Perimenopause and menopause symptoms and treatment options

Menopause is a normal life transition. But it can be a tough one, with significant changes to your body and emotions. Most of these changes are caused by shifting hormone levels.

The good news is that you’re not alone. Whether you’re just starting perimenopause or have been dealing with it for years, we’re here to help you understand common symptoms and discover ways to feel better.

9 common menopause symptoms — and how to feel better

Hot flashes and night sweats

Vasomotor symptoms, more commonly known as hot flashes and night sweats, are the most common symptoms of perimenopause. Hot flashes are just what they sound like — a sudden sensation of heat that can be mild or intense. You might also start sweating or feel anxious.

Night sweats are hot flashes that happen at night and disturb your sleep. Hot flashes usually only last 1 to 5 minutes — but for some people they can last longer. Either way, they can be disruptive and uncomfortable.

How to feel better:

• Dress in layers during the day so you can easily take one off if you have a hot flash. Keep your room cool at night. Moisture wicking clothing can also help.
• Practice deep breathing or relaxation techniques.
• Talk to your doctor about treatments like hormone therapy (HT), formerly known as hormone replacement therapy (HRT). Nonhormonal options are also available.  
• Reduce your use of tobacco, alcohol, and caffeine, which can worsen hot flash symptoms.

Vaginal and bladder changes

Starting in perimenopause, the tissue in your vulva and vagina becomes thinner and less elastic. This can lead to irritation, dryness, and discomfort. You might also feel an urgent need to pee more often, or experience urine leakage.

These concerns aren’t unusual, but it’s important to talk to your doctor about them to rule out an underlying infection or symptom that can be relieved through treatment. They can get worse over time if they’re not addressed.

How to feel better:

• Use vaginal moisturizers and lubricants.
• Try pelvic floor exercises, like Kegels, to strengthen muscles.
• Ask your doctor about low-dose vaginal estrogen.

Weight gain

Weight gain is common as we grow older due to slowing metabolism. During perimenopause, many people notice more weight around their mid-section. You might also find that things you’ve done in the past to maintain a healthy weight no longer work, which is frustrating.

How to feel better:

• Eat plenty of whole foods like vegetables, fruits, healthy fats, and lean protein.
• Make it your mission to move your body every day, in ways that feel good to you.
• Add strength training to your routine to help build muscle and boost metabolism.
• Explore our weight management and healthy eating classes and support groups.  

Trouble sleeping

Many people find it hard to get a good night’s rest during perimenopause and menopause. Things like night sweats, anxiety, and having to get up to use the bathroom more often can make sleeping soundly feel almost impossible. And on top of feeling tired, lack of sleep can make other symptoms more severe. But prioritizing sleep is important.

How to feel better:

• Set the stage for better sleep with a consistent, calming bedtime routine.
• Limit screen time, caffeine, and alcohol, which can disrupt sleep.
• Try sleep or meditation apps, which are available at no cost to most Kaiser Permanente members.*
• Talk to your doctor to rule out other health conditions like sleep apnea.

Mood or mental health changes

Emotional ups and downs are common symptoms of perimenopause and may continue into menopause for some people. Sleep disruption due to night sweats may worsen mood changes and irritability. You might feel worried, sad, tired, or irritable, or have less interest in doing things you used to enjoy. These feelings can be even more severe if you’ve had depression or anxiety in the past.

How to feel better:

• Build healthy sleep habits to ensure a good night of sleep.
• Explore our mental health and wellness resources and support.
• Practice self-care. with apps and other tools.
• Talk to your doctor about what you’re experiencing. They might recommend medication, therapy, or other support.

Memory issues and brain fog

Have you ever forgotten why you walked into a room? Misplaced your glasses only to find them on your head? It could be brain fog. Memory can naturally decline with age and often worsens around perimenopause and menopause. Stress, sleep loss, and hormonal changes are also contributing factors. A lot of people experiencing brain fog worry that they’re developing dementia, but that’s usually not the case.

