.

Because I didn’t experience the standard symptoms, it took me a while to work out what was going on, and honestly if I didn’t have a friend who identified my symptoms early on and then spent an embarrassingly long-time cattle-prodding me into getting help, I might still be thinking I’m just a bit low, or if only I could just get myself together, or migraines are normal, right?

Let’s get into it…

IMPORTANT NOTE: I am not paid for my opinion, nor do I receive endorsements. I am not a medical professional, so please always seek medical advice before believing the internet.

1. It can start YOUNG!

Perimenopause can begin up to (and sometimes more than) ten years before actual menopause.

Menopause is your period’s last gasp – the final one. That’s it, no more periods. I wonder how many women knew that would be their last period, like THAT was menopause? When you haven’t had a period for 12 consistent months, you get to graduate to post menopause.

So, let’s think about this, the normal range for menopause is between 45-55 years old (average in Australia is 51). That means, a menopausal woman at 45 could have started perimenopause at 35. 35! I have so many friends in their late 30s and early 40s who have been told by their GPs that the symptoms they are experiencing couldn’t possibly be perimenopause, and they couldn’t possibly start MHT so young. WRONG! This is wrong. And if this is you, find yourself a better doctor.

2. Problems with your eyes

Estrogen is EVERYWHERE in our bodies, but I’ve only really ever heard it talked about in relation to menstruation, and then later in relation to menopause. But MEN have estrogen too – it’s essential to so many parts of the human body. And yep, your eyes need estrogen too.

As estrogen decreases in the body, your eyes may be affected in the following ways:

Dry Eyes

• As estrogen levels decrease, tear production is affected, and this can make your eyes feel really dry. This can sometimes feel like burning, itching or like you have sandpaper in your eyes.

2. Blurred Vision

• Sometimes my eyes can go from being clear to really blurry and I spend a lot of time blinking to try and clear my eyes. Apparently, the position and thickness of the cornea can change due to reduced estrogen which is the reason for this.

3. Increased Sensitivity to Light

• I have always experienced light sensitivity and migraines pre-menstrual, so it makes sense that in perimenopause this can really ramp up for some women. It definitely did for me!

4. Changes in Prescription Needs

• You may find yourself updating your prescription more frequently.

5. Higher Risk of Eye Diseases

• Clearly estrogen is important for eye health, so it’s no surprise that some eye diseases, while not caused by menopause, may be precipitated by menopause; these include cataracts, glaucoma and macular degeneration.

I visited the optometrist for a routine check and found out I had visible degradation in my retinas. I thought this was age-related (I was 45). I started MHT unrelated to this issue and went back for another routine check a year later and the optometrist was surprised to find that the degradation had resolved!

~KC, aka my friend~

Some links to more info about perimenopause and vision:

3. It’s gross, but I STUNK!

There was a pungent smell in the air, and I sniffed around looking for it. Well, imagine my HORROR when I realised it was ME! I smelled like a… like a … MAN! But a man who had just wrestled with 10 other men during a heat wave.

The most obvious answer to this is hot flashes and night sweats… except I wasn’t having either of those. While they are the most common perimenopause symptoms, neither were regular occurrences for me.

It could be that my sense of smell was changing.

Aging can cause a condition called presbyosmia, which affects the way you perceive scents. Some women experience dysosmia (a distorted sense of smell) or even phantosmia (smelling odors that aren’t there). This can make you more aware of—or even imagine—changes in your scent. (menopausenetwork.org)

Or it could be that because of declining estrogen, I was simply left with higher testosterone levels in my body.

Testosterone stimulates the production of androstenol, a chemical linked to a musky scent. It also contributes to greater bacterial diversity on the skin, which can alter and intensify body odor. (menopausenetwork.org)

4. Numbness or feeling tingles, like pins and needles on the skin.

…studies have shown that estrogen affects almost every tissue or organ system, including the heart and blood vessels. Estrogen likely affects the cardiovascular system in other ways, too, that are not yet understood. (Dr Leslie Cho, MD – Cleveland Clinic)

Estrogen is known to be cardioprotective, so naturally declining estrogen puts woman at greater risk for cardiovascular issues, including circulatory issues. This means your arms, legs, feet, hands or indeed just your skin may feel cold, tingly or numb.

I experienced this in my toes – my little pinky toe would just go numb sometimes. I would wriggle my toes and there was just a weird empty feeling where pinky should be. She was pink and healthy looking, just strangely numb.

Naturally there are other reasons you could be experiencing these sensations, so please see your doctor before you chalk it up to another perimenopause symptom.

Here is a great video from The Menopause Society that talks about estrogen and cardiovascular health.

5. Feeling extra anxious and irritable?

I knew I was irritable – my irritability was so tangible I could taste it. It was like I had constant PMT. But the anxiety was a little more masked. And it’s really only in hindsight and with the gift of MHT that I can look back and go, oooooh yeah, I was super anxious ALL THE TIME!!! Small things became big things and big things became catastrophic.

