I would see a doc to rule out anything, but will say, it's not uncommon to feel nauseous since your hormones are fluctuating a bit... It's also not uncommon to have trouble sleeping during Perimenopause, happens to me all the time... What you are experiencing in part is that when your Estrogen falls (esp in the first part of Perimenopause) your anxiety level can totally increase. It does this because Estrogen controls CORTISOL, the stress hormone and when we begin to make LESS Estrogen, cortisol can then run amuck and make us feel jittery and or downright Claustrophobic. Also, the fall in Estrogen causes an imbalance in the Progesterone, in other words, while you aren't making more of it, because you are making less Estrogen, the Progesterone can become dominant.. In turn, this can make periods much HEAVIER... why? because Progesterone is what thickens the lining (remember back to when you might have been pregnant) in that third trimester, you were Progesterone dominant. Same applies monthly.. Your lining builds and then if not pregnant, you shed it.. Well in us Perimenopausal women, this often means much heavier periods.. Again, it's in part to the Progesterone being more dominant. Also, it could be that you may or may not have Fibroids. which depending were they are can block blood flow and when you do finally pass it, it's in clumps and have blood behind it, causing what is called, "flooding" and can be somewhat painful...
what can you do... for the nausea and other problems.. I drink Camomile tea.. it soothes and relaxes me. Additionally, I only drink about 4 oz of coffee a day and no Sodas and other caffeine drinks. I also exercise more which tires me out and helps me sleep... I would also add that I track my monthly cycles. by doing this, it allows me to see first hand how hormones are affecting my cycle. E.g.. when in the Follicular phase, alcohol (which I drink very little of) doesn't affect me in the sense that I can have a glass of wine and not be wide awake all night.. whereas in the Luteal Phase (ovulation and on) I don't drink because it not only affects my sleep but my mood (I become a little depressed)
I think if you too can begin to track your cycles., you can pinpoint better when you feel more nausea and even anxious. I think before the doctor increases your meds anymore, they NEED to look at what hormones do and how they are very much a reason as to why some women begin to get more anxious (esp when entering their 40s) as of late, docs like to blame that all on LIFE and how we women are taking on more, hence more stress.. ALL true... but our hormones are also giving us a run for our money....
It saddens me that so often, not many docs check our hormone levels and instead.. medicate instead of educate... I went to several practitioners for different ailments, sinuses, depression, anxiety and NONE of those docs ever said, hormones (Perimenopause) had a thing to do with anything..... it wasn't until I began to read up on things that I find out.. Hey this isn't all in my head, I am actually feeling physical symptoms and there is a reason for it..
I recommend Dr. Vliet's book, Screaming to be heard and or her other books. she speaks in great detail about emotions, physical wellbeing and the hormone connection..
I wish you all the best