More than just hot flushes: The perimenopause symptoms we don’t talk about

We are all familiar with women who have hot flushes or irregular periods before they get their “change of life”. But what is less spoken about – yet as common – are the cognitive issues, the emotional issues, and the downright embarrassing issues.

Perimenopause (which means near menopause) is the period during which your body transitions to menopause. Estrogen and progesterone – two hormones secreted by the ovaries – are responsible for ovulation and menstruation. As you age, your ovaries start producing less estrogen to the point where they will stop releasing eggs altogether. The decline in estrogen also affects the balance with progesterone, causing these hormone levels to fluctuate, hence all the perimenopause symptoms!

Perimenopause usually starts when you’re in your early 40’s and can last anything from two to ten years before menopause sets in. When you’ve had 12 months of no periods, you’ve officially reached menopause.

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Here’s what you can expect as you transition:


Physical changes
  • Irregular periods. Your flow might get heavier or lighter, you may skip periods, and the length of your period may get longer or shorter.
  • Hot flushes and night sweats (a sudden feeling of warmth that spreads across your body). These can vary in intensity, length, and frequency.
  • Sleep disturbances. Whether it’s due to hot flushes, night sweats or not, sleep becomes unpredictable.
  • Vaginal and bladder problems. With decreasing estrogen levels, the vaginal issues lose lubrication and elasticity, while the muscles in the bladder and pelvic floor weaken. This causes vaginal dryness and may lead to painful sex, vaginal infections, urinary tract infections (UTIs), the need to urinate frequently, and even urinary incontinence.

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  • Decline in libido.
  • Decreasing fertility. With irregular ovulation, your ability to conceive drops. However, as long as you’re having periods, you can still get pregnant!
  • Weight gain. Many women experience weight gain, which can be linked to a drop in estrogen levels, low-quality sleep, and age-related metabolism changes. The weight is often redistributed to the belly, hips, and thighs, giving one a more apple-shaped body.

You’re also at risk for:

Osteoporosis – declining estrogen levels cause loss of bone mass more quickly than you replace it.

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Heart disease – declining estrogen levels may lead to adverse changes in blood cholesterol levels.

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The lesser-known physical symptoms include dry eyes, acne breakouts, hair thinning on your head and – eek! – more facial hair.

Emotional changes

According to a paper on perimenopause published by the Obstetrics & Gynecology International Journal1 , “Progesterone and estrogen, while responsible for female sex characteristics (the female body and procreation), are also highly influential in our moods. Progesterone is the ‘feel good’ hormone; it is the calming, soothing antidote to the very energising (and sometimes stress-inducing) estrogen.”

It is during ovulation that calming progesterone is produced and released. When there is no ovulation, there is no production of progesterone, leaving women without one of their most calming hormones.” As a result, you may have mood swings and be chronically irritable. For those suffering from mental health conditions such as anxiety or depression, perimenopause may actually make it worse.

Cognitive changes

Over 60% of women experience cognitive difficulties (memory, recall and processing) during perimenopause and menopause. The UK-based non-profit, The Menopause Charity, explains that estrogen and testosterone – another female hormone – play an important role in cognition and memory. When their hormone levels decrease, it can lead to subtle and “possibly temporary”2 cognitive problems, including:

  • brain fog
  • memory loss, also affecting verbal memory (learning and remembering information new words you have heard) and verbal fluency (quickly retrieving words from your memory)
  • difficulty staying focused
  • losing your train of thought

Perimenopause is a natural progression in a woman’s reproductive cycle, and even though these changes can be overwhelming, there are tools and treatments available to continue living your best life. If you’re concerned about any of these issues, speak to your healthcare provider and schedule regular check-ups to monitor your health.



  1. Wagner D. (2016). Perimenopause – The untold story. Obstetrics & Gynecology International Journal. 5(1):248-249. DOI: 10.15406/ogij.2016.05.00140.
  2. Gurvich, C., Zhu, C. & Arunogiri, S. (2021). ‘Brain fog’ during menopause is real – it can disrupt women’s work and spark dementia fears. The Conversation [Online]. Accessed on 12 April 2023. Available from can-disrupt-womens-work-and-spark-dementia-fears-173150



  1. Cleveland Clinic. (2021). Perimenopause. Cleveland Clinic [Online]. Accessed on 12 April 2023. Available from 
  2. Gurvich, C., Zhu, C. & Arunogiri, S. (2021). ‘Brain fog’ during menopause is real – it can disrupt women’s work and spark dementia fears. The Conversation [Online]. Accessed on 12 April 2023. Available from 
  3. Mayo Clinic. (2021). Perimenopause. Mayo Clinic [Online]. Accessed on 12 April 2023. Available from
  4. Rosser, M. Everything you need to know about perimenopause. Columbia University Irving Medical Center [Online]. Accessed on 12 April 2023. Available from 
  5. Sharkey, L. (2021). 9 ‘Weird’ Perimenopause Symptoms and How to Manage Them. Healthline [Online]. Accessed on 12 April 2023. Available from have-weird-symptoms-with-perimenopause 
  6. The Menopause Charity. (n.d.). Brain Fog. The Menopause Charity [Online]. Accessed on 12 April 2023. Available from
  7. Wagner D. (2016). Perimenopause- The untold story. Obstetrics & Gynecology International Journal. 5(1):248-249. DOI: 10.15406/ogij.2016.05.00140.
  8. Weber, B (2022). What is the connection between menopause and UTIs?, Medical News Today [Online]. Accessed on 13 April 2023. Available from 

These articles are for information purposes only. It cannot replace the diagnosis of a healthcare provider. Pharma Dynamics gives no warranty as to the accuracy of the information contained in such articles and shall not, under any circumstances, be liable for any consequences which may be suffered as a result of a user’s reliance thereon.

The information the reader is about to be referred to may not comply with the South Africa regulatory requirements. Information relevant to the South African environment is available from the Company and in the Professional Information/Patient Information Leaflet/Instructions for Use approved by the Regulatory Authority.

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