The falling levels of oestrogen, progesterone and testosterone influence your brain. The resulting imbalance of lower chemicals such as serotonin and endorphins – and increased ones such as cortisol and adrenaline – can lead to feelings of anxiousness and irritability.”

Dr Radhika Vohra (The Menopause Charity)

While hormonal fluctuations and decline are a great answer as to why anxiety increases during perimenopause, there is also research that shows a strong and vital relationship between dopamine and estrogen and estrogen as a neuroprotectant.

Estrogen influences dopamine by affecting its production…This means that higher estrogen levels can lead to increased dopamine production in certain brain regions. (neurolaunch.com)

Estrogen also affects dopamine receptors. It can increase the density of dopamine receptors in some brain areas, particularly those involved in reward and motivation. This enhancement of dopamine signaling can lead to increased sensitivity to the effects of dopamine, potentially influencing mood and behavior. (neurolaunch.com)

6. Who am I?

My perimenopause began as a loss of self – just pieces of me slowly disappearing. A general feeling of meh.

My friend’s experience was an entire shift of her personality:

I felt like someone else, someone I didn’t know or understand. My interests had changed, and my personality had changed. Would it stick? Was it permanent? Should I get rid of the stuff associated with my old personality? Or would I eventually revert back? I had no idea!

I remember going to an art installation which is something I usually loved. But I hated it, I didn’t want to be there. And yet I loved it and DID want to be there. Both of these feelings existed simultaneously and at equal volume. (KC)

7. Bladder problems and Genitourinary syndrome of menopause (GSM)

This is a super fun one and I haven’t experienced it myself, although because I know people who have, I am taking preventative measures via an estrogen cream.

My friend described her experience with severe bladder problems as ranging from extremely uncomfortable to extremely painful. She said she woke up regularly feeling like she had to go to the toilet, as though she had a urinary tract infection, but after being treated for a UTI, soon realised it was something else. She said at one stage; she felt her bladder was prolapsing and after a self-assessment she found things were not where they were supposed to be.

And if all of this wasn’t bad enough, the whole area around her vulva felt painful, like spines and spikes were sticking out of her – she could barely walk. She sent me the pic on the right as a floral representation of her pain. And yep, it’s bloody funny, but I also involuntarily crossed my legs! I found the one on the right hilarious so obviously had to include that one too.

Genitourinary Symptom of Menopause (GSM) is a massive problem affecting more than 70% of peri and post-menopausal women. It is characterised by: urinary leaking and incontinence; increased UTIs; vaginal dryness, itching, and burning; painful intercourse; and low libido.

8. Cold Flashes

Sure, you’ve heard about hot flashes, but have you met the complete opposite, the evil twin of the hot flash: the COLD FLASH?

Essentially, the hypothalamus gland, which regulates body temperature, can become more sensitive to small changes in body temperature, causing it to overreact.

Some really lucky women get to experience them one after the other, going from sweating to freezing and back again.

9. Sleep issues

Estrogen and progesterone help regulate sleep by buddying up with neurotransmitters (serotonin and gamma-aminobutyric acid (GABA)), which promote relaxation and sleep. So, you can imagine fluctuating and declining hormones may well influence your chances of a good night’s sleep.

Estrogen not only buddies up with neurotransmitters, but it also works with the hypothalamus to control your body temperature and give that crucial drop in core temperature necessary for sleep. Estrogen ALSO helps maintain the circadian rhythm and has a mood-stabilising effect through its relationship with dopamine and serotonin. Estrogen is ALSO thought to help transition through different stages of sleep, ensuring we reach the restorative deep sleep and REM phases.

Progesterone is a little workhorse too who enhances the calming effects of the GABA neurotransmitter and acts as a natural sedative. It’s so effective that I love the 2 weeks of the month that I take progesterone before bed.

All of this to say, you will most likely experience sleep issues during perimenopause. Do what you can to protect your sleep.

Here are some things I do:

• Sensory deprivation: around pre-dawn, I always wake up and put on my blackout sleep mask and pop in my ear plugs. The dawn hours are dangerous for me – if something wakes me up, I have trouble getting back to sleep.
• Temperature control: Whether it’s a fan or AC, I try and keep my bedroom cool.
• Limit fluid after 7: you do not want to start a bad bladder habit! Your bladder has enough to worry about during perimenopause. Drink HEAPS of water during the day, but nothing after 7 (or 3-4 hours before bed).
• Sleep alone: I know, I know, some of you may love sleeping with your partners. You do you, but I don’t want to be woken up by snoring, movement or ANYTHING!

10. I feel stupid… a lot.

Brain fog and lack of concentration is a big one. It comes into the sphere of not really feeling like yourself and then it goes one step further by making words not come out rightly, or you can’t say things proper, or words come out wrong-like… grammar is stupid anyway.

I have things to say but I often can’t get them from my head out of my face hole.

KC

Here is an interesting article about brain fog.