Changes Associated with Perimenopause 

Sudden intense heat in face, neck, and chest which may come with perspiration, quickened heart rate, anxiety, and may be followed by a period of feeling chilled. Night sweats are hot flashes that happen at night.

Along with shifts in period frequency, this is one of the signature hallmarks of perimenopause. Hot flashes and night sweats often peak in post menopause.

These are believed to be caused by the decreases in estrogen and increases in FSH which are hallmarks of perimenopause and menopause. However, since experiences vary widely it is believed there are other factors also impacting the prevalence of hot flashes & night sweats.

Average hot flashes per day range from 4 to 20.

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(Avis et al, 2018)

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Menstruation might be more or less frequent or there may be significant changes in flow. All of these could be signs of perimenopause.

Trouble falling asleep or waking after falling asleep.

Sex hormones play a role in sleep regulation so the fluctuations of these hormones during perimenopause may introduce new challenges with sleep. (Coborn et. al, 2022 and Pengo, et. al, 2018) While there is a link between night sweats and decreased ability to sleep through the night, night sweats are estimated to account for less than 30% of the sleep disturbances in perimenopausal women. (Coborn et. al, 2022and Summer, 2024)  Restless Legs Syndrome (RLS) and Obstructive Sleep Apnea (OSA) are two conditions found in roughly 50% of women with trouble sleeping during perimenopause. (Summer, 2024)

Anxiety and frustration with a lack of trust in one's own ability to sleep can create a viscous cycle of sleep disturbances. (Summer, 2024)

There is evidence to suggest these disruptions continue through post menopause (Pengo, et. al, 2018).

Proportions of fat and lean mass shifting as women head into menopause. So while the scale might read the same, there might be more fat and less muscle. At the start of perimenopause, fat gain rates double and lean mass declines. These changes stabilize within 2 years of experiencing menopause. (Greendale et al, 2019)  Estrogen and FSH are both linked to changes in fat mass, and both of these hormones fluctuate significantly as women prepare for and move through menopause. (Fenton, A., 2021)

These changes highlight reductions in metabolism, changes in liver function, insulin resistance, and lower satiation rates which can lead to increased weight gain and low grade inflammation.  These changes and the risk factors associated with them can be alleviated through lifestyle. Nutrients including Vitamin D, Calcium, Vitamin C, B Vitamins and protein are all thought to play a large role in alleviating some of the risk factors mentioned above. (Erdelyi, et al, 2019)

The links between the gut microbiome, Estrogen, and FSH aren't well understood. Some preliminary research in animals has shown the gut microbiome may impact estrogen metabolism. (Fenton, A., 2021)

Skin. As estrogen levels decline, skin loses thickness, collogen, and elasticity. (Thorton, MJ, 2013) Skin may also take longer to heal from wounds. (Thorton, MJ, 2013) There may also be more dark spots and irregularities in pigmentation. (Bravo et al, 2024)

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Hair. Decreases in estrogen may lead to thinning hair and or the increase of hair growth on the face. (Zouboulis et al., 2022)

Nails. May become brittle or have increased ridges. (Zouboulis et al., 2022)

All of these changes were grouped together in 2014 to be called Genitourinary Syndrome of Menopause. The name here can be confusing since it's called of Menopause. It's called of menopause because if left untreated, the symptoms will persist or worsen. So unlike hot flashes, these don't typically go away on their own once hormone levels even out. If someone is going to experience symptoms here, they often begin in perimenopause and continue until they're treated. These changes are driven by decreases in estrogen levels. Decreases in estrogen levels can change structures, pH, and microbiomes of these systems.  Some more specific examples of what these changes can entail include: vaginal dryness, irritation, burning, pain during sex, pelvic pain, UTIs, increased urinary frequency, and urinary incontinence. These changes can significantly impact quality of life and are treatable. (Carlson & Nyugen, 2024, and Park et al., 2023)

Lactobacilius are the predominant microbiota in the biome of the vagina before the overall decline in estrogen which begins in perimenopause. Once estrogen declines so do the number of lactobacillus throwing the balance of the biome out of whack, which is when women sometimes experience physical changes and discomfort. (Mercier et al, 2023)

Women who suffer from urinary changes including symptoms in their urinary tract are 7x more likely to experience painful intercourse and are 4x more likely to have issues becoming sexually aroused. The two systems are linked, and treating urinary issues can have significant impacts on sexual health and quality of life. (Wasserman & Rubin, 2023)

Since the name changed recently (2014), here are some other names these changes have gone by: vulvovaginal atrophy

Typically reported and researched as changes in verbal skills, attention, processing speed, and short term memory.

Changes in hormone levels can lead to feelings similar to those experienced in PMS.

Specific symptoms include irritability, depression, anxiety, low energy, and difficulty concentrating. (Mallory, AB, 2022)  These changes are driven by fluctuations in hormones ahead of menopause. They may no longer be linked with menstrual cycles.

There is a link between prior history of depression or bipolar disorder and relapse during perimenopause. (Musial, et al, 2021) 

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Many of the hormones which fluctuate significantly during perimenopause (Estrogen, Progesterone, and FS)  have an impact on production of and reception of serotonin. Serotonin helps your body with cognitive function, happiness, temperature, sleep, sex drive, and hunger. (Cleveland Clinic, 2025)

Coming soon..

Declining levels of estrogen impact arousal and can also impact vaginal dryness, vaginal tissue density, and urinary issues.

Changes driven by hormonal shifts during this time may also be impacting sex drive. So, resolving other changes, may help with changes in sex drive. Lack of sleep, depression, and anxiety have been linked to a decrease in sex  drive (Woods et al, 2010)

Experiencing any of the changes described above can be unsettling. They may also be keeping you from engaging in activities you used to enjoy or engaging with friends in the same way you did before.  (Menopause Center 2025)

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Many women report feeling more confident once they're post menopause.