Perimenopause: Key Signs, Hormone Shifts and the Transition to Menopause
- Feb 21, 2022
- 5 min read
Miyara Women | Feb 21, 2022 | Updated: Jun 19, 2024
Are you in your 30s or 40s? Are you experiencing night sweats, irregular periods, dry, itchy skin, or other strange symptoms? Are you confused about what might be causing it? You might be wondering, isn't it too early for menopause? Could these symptoms be caused by something else? You aren't totally wrong. You might just be experiencing perimenopause, and in India, where only 18.1% of rural women are aware of menopausal symptoms compared to 51.4% of urban women, most of us are navigating this transition entirely on our own.
What's the Difference Between Menopause and Perimenopause?
Menopause, the end of the menstrual cycle, is a topic that has attained a fair degree of familiarity around the world. The average age of menopause in India is 46 years — nearly four years earlier than the global average — which means Indian women are entering perimenopause in their late 30s or early 40s, often without realising it. However, there is yet another important stage experienced by women which needs to be talked about too – the "perimenopause."
"Peri" meaning "around" is the transitional stage that occurs before menopause. Menopause is just one day, the anniversary of your last period. Perimenopause is the 4 to 10-year lead-up to that day.
What Exactly Is Perimenopause?
Perimenopause is your ovaries' way of preparing for menopause. The ovaries gradually decrease their secretion of estrogen, the hormone that regulates the menstrual cycle. The fluctuation in estrogen results in irregular menstrual cycles, usually the most noticeable marker of looming menopause. The drop in estrogen escalates in the last one or two years before menopause, when many women start to experience typical menopausal symptoms. It's important to note that the ovaries continue to release eggs through the perimenopause period, so perimenopausal women can get pregnant.
There are two stages of perimenopause – the early transition stage with relatively fewer interruptions in the menstrual cycle and the late transition stage, where the cessation of the menstrual cycle could last even up to 60 days.
How Do You Know If You Have Entered Perimenopause?
One important thing to understand first: in India, perimenopause is frequently misattributed to stress, aging, or unrelated illness. Research published in BMJ Global Health notes that cultural stigma around aging means women often link symptoms to "getting older" rather than a specific hormonal transition — delaying care by years. Watch out for these symptoms.
Hot flashes are experienced by 30 to 70% of perimenopausal women. They are characterized by sudden sweating (or flushing) lasting for 5 to 10 minutes. The intensity and duration vary from person to person. Some simply feel warm, while others sweat profusely.
Sleep disturbances – When hot flashes occur at night, they are called night sweats. As one can imagine, they can disturb sleep.
Vaginal dryness – During the late perimenopause stage, estrogen levels decline drastically. This may cause the vaginal tissue to become thin and dry, which leads to irritation and itching. It might cause pain during intercourse and lead to reduced sexual desire.
Mood changes – The body goes through numerous changes during perimenopause. Whether due to the lack of sleep and discomfort associated with perimenopausal symptoms, or the decline in estrogen's effect on mental health, irritability, anxiety and depression may be symptoms of perimenopause.
A study published in the Journal of Midlife Health on women in Uttarakhand found that the most prevalent symptom was muscle and joint pains (55.81%), followed by feeling tired or a lack of energy (51.19%) and feeling unhappy or depressed (36.43%). Notably, Indian women report higher rates of physical symptoms like joint pain compared to Western women, who more commonly lead with vasomotor complaints like hot flashes. Pan-India studies on menopausal symptoms are lacking — a research gap that scientists have repeatedly flagged. Discuss with your physician if you experience these changes.
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Why Is Perimenopause Important to Be Aware Of?
Estrogen does more than just regulate the menstrual cycle. It is a hormone that has functions all over the body. Thus, the changes that accompany perimenopause need to be taken note of so that problematic health effects do not occur. As Dr. Stephanie Faubion, MD, noted at ACOG 2024, "women really are suffering from these often" — and solutions exist.
Increase in cholesterol – Estrogen plays an important role in cholesterol regulation. Due to the decreasing estrogen, perimenopause may lead to an increase in low-density lipoprotein (LDL) cholesterol levels, which is referred to as "bad cholesterol." Regular blood tests will become your best friend!
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Heart disease – Along with monitoring cholesterol levels, estrogen helps maintain the flexibility of blood vessels, aiding their relaxation and constriction to accommodate proper blood flow. An increase in cholesterol levels and a decrease in flexibility increases the risk for heart ailments. Research confirms that after menopause, the incidence of heart disease increases in women at a faster pace compared to men. Studies have shown that the first myocardial infarction attack occurs in 4.4% of Asian women at a younger age than in European women.
Diabetes – Metabolism begins to slow down during perimenopause which results in lesser calorie-burning efficiency. The resulting weight gain may make the body insulin-resistant. This leads to an increase in blood glucose levels. In India, type 2 diabetes occurs a decade earlier than in Caucasians.
Alzheimer's disease – Estrogen regulates glucose transport within the brain. Glucose is vital for the brain to produce energy. Estrogen dysregulation during perimenopause could alter this mechanism, leading to cognitive decline which in turn increases the risk of developing Alzheimer's disease. Emerging research now identifies perimenopause as a critical window: women develop Alzheimer's at nearly twice the rate of men, and a $50 million global initiative at Weill Cornell Medicine is actively studying estrogen's role in early prevention.
How Are Perimenopausal Symptoms Treated?
Hormone Replacement Therapy (HRT) counteracts the body's dropping estrogen, alleviates menopausal symptoms, and counteracts early-onset osteoporosis for those who go through early menopause. The 2023 Non-Hormone Therapy Position Statement of NAMS also supports some types of antidepressants, in particular selective serotonin receptor inhibitors, to help alleviate mood swings. Topical estrogen creams help reduce dryness in the vagina.
How Do I Effectively Take Care of Myself During This Transition?
Regular exercise may stabilize mood swings. Avoid exercising before bed as this can disturb sleep further by leading to night sweats. Smoking, caffeine intake, and spicy foods are some hot flash triggers — cut back on them to feel more comfortable. Joining a menopause support group is also worth considering. In India, where a 2025 BMJ Global Health paper calls for urgent, culturally appropriate menopause health programmes, finding or building a community of women going through the same transition may be the most powerful step of all.
Please consult your physician for personalized medical advice. Always seek the advice of a physician or other qualified healthcare provider with any questions regarding a medical condition.
Edited by Aishwarya Viswamitra
About the author
Niranjana S. Rajalakshmi is a veterinary microbiologist turned science journalist, currently based in India. After her under graduation in Veterinary Medicine, she was curious to study diseases at a molecular level which led her to pursue a Master’s in Veterinary Microbiology. When the pandemic struck, she being a microbiologist felt the need to communicate about the hitherto unknown virus and its possible implications to a large audience. Subsequently, she produced several pieces on COVID-19 and other topics related to health, which are being published in leading news outlets in India.
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