What Are the 34 Symptoms of Perimenopause?

Hot flashes, low libido, mood swings, and irregular periods are just some of the most common symptoms of perimenopause.

Perimenopause is a transitional phase leading up to menopause, typically starting in your 40s but sometimes as early as your mid-30s. During this time, your body goes through some major hormonal changes, primarily decreased estrogen, testosterone, and progesterone levels. These changes can lead to various symptoms — some expected, others less so. 

Everyone’s experience with perimenopause is unique, so there is no real one-size-fits-all checklist of symptoms. Nevertheless, there are some telltale signs that you may have started perimenopause, and understanding these symptoms can help you better navigate this life stage. Below, we’ll delve into the 34 symptoms most commonly associated with perimenopause, and how to manage them. 

What is perimenopause?

Perimenopause — also referred to as the “menopause transition” — is the stage leading up to menopause. Menopause is the moment in time when a person hasn't had a period for 12 consecutive months. 

 People often use the term “menopause” when they’re actually referring to perimenopause, but it’s important to make a distinction between the two. Perimenopause can last up to 10 years, with the average being four years.

The start of perimenopause varies from woman to woman, generally beginning in the 40s, but some may experience it in their 30s. The average age of menopause in the United States is 52.

During perimenopause, estrogen, testosterone, and progesterone levels start to fluctuate and decline, leading to symptoms. These hormones are crucial for women's health and can impact everything from mood, cognitive function, bone health, and metabolism. 

What are the 34 signs of perimenopause?

The symptoms of perimenopause can kind of sneak up on you over time. They can start pretty mild and you might not even notice them at first, and it can be tough to figure out what's causing them — especially since some can seem pretty random (more on that below). Most women are caught off guard by this transition due to a severe lack of education and awareness about perimenopause, but knowing what to expect can make a huge difference.

Below, we've put together 34 signs of perimenopause, but don't worry, you might not experience all of them. You might only have a few of these signs, or even some that aren't listed here. This list is here to help you recognize what to look out for and make sense of symptoms if and when they show up.

1. Irregular periods: One of the hallmark signs of perimenopause is a change in your menstrual cycle. Periods may become lighter or heavier, shorter or longer, or they may skip entirely for a month or more.
2. Hot flashes: Hot flashes are sudden feelings of intense heat, often accompanied by sweating and redness of the skin. They can occur at any time and may be particularly bothersome at night.
3. Night sweats: Similar to hot flashes, night sweats are intense episodes of sweating that can drench your clothes and sheets, disrupting your sleep.
4. Vaginal dryness: As hormone levels decrease, the vaginal tissues can become thinner, drier, and less elastic, causing discomfort such as dryness, itching, and irritation, especially during penetrative sex.
5. Decreased libido: A decline in sex drive is common during perimenopause due to hormonal shifts, including decreased estrogen and testosterone.
6. Fatigue: Persistent fatigue that doesn’t seem to improve with rest can be a frustrating symptom, often linked to sleep disturbances, night sweats, and hormonal changes.
7. Mood swings: You may experience rapid mood changes, ranging from irritability and sadness to anger and anxiety. Hormonal fluctuations play a significant role in these emotional changes.
8. Poor sleep: Difficulty falling asleep, staying asleep, or waking up too early is common during perimenopause, often exacerbated by night sweats and anxiety.
9. Weight gain: Many women notice an increase in weight, particularly around the abdomen. Hormonal changes slow down metabolism and may alter fat distribution.
10. Bloating: Hormonal fluctuations can cause water retention and bloating, making you feel uncomfortably full or swollen.
11. Breast tenderness: Tender, swollen, or sore breasts are a common symptom, often linked to hormonal changes during your cycle.
12. Headaches: Hormone-induced headaches or migraines may become more frequent or intense during perimenopause.
13. Joint pain: Aching or stiff joints can occur due to declining estrogen levels, which have an anti-inflammatory effect on the body.
14. Brain fog: You might find yourself forgetting things more often, or struggling to concentrate. 
15. Difficulty concentrating: Alongside memory issues, you may find it harder to focus or concentrate on tasks, sometimes making you feel scattered or overwhelmed.
16. Dizziness: Some women experience bouts of dizziness or lightheadedness, which can be unsettling.
17. Hair thinning or loss: Hair may become thinner, more brittle, or fall out more easily due to hormonal changes.
18. Changes in hair texture: You might notice your hair becoming drier, frizzier, or losing its natural shine.
19. Dry skin: Estrogen plays a key role in maintaining skin moisture. As estrogen levels decline, you might notice your skin becoming drier, thinner, or more prone to itching.
20. Acne: Hormonal imbalances can trigger acne flare-ups, even if you’ve never had skin issues before.
21. Changes in body odor: Some people notice a change in body odor due to hormonal shifts and increased sweating.
22. Heart palpitations: An irregular heartbeat or feeling like your heart is racing can be alarming, but it’s a known symptom during perimenopause.
23. Digestive issues: Hormonal changes can affect your digestive system, leading to issues like gas, indigestion, or constipation.
24. Allergies: You may find that you develop new allergies or that existing allergies become more pronounced during perimenopause.
25. Panic attacks: Anxiety and panic attacks can increase in frequency due to hormonal fluctuations and stress.
26. Increased PMS Symptoms: For those who already experience PMS, symptoms like mood swings, bloating, and cramps may intensify during perimenopause.
27. Frequent urination: Lower estrogen and testosterone levels can weaken the pelvic floor muscles, leading to more frequent urination or even incontinence.
28. Urinary tract infections (UTIs): The urinary tract becomes more susceptible to infections during perimenopause, often due to changes in vaginal pH, loss of healthy bacteