Symptoms of Menopause and Perimenopause

Hot Flashes

Women suffering from early stages of menopause often experience hot flashes that range from feeling flushed, sweaty, to hot and cold, or feverish. Women describe their experience in different ways. Many say they literally feel like the heat is coming from the inside of their bodies and that this fluctuation in temperature can come in a flash or can last for days on end. The hot flashes occur when blood vessels open widely, letting more blood flow to the head and neck, causing heat, redness, and frequently perspiration. Sometimes it occurs at night (night sweats), followed by a chill. These hot flashes are usually over in a few seconds, but they always arrive unexpectedly and at the most inconvenient times. They are triggered by falling estrogen levels. For many women, there is a tremendous void in treatment of menopausal symptoms.


Dry Skin

Estrogen is known as the great moisturizer! Menopause and the declining levels of estrogen are directly linked to signs of aging. As the face has many estrogen receptors, low estrogen often shows itself through wrinkles, dry skin caused by less productive oil glands as well as thinner, looser skin due to less collagen production. Replacing missing hormones can help combat the signs of aging that come with hormone imbalance. Hormone replacement therapy can help women regain their youthfulness of their 30’s.


Diminished Sex Drive / Low Libido

Testosterone is the hormone of sexual desire. Perimenopausal and menopausal women often experience a decreased desire for sex caused by an imbalance in the hormones: estrogen, progesterone, and testosterone. Surgical menopause (i.e., removal of uterus and ovaries) causes immediate decline in testosterone by 50% as well as an 80% fall in Estradiol. The decline in libido continues steadily from approximately 30% of 30-year-old women to 50% of 50-year-old women. Women who are having normal periods in their 40’s and 50’s may still be 50% low in testosterone levels compared to 30-year-old women. Testosterone levels are reduced by more than 40% with estrogen replacement. This is because after menopause, the pituitary gland in our brain continues to secrete a hormone (LH) that stimulates the ovary to continue producing androgens. (Libido actually improves for some women after 50.) Adding replacement estrogen, however, keeps the pituitary from producing the androgen-stimulating hormones. Symptoms in addition to decreased or low libido and sex drive and decreased intensity of orgasm may include loss of energy and sense of well being, and affect as many as 50% of menopausal women.


Weight Gain due to Hormone Imbalance

Starting as early as 10 years before menopause, hormone levels decline. These hormone changes often result in an increased craving for sugar. During these menopausal years, the woman’s body is making less estrogen and her body tries to find hormones in other places such as fat cells. As fat cells generate estrogen, the body begins storing more fat. At the same time, the woman’s body is losing testosterone which leads to declining lean muscle. Since lean muscle is responsible for burning fat, the more muscle lost, the more fat will be stored and the more weight gained. These hormone imbalances make it difficult to maintain a healthy weight and nearly impossible to lose weight even with exercise.

One of the biggest reasons women do not take hormone replacement therapy during menopause is because they perceive they will gain weight. In fact, evidence shows women on hormones are less likely to gain weight than women who take nothing during menopause.


Mood Swings

Everyone has a different progression of hormonal changes. During perimenopause and menopause, estrogen levels sometimes fly up extremely high and then crash down very low. These types of hormonal shifts will often precipitate mood swings, as well as irritability, headaches, sleep disturbances, hot flashes, and sexual difficulties. It is normal for menopausal women to be easily upset, especially considering their physiological changes.


Lack of Focus / Decreased Concentration

Some of the earliest symptoms of menopause are frequent waking at night and poor focus. These two symptoms are linked together because poorer quality sleep interferes with rapid eye movements (REM) during sleep. REM is critical to all sorts of thought processes such as problem solving and short-term memory. Going without adequate sleep over time can impair these cognitive functions, leading to a decreased ability to focus and concentrate, a decline in memory, and chronic fatigue. Until you start treating the hormone deficiencies causing the problems, the cycle of menopausal symptoms will not stop.



Sleep disturbances including difficulty in falling asleep and staying asleep are common occurrences among perimenopausal and menopausal women. Sleep occurs when body temperature begins to fall. Heat is lost through the skin and we become drowsy. Shifting hormonal levels during the night upset the mechanisms our bodies use to regulate our body temperature and as a result, we no longer obtain a good night’s sleep. Also, due to fluctuating hormonal levels, women are often awakened by night sweats or hot flashes in the middle of the night, making it difficult to sleep soundly enough to feel adequately rested. These changes in sleep may begin as early as 10 years before menopause. Trouble falling asleep as well as frequent weight gain are common occurrences which leave many women chronically fatigued. This is a result of hormonal changes occurring with menopause.



It has been reported that declining or fluctuating hormone levels in addition to chronically high levels of stress hormone can all lead to depression. Women are, therefore, especially vulnerable to depression starting during perimenopause and lasting into late menopause.

Frequently hot flashes and depression occurring with estrogen deficiency are treated with Prozac or similar antidepressants. These drugs are used to ease the flushes and depression, but why treat the symptoms when you should be treating the deficiency?

Studies have shown that women developing depression in the first few months of menopause responded well to hormone replacement without using antidepressants, so why not give women what they need?


Vaginal Dryness

Estrogen is known as the great moisturizer. It helps stop vaginal thinning and dryness that women often go through during perimenopause and menopause. Estrogen is also the great moisturizer for the skin, hair and eyes, and in fact there are estrogen receptors in the bladder and urethra, and if this is dry, you will get some mechanical friction and irritation, resulting in bladder leakage. Replacing missing hormones will relieve vaginal dryness, reduce bladder leakage, and improve the quality of your skin and hair.


Urinary Leakage

A symptom not often mentioned but very common in menopause is bladder leakage, and this may occur in as many as 70% of women. Why do women experience urinary leakage? The vagina, bladder, and urethra all have estrogen receptor sites. Think of these like a lock and key, with estrogen being the key that fits in the receptor. These receptor cells are very sensitive to falling levels of estrogen. The bladder becomes more sensitive to many stimuli, resulting in an increase in the urge to urinate. In addition, low testosterone results in diminished muscle tone, making it harder to control the muscles that allow you to hold back the need to urinate. With these hormone deficiencies combined, they result in the bladder leakage problems.



Osteoporosis is a chronic degenerative bone disease. Bone loss is often referred to as a “silent disease” because it occurs without symptoms. Bone isn’t lost all at once, it sneaks up on you over a lifetime. Studies show that by their 40’s both women and men are losing bone at a rate of approximately 0.5 percent a year. We now know that a declining level of sex hormones plays a significant role in the development of bone loss and osteoporosis. Replacing your hormones through HRT can help slow bone loss and in some cases partially reverse it.

* All information subject to change. Images may contain models. Individual results are not guaranteed and may vary.