Perimenopause symptoms go far beyond hot flashes and irregular periods.

Perimenopausal changes can begin earlier than many women expect.

Recognizing unexpected perimenopause symptoms can help women start the right conversation with their doctor.

My mother told me about menstruation, and my grandmother told me about menopause, but nobody told me about perimenopause. Research and conversations with my patients tell me that not much has changed. Many women say they are still unclear about the terminology, the symptoms, and the timing of perimenopause, and were surprised when their doctors said their "problems" were related to perimenopause.

The two signs of perimenopause that are well recognized are irregular menstrual cycles and hot flashes, day or night. They are both vasomotor changes caused by hormonal shifts leading toward a final menstrual cycle. Twelve months after that final period, we are officially in menopause. But there are many other perimenopause changes that are less obvious, and because so many assume perimenopause doesn’t begin until a woman is in her late 40s, the symptoms are written off as fatigue or stress. Actually, about 30 percent of women who consult a doctor about perimenopause-related symptoms are aged 30–451, so here are some less-known symptoms that may be associated with perimenopause.

Burning Mouth/Dry Tongue

Hormonal changes during perimenopause affect all the body’s mucous membranes, and that includes the oral epithelium (the inside of the mouth). If it thins or atrophies, it’s more easily scratched and painfully irritated. Saliva glands may also be compromised, and a dry mouth means increased susceptibility to yeast infections, nerve sensitivity, gum disease, and pain without obvious injury, often called burning mouth syndrome. Your dentist will help by recommending rinses, medications, and a diet to keep your mouth........

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