Menopause can hit hard with symptoms that affect physical, psychological, and emotional well-being. Some people have an easy time with menopause, but for many it can be overwhelming. Fortunately, there are treatment options that can help ease uncomfortable symptoms that commonly occur.

Menopause happens when you permanently stop having menstrual periods and haven’t had a period for 12 straight months — on average at age 51 or 52. Perimenopause, also known as the menopausal transition, starts several years earlier as the body decreases the production of estrogen and progesterone, two hormones that are needed for sexual reproduction and other functions in the body. Perimenopause is typically when the most bothersome symptoms occur.

If you’ve started experiencing perimenopausal symptoms, it’s helpful to know what you may expect. Perimenopause can be a distressing time, especially if symptoms are severe. It’s important to talk to your doctor about any discomfort you may be experiencing and find out what treatment plans may be best for you.

Here’s more on some of the common symptoms of perimenopause.

1. Vasomotor Symptoms

Hot flashes are one of the most common symptoms of perimenopause. They occur in as many as 80 percent of women in perimenopause, according to The Menopause Society. Hot flashes cause a sudden feverish feeling of heat primarily in the chest, neck, and face and can cause excessive sweating and a racing heartbeat. Night sweats are hot flashes that occur while sleeping.

Hot flashes and night sweats are called vasomotor symptoms. Vasomotor symptoms are caused by blood vessels widening and constricting abnormally. Hot flashes usually last about one to five minutes and may cause the skin to flush. They can also cause anxiety and chills.

2. Trouble Sleeping

Poor sleep quality is another common symptom that occurs in perimenopause. Fluctuating body temperature with hot flashes is a key factor in sleep disturbance and insomnia. Sleep problems affect more than half of all menopausal women, according to Mayo Clinic.

Additionally, Mayo Clinic notes that menopausal women are also prone to developing sleep apnea, a breathing disorder that occurs during sleep. Sleep apnea is characterized by loud snoring and sleep being disturbed throughout the night by gasping for air. According to Johns Hopkins Medicine, postmenopausal women develop sleep apnea at a rate that is 2 to 3 times higher than premenopausal women, which can cause daytime sleepiness and other more serious complications.

If you experience sleep apnea symptoms, it’s important to talk to your doctor. Untreated sleep apnea can lead to life-threatening health conditions, such as heart disease and diabetes. Sleep apnea can be effectively treated in most people.

3. Hair and Skin Changes

Changing hormone levels can affect the skin and hair. The American Academy of Dermatology estimates that women lose 30 percent of the collagen in their skin in the first five years of menopause. Changes in skin on the face can include more visible wrinkles, sagging skin, and lines from the jowls along the jawline.

In menopause, age spots are more likely to appear and there’s an increased risk of skin cancer. The skin also becomes thinner and drie and is more likely to bruise. Skin can also become more sensitive and more prone to irritation and rashes.

Lower estrogen levels can affect hair follicles and the production of sebum, which is naturally occurring oil in the skin that nourishes hair. Changes in hair may include hair loss, hair thinning, dryer hair, and hair texture changes that make hair coarser and more brittle.

4. Pain and Changes in the Body

Some symptoms of menopause may be painful. Perimenopause may cause joint pain and stiffness in the knees, back, neck, jaw, and fingers, among other areas of the body. This occurs because estrogen helps to lower inflammation. As estrogen levels decrease, joints are more likely to become inflamed.

Headaches, including migraine headaches, can also occur due to hormonal fluctuations in perimenopause. Migraine headaches can also occur more often and become more severe for those who have a history of migraine attacks. Some people experience a migraine headache for the first time during perimenopause.

Weight gain is also common with menopause, as well as a change in body shape with more weight in the abdominal area. Weight gain during this time is because of changes in the body’s metabolism that are caused by aging and lower levels of estrogen and progesterone. Sleeplessness can also contribute to weight gain.

5. Cognitive Problems and Mood Changes

Menopause can also affect how you think and feel. Many complain about brain fog during perimenopause, which causes memory problems and difficulty concentrating. Cognitive problems can affect everything from work to family life. Brain fog has been linked to a decrease in estradiol, a form of estrogen that helps regulate brain function. Poor sleep during menopause can also affect cognitive function.

Mood swings and mood changes are also common during menopause. One reason for an increase in irritability, anxiety, and depression is that serotonin levels may shift. Serotonin is a chemical in the brain that regulates mood, and estrogen and serotonin are produced at the same time. Decreased estrogen levels are believed to affect serotonin levels.

Disturbed sleep can also play a role in mood swings and irritability. Depression, which can also develop during perimenopause, may be a factor in poor sleep. Depression and other mood changes are also linked to the psychological impact of aging, which can affect self-esteem.

6. Vaginal and Urinary Problems

Vaginal dryness is a common symptom of perimenopause and can cause itchiness, burning sensations, and painful sex. The lining of the vagina, like the skin in other parts of the body, tends to get thinner, dryer, less elastic, and more sensitive as estrogen levels decrease. Pain during sex can lead to a decreased sex drive, or low libido. A low libido may also be caused by hormonal changes during perimenopause.

You may also have irregular periods during perimenopause, which may include heavy bleeding or missed periods. While changes in the menstrual cycle are normal during perimenopause, unusual uterine bleeding should be reported to your doctor or gynecologist. In some cases abnormal bleeding may be a sign of a more serious condition, such as an infection or cancer.

Vaginal dryness is also known as vaginal atrophy. However, many healthcare professionals now prefer the term, genitourinary syndrome of menopause (GSM), because the condition also affects the urinary tract. GSM can affect the urethra — the tube urine passes through — and the bladder. GSM can cause urinary incontinence (inability to control the bladder) and increases the risk of urinary tract infections (UTIs). Another factor in UTIs during menopause is hormonal changes that affect bacteria in the urinary tract and make infections more likely.

7. Difficulty Getting Pregnant

Hormonal changes cause a decrease in fertility — the ability to become pregnant. The American Society for Reproductive Medicine states that fertility starts to decline when a woman is in her 30s and continues up until menopause, when it’s no longer possible to become pregnant. In general, it’s not easy to become pregnant during perimenopause, although it’s still possible. Even though pregnancy is rare in perimenopause, if you don’t intend to get pregnant it’s a good idea to use birth control if you’re sexually active.

Menopause Symptoms Can Be Managed

In the past, menopause was misunderstood and often not treated. Luckily that’s changing and you don’t need to suffer without help. If menopausal symptoms are affecting your quality of life or mental health, it’s important to find the right healthcare provider — someone who has experience in women’s health and treating menopause. You can discuss treatment options that may be best for your particular symptoms.

Healthy lifestyle changes can also help improve menopausal symptoms and support your health overall. You can take steps to improve your well-being with menopause, midlife, and aging, including:

• Quitting smoking, which is linked to hot flashes
• Maintaining a healthy weight
• Reducing alcohol, which is linked to breast cancer
• Exercising regularly to improve bone and cardiovascular health
• Talking to your doctor about supplements such as vitamin D and calcium