The reason? Estrogen affects neurotransmitters in the brain that impact memory, mood, and sleep, so fluctuating levels can result in cognitive changes. Hormonal shifts may also alter how brain cells are produced and connect with other cells and may lower the brain’s main fuel source, glucose. These changes can manifest as forgetfulness, confusion, or difficulty concentrating. If you tend to get hot flashes, your brain fog may also be worse, research suggests, thanks to the way the uncomfortable symptoms disrupt sleep and affect quality of life and mood.
2. Sleep problems
Speaking of sleep: About half of perimenopausal women say they struggle to get a good night’s sleep, according to research. This can look like having trouble falling asleep in the first place or experiencing sleep disturbances throughout the night. For example, you might doze off with no problems but then wake up at 3 a.m. feeling anxious or energetic, Karen Horst, MD, a reproductive psychiatrist and assistant professor of obstetrics and gynecology at the Baylor College of Medicine in Houston, Texas, tells SELF.
Levels of the sleep hormone melatonin start to decline during perimenopause and drop more once a woman is in menopause. Stress, which tends to intensify during perimenopause, can also cause sleep disturbances. Additionally, estrogen fluctuations can affect the part of the brain that regulates temperature, triggering hot flashes and night sweats, which may also lead to restless sleep and frequent awakenings throughout the night.
3. Anxiety and mood changes
Mood shifts, including irritability, frustration, or difficulty dealing with life’s complications, often come up during perimenopause, Dr. Horst says. Estrogen fluctuations can even contribute to mood disorders and other mental health problems. But you might not connect these changes to perimenopause at first. After all, your 40s are a time when you have a lot going on: perhaps a demanding job, numerous financial obligations, raising children, and caring for aging parents. Layer on the political and social issues of today, and it gets complicated, Dr. Adams adds. “Our stress is traffic and deadlines and our kids and climate change and politics and all the things,” she says. “We’re swimming in this cortisol soup all the time.”
4. Joint and muscle pain
If your knee suddenly starts aching after a workout or you get muscle cramps for seemingly no reason, perimenopause could be to blame. More than 70% of perimenopausal women experience musculoskeletal pain, and many others deal with muscle tightness, stiffness, and aches, research shows. “I have patients tell me their feet hurt in the morning; they have to be kind of ginger about their first steps,” Dr. Horst says.
