No. There is a great deal of variability in the types and severity of symptoms. Genetics may play a role, so if possible, looking at your family history can help set your expectations for your own symptoms.

1. Dennerstein L, Dudley EC, Hopper JL, et al. A prospective population-based study of menopausal symptoms. Obstet Gynecol. 2000; 96:351–358. [PubMed: 10960625]


Your reproductive hormones are the main hormones changing their levels. These include estrogen and progesterone (from your ovaries), and luteinizing hormone (LH) and follicle stimulating hormone (FSH) from your hypothalamus located in your brain. During perimenopause, estrogen levels decrease overall, but might vary between very high or very low levels. These hormonal swings may account for mood disturbances (mood swings) and hot flashes.


2. Melmed et al.Williams Textbook of Endocrinology 14th edition.

3.Santoro_2016_Perimenopause: From Research to Practice

4. Allshouse et al._2018_Menstrual cycle hormone changes associated with reproductive aging and how they may relate to symptoms

5. Minkin_2019_Hormones, Lifestyle, and Optimizing Aging


Yes, this is a normal symptom. As estrogen declines during the perimenopausal transition, inflammation in your system develops because estrogen modulates your immune system and the biochemical signals that cause inflammation. You may notice you are developing osteoarthritis in some of your joints, and old joint injuries may begin to hurt and become stiff. As well, some women may experience an increase in their auto-immune disease symptoms.

To date, it isn’t known whether standard HT with estrogen is helpful for joint pain and inflammation. However it is known that joint inflammation can be reduced by regular moderate exercise including modified strength training. Low- impact exercises such as swimming and cycling are excellent at reducing pain and inflammation, promoting high quality sleep and they won’t damage your spine, knees and hips.


Episodes of rage and anxiety are normal. They may be intense but usually pass quickly. Changes in mood are not very well understood so treatment options are currently limited.

If you are concerned about your rage, seek help from your healthcare provider and/or trained counsellors/psychologists. As well, talking openly about this challenge with family and friends can help them understand what is happening and allow them to support you in ways that are meaningful to you.


Regular cannabis use by mid- life women in North America is fairly new and there is not much data on the safety and effectiveness of cannabis with respect to menopausal symptoms. Make sure your care provider knows about your cannabis consumption, particularly if you are using prescription medications.

Hot flashes can be addressed in many ways but it’s best to collaborate with your care provider to find a therapy that works for you. Hormone therapy (HT) can be effective at reducing the frequency and intensity of hot flashes for many women. Antidepressants, meditation and relaxation techniques work also well as they lower stress hormones. Ensuring you are eating a well-balanced nutritious diet can also help.

A Stress urine leakage or stress urinary incontinence (UI) occurs when the pressure in your bladder is stronger than your urethra, the tube that empties your bladder. You may pee suddenly when lifting, jumping, laughing or sneezing. Stress UI happens during perimenopause and post-menopause when the muscles that keep your urethra closed weaken due to lack of hormonal support.

You can help strengthen your pelvic floor muscles with Kegel exercises – see a trained physiotherapist to get training on the correct set of exercises for you. HT with estrogen applied topically (in creams or tablets) within the vagina is effective for both dry vaginal pain and urinary incontinence. The outer third of the urethra is estrogen-sensitive. When the estrogen cream is applied to the vagina it can increase blood supply to the urethra and nerve function which can help strengthen the muscle.

It might be also advised to stay away from caffeinated drinks because caffeine is a bladder irritant.

You should request a bone density exam by age 65 in order to test for osteoporosis (fragile bones). If you are at risk for low- impact fractures (because of family history) or you have had a low- impact fracture, request this exam by age 50. Low impact fractures commonly occur from falls and result in breaking a wrist or fracturing a vertebrae or hip bone). These types of fractures indicate you may be developing osteoporosis. Losing height by 1.5 inches or more also suggests that you may have some osteoporosis in your spine.

Women who are low-normal or below normal weight, who smoke, drink alcohol, and have low rates of exercise are at higher risk for osteoporosis in post- menopausal life.


This isn’t necessarily due to menopause! During the aging process, the lens of your eye undergoes natural changes that may make it harder to adjust your focus. However, decreasing estrogen in your blood can disrupt tear and oil secretions needed for lubricating your eyes, which can make vision blurry or dry your eyes. Your optometrist or your pharmacist can help with therapies for these symptoms.

Yes! Until you have had 12 consecutive months without a period, use contraception if you don’t intend to get pregnant.

Note that women who become pregnant after age 35 have an higher risk of miscarriage, and more than half of all pregnancies after age 45 end in miscarriage.

American Society for Reproductive Medicine


Mood swings are normal. They can be mild, very strong and disorienting or even make you feel giddy or reckless. Episodes of rage and anxiety may be intense but usually pass quickly. Mood swings are not very well understood so treatment options are currently limited.

If you are concerned about your mood swings, seek help from your healthcare provider and/or trained counsellors/psychologists. As well, talking openly about this challenge with family and friends can help them understand what is happening and allow them to support you in ways that are meaningful to you.


Two things happen to women mid-life: their biological metabolism slows down and hormone levels change, both of which can lead to an increase in weight gain. Two hormones in particular are known to affect weight gain: estrogen (that declines), and follicle stimulating hormone (FSH) (that increases).

As well, women often decrease their exercise and movement levels, may eat more and drink more alcohol, and their quality of sleep decreases. All of these factors combined can cause weight gain, particularly around the middle – called central adiposity. Weight gain is not inevitable – simple actions such as walking 30 minutes daily and paying extra attention to healthy nutrition can help manage this impact.


There are options to help reduce or manage some symptoms. The primary tool is called Hormone Therapy (HT), also called hormone replacement therapy (HRT), menopausal hormone therapy (MHT), or hormone management therapy (HMT). HT is helpful for decreasing hot flashes, improving the health of your vagina and urinary systems, and supporting your muscle and bone health and strength.

Unfortunately, other symptoms may not respond as well to HT. Physiotherapy can help with physical pain and psychological counseling and therapy can help with emotional troubles. Lifestyle changes to promote quality sleep, good nutrition, and exercise are important and known to decrease menopausal transition symptoms.


No, about 20% of women have mild or no symptoms, or don’t seek medical care. About 40% of women have mild to moderate symptoms and seek medical care. Another 20 % have intense symptoms and need medical care.

Generally, women who have a high BMI and chronic stress in their lives tend to have more menopausal symptoms and those symptoms last for longer periods of time. Genetics may also impact your perimenopausal symptoms. There is a good correlation between the length and intensity of your menopausal transition and your mother’s menopausal transition.