How to feel better:

• Move your body — it “works out” your brain, too.
• Get a good night’s sleep.
• Keep your mind engaged with things like reading, puzzles, and social activities.
• If you have high blood pressure, diabetes, or high cholesterol, follow your doctor’s recommendations for how to manage them.

Changes in sex drive

Changes to sexual desire are common during perimenopause and menopause. Some people notice a drop in desire (libido), while others feel the same — or even more interested in sex. Certain menopause symptoms, like vaginal dryness, can also make sex uncomfortable.

How to feel better:

• If you have a partner, talk openly with them so they can understand your needs.
• Use vaginal lubricants and moisturizers.
• Try pelvic floor exercises to maintain muscle tone and elasticity.

Hair loss or thinning

Many people experience hair loss or thinning as they age. It’s often due to genetics, but hormonal changes can also play a role.

How to feel better:

• Be gentle with your hair by limiting excess heat and harsh chemicals.
• Ask your doctor about medications that can help keep and regrow hair.
• Share your concerns with your doctor to help rule out underlying health conditions that can lead to hair loss.

Joint and muscle pain

Many people have more aches and pains during perimenopause. Other normal, age-related factors also play a role. Menopause-related joint pain often gets better with time — but there are simple things you can do to find relief.

How to feel better:

• Do gentle exercise like walking, swimming, and yoga to boost circulation and reduce pain and stiffness.
• Use ice packs or warm compresses to help with pain.
• If you need to, take over-the-counter medicines like ibuprofen or acetaminophen.
• Talk to your doctor to help rule out underlying health conditions like arthritis.

Supporting your body and mind through menopause

There’s no one-size-fits-all approach to managing perimenopause and menopause symptoms. What works well for one person might not work at all for another. And you may need to try a few different things before you find your rhythm and start feeling better.

Here are some things that can help — alone or in combination:

Lifestyle changes — A healthy lifestyle can help you manage symptoms. It can also help lower your risk for health problems that become more common after menopause. Helpful healthy habits include:

• Quitting smoking if you’re a smoker, and limiting caffeine and alcohol
• Eating a heart-healthy diet high in calcium and vitamin D
• Exercising regularly to keep your heart and bones strong and lift your mood

Medication — Hormone therapy (HT) mimics the hormones your body naturally loses during perimenopause and menopause. Since the drop in hormones is what causes symptoms, HT can help relieve them. There are 2 main types of HT:

• Systemic hormone therapy is proven to help with hot flashes and night sweats, vaginal and bladder issues, and bone loss. It doesn’t help with weight gain or mood changes.
• Localized vaginal estrogen can help with vaginal and bladder symptoms. It can be a cream, tablet, or ring. It usually has less estrogen than systemic hormone therapy, which means there’s less risk for side effects.

You may have heard that HT can cause cancer. While it’s true that there’s a very small increase in risk, HT is generally safe. The benefits outweigh the risks for most people, but each person is unique. Your doctor will work with you to tailor your HT care so that it’s right for you. There are also nonhormonal medications that can help with hot flashes, sleeplessness, anxiety, and other menopause symptoms.

Cognitive behavioral therapy (CBT) — CBT can help you build positive ways to cope with menopause challenges. Along with individual and group therapy, Kaiser Permanente offers classes, digital apps, and coaching based on CBT. These tools can help with stress, managing weight, and more.

Alternative therapies — Some people find things like acupuncture and acupressure helpful. They can help with relaxation and relieve physical tension. Other people use supplements to help manage perimenopause and menopause symptoms. You can ask your doctor about supplements or alternative therapies anytime.

Give yourself grace — and ask for help when you need it

Remember that there’s no “normal” way to experience perimenopause and menopause. Symptoms can come and go, and may change over time. It’s a challenging transition, but you’ll get through it. And your care team is always here to help you along the way.