Scientists are still learning why some people experience worse perimenopause symptoms than others. Some possible factors that may contribute include a higher body mass index (BMI), smoking, and alcohol consumption.

This information comes from a 2018 review.

In some people, severe symptoms may also be a sign that a person has a different health condition. For example, uterine fibroids may cause symptoms that overlap with perimenopause.

In this article, we will explain what typical and severe perimenopause symptoms might look like, why they happen, and what can help.

A note about sex and gender

Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth. Click here to learn more.

A woman holding a hand to her head due to horrible perimenopause symptoms.Share on Pinterest
Studio Firma/Stocksy

Perimenopause symptoms are severe when they affect a person’s ability to carry out daily tasks or when they significantly affect their mental health. A person may experience:

Not everyone will experience every symptom, though. Having only one of these symptoms intensely could qualify as severe perimenopause.

Researchers are not entirely sure why some people have worse perimenopause symptoms than others. However, research suggests several factors may contribute, such as:

  • having a higher body mass index (BMI)
  • currently or formerly smoking cigarettes
  • drinking alcohol
  • other conditions that worsen or add to a person’s symptoms, such as uterine fibroids
  • earlier onset, as this appears to predict longer and more severe menopause symptoms

Keep in mind that these factors do not guarantee a person will have severe symptoms. They may only increase the risk or represent an association that scientists have noticed in data.

Link with health inequity

Perimenopause and race

A 2019 study using data spanning 23 years in the United States found differences in menopause symptoms between racial and ethnic groups. Among the 3,302 women who participated, Black women experienced more hot flashes, and for longer, compared to Asian, Hispanic, and white women.

Another 2022 review of the same data argues that some of the disparities in female health at midlife are due to systemic racism.

When researchers began collecting this data, Black participants were:

  • more likely to have experienced socioeconomic hardship than white participants
  • more likely to report experiencing discrimination than white participants
  • more likely to experience depression, although this association disappeared after adjusting for socioeconomic factors that raise the risk of depression, such as financial strain, stressful life events, and a lack of support

All of these factors can make menopause a more challenging experience and may make the symptoms themselves more severe. Because of this, the authors say it is likely that social inequity is at least partly responsible.

The median age symptoms of perimenopause begin is around age 47. They tend to last about 4 years but can last longer. People may have varying degrees of hot flashes for about 10 years.

It is difficult to compare perimenopause and menopause symptoms, as everyone’s experience is unique. Generally speaking, though, experts know perimenopause as being the most symptomatic phase of menopause. This may mean a person’s symptoms improve after menopause.

Certain symptoms, such as vaginal dryness and hot flashes, may continue into postmenopause for some people.

Perceptions about menopause

Some research has found that people perceive menopause more favorably in the postmenopausal stage than during perimenopause. This may be due to a tendency to overestimate the emotional impact of future events, which is known as “affective forecasting” in psychology.

Managing severe perimenopause symptoms may involve a combination of lifestyle changes, self-care, and medications. It may help to:

  • stop smoking, if relevant
  • avoid hot flash triggers, such as caffeine, alcohol, or spicy foods
  • maintain a healthy BMI
  • get regular exercise
  • eat a balanced diet
  • reduce stress
  • get enough rest and sleep

People can also practice self-care to manage their symptoms when they do occur, which may involve:

  • sleeping with a fan on
  • wearing lightweight clothing
  • staying hydrated
  • using lubricant for vaginal dryness

If self-care does not reduce the symptoms, people can speak with a doctor for further support. They may suggest:

  • Medications: Hormone replacement therapy (HRT) is an effective treatment for perimenopause symptoms, but there are other options.
  • Support groups: Speaking with people going through similar experiences can provide emotional support during perimenopause. Online resources are available through the Endocrine Society. A doctor may also be able to recommend a local support group.
  • Symptom tracking: Recording symptoms using a diary or app may help a person feel more in control, gain a better understanding of their symptoms, or potentially spot patterns.

The North American Menopause Society has a search tool for finding menopause specialists by zip code.

Find more natural remedies for perimenopause symptoms here.

Anyone with severe perimenopause symptoms can speak with a doctor for help and advice. People should also consult a medical professional if they are unsure they are in perimenopause, as there could be other explanations.

Talk with a doctor if any symptoms appear suddenly, get much worse, or do not fit with descriptions of perimenopause. This is especially important if a person experiences any of the following:

  • watery or bloody vaginal discharge
  • bleeding after sex
  • worsening back or pelvic pain
  • unintentional weight loss

These symptoms may be signs of endometrial, ovarian, or cervical cancer.

Perimenopause can affect sleep, mood, energy levels, and sexual health. Scientists are not sure why some people experience more severe symptoms than others, but evidence suggests that certain factors may increase the risk.

A higher BMI, history of smoking, and health inequity may all play a role in perimenopause severity and the age of onset. Generally, this phase is the most symptomatic of all the stages of menopause, so a person’s symptoms may improve in postmenopause.

Treatment involves a combination of lifestyle changes and medications to relieve symptoms. However, it is important to seek medical advice if a symptom suddenly appears, gets significantly worse, or is not typical for perimenopause.