Symptoms can vary from subtle and infrequent to extreme and daily.  They can also be mild, moderate, or severe. 

• Menstrual irregularities and changes in the amount of blood loss (during perimenopause);
  
• Daytime hot flashes and/or night sweats;
  
• Vaginal dryness and thinning;
  
• Insomnia and sleep disturbance;
  
• Weight gain;
  
• Fatigue;
  
• Decreased libido, decrease in arousal and orgasmic response;
  
• Emotional changes- depression, irritability, anxiety, overwhelmed;
  
• Changes in memory and cognition – sometimes referred to as "foggy brain";
  
• Hair loss on head, hair growth and acne of face;
  
• Skin changes;
  
• Heart palpitations;
  
• Nausea;
  
• Migraines and headaches;
  
• Urinary tract infections and urinary incontinence; and
  
• Lesser known symptoms can include frozen shoulder syndrome, dry eyes, gum disease, voice changes and joint pains. 

About 10-25 percent of postmenopausal women will continue to have significant symptoms beyond menopause.  

Menstrual Changes

One of the earliest signs that perimenopause is occurring and menopause is approaching is a change in the menstrual period. 

Many changes can occur- missed periods, periods that are closer together or farther apart, a change in the amount of flow becoming lighter or heavier, and bleeding that may last shorter or longer than what you are used to. It is important that you be aware of bleeding that is not normal for you.  Report these changes to your primary health care provider:

• Change in your monthly cycle;
• Heavy bleeding;
• Bleeding that lasts longer than normal;
• Bleeding more often than every 3 weeks;
• Bleeding after sex; and
• Bleeding between periods.
  

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