I'm hot all the time! Am I in perimenopause?

what perimenopause is

Hot flashes and sleep problems are common during perimenopause, but they are not the only symptoms of perimenopause. Perimenopause is a transitional period in a woman's life, before entering menopause. It usually occurs in the mid-forties, although it can also start in the late thirties. Perimenopause, ie the period before the final cessation of the menstrual cycle, can last from two to ten years.

What happens in perimenopause?

Already in perimenopause (and not at the beginning of menopause, as it was once thought), the ovaries produce less estrogen, the level of which can change considerably, to be an hour higher, an hour lower… These changes in hormone levels can significantly disrupt a woman's daily life. 

Since there is no universal cure, the approach to solving these problems is individual and is based on testing methods and preparations until a final solution is discovered. In addition to the type, the symptoms also vary in intensity - about 25% of women will not feel the pronounced symptoms. 

Half will have problems that can be eliminated by changing their life habits, while the rest will need medical help - such as hormonal preparations or antidepressants to alleviate hot flashes. In any case, you will not experience all the symptoms of perimenopause, but it is good to know that you recognize them. Irregular menstruation and hot flashes are the most common.

Irregular menstruation

As ovulation becomes more unpredictable, the period between menstruations can be longer or shorter. If your menstrual cycle is constantly changing, seven days or more, you may be in early perimenopause. If the period between two menstrual periods is extended to 60 days or more, you may be already in late perimenopause. 

But irregular menstruation is not the only change. It can happen that your menstruation suddenly becomes painful, hard, or if you have had long-lasting and heavy bleeding before, that it suddenly becomes scarce.


Hot flashes are a common occurrence and one of the main symptoms of perimenopause. They can be described as a rising wave of heat from within that makes your whole body overheat. Hot flashes are even more common in menopause - they affect about 75% of menopausal women. Hot flashes can be of different intensity and duration, they can occur only a few times during the day or much more often. Fortunately, hormone replacement therapy is very effective in solving this problem.

Sleep problems and night sweats

Some women wake up sweating during the night because of the hot flashes, they are so wet that they have to change their nightgowns and bedding. Like hot flashes during the day, night sweats are a vasomotor symptom - the body temperature regulator does not work properly due to changes in hormone levels. 

These bursts of heat, hot flashes, and night sweats cause sleep problems. Frequent waking during the night leads to insomnia and fatigue, but sometimes sleep becomes unpredictable and without hot flashes.

Mood changes

Even before menopause, in the period when the levels of sex hormones begin to oscillate, sudden mood changes often occur. As many as a third of perimenopausal women say that they feel inexplicably in a bad mood. You can feel yourself suddenly becoming irritable, on the edge of your nerves, without any patience or control. 

This can create problems not only for you but also for your family and loved ones. During perimenopause, the risk of anxiety and depression increases, and a bad mood can overwhelm you so much that you can't see the way out. 

Exhausting physical symptoms of perimenopause, hot flashes, night sweats, disturbed sleep, but also factors that are not related to hormonal changes contribute to a bad mood.

Fatigue and headaches

During this period, you will probably feel constantly tired and exhausted. The cause of that is low levels of estrogen but also disturbed levels of progesterone, thyroid hormones, and adrenal glands. The amount of energy depends on all these hormones, so when they are disturbed, women feel exhausted and chronically tired.

Changes in hormone secretion can also cause worsening headaches during perimenopause. However, at menopause, this symptom recedes.

Problems with the vagina and bladder

When estrogen levels start to drop, you will feel itching and discomfort during sex. Due to the lack of estrogen, the vagina and the inner mucosa of the vulva are not sufficiently "lubricated" and elastic and are easily irritated during intercourse, which causes pain. 

Topical estrogen or hormone therapy may help. Low estrogen levels also lead to more frequent urinary or vaginal infections. And the loss of tissue tone can cause urinary incontinence.

Decreased libido

During perimenopause, sexual arousal often changes. Even if you had a satisfactory libido and sexual intimacy before menopause, it can easily happen that you suddenly don't feel like having sex at all. When the level of estrogen and testosterone (yes, this "male" sex hormone is also produced in a woman's body!) 

Drops drastically during menopause, the consequence can be a decrease in sexual desire. To return your libido to the old setting, you will need a lot of understanding from your partner.

Primenopause Sleep problems

Decreased fertility

In perimenopause, ovulation becomes irregular, and your ability to conceive declines. Fewer and fewer eggs mature in the ovaries. However, as long as you have menstruation, pregnancy is still possible. If you want to avoid pregnancy, use contraception until you enter menopause, ie. until you have menstruated for 12 months.

Irregular heartbeat

Keep in mind that heart palpitations may also occur during this period due to changes in hormone levels. This is often associated with hot flashes, but it doesn’t have to be. If these palpitations are accompanied by difficulty breathing or a feeling of fainting, schedule a medical examination.

Change in cholesterol levels

Low estrogen levels and aging can also lead to changes in blood cholesterol levels. It increases the level of bad cholesterol (LDL) and decreases the level of good cholesterol (HDL) - which contributes to an increased risk of heart disease.

Digestive problems

Hormonal changes can lead to IBS-type symptoms, such as bloating, indigestion, constipation, diarrhea, and cramps. Estrogen causes bloating because the body retains water. However, this should always be discussed with your doctor, as bloating and pain can be a symptom of other more serious conditions, including ovarian cancer.

Itchy skin

Studies more than twenty years ago showed that the skin becomes thinner and more fragile in women after menopause. Collagen is also affected, which makes women more prone to wrinkles. There is evidence that HRT enhances hydration, skin elasticity, skin thickness, and also reduces skin wrinkles.

Hair loss

Hair loss is not uncommon in perimenopause. In some women, pulling hair around the temples begins to be noticed, in others, thinning hair. Blood tests can show if this is due to an increase in androgen levels. The cause can be perimenopause, but also oral contraceptive pills or polycystic ovary syndrome.

Poor concentration and memory

Poor memory and difficulty concentrating are common symptoms of perimenopause. Due to fluctuating estrogen, we can't remember the "right" word!

Weight gain

The increase in body fat during perimenopause and menopause is associated with decreased estrogen levels, poor sleep, and slowed metabolism, as well as a loss of muscle mass.


Changes in the levels of the female hormones estrogen and progesterone can affect the circulation and blood vessels. And due to fluctuations in blood pressure, dizziness can occur.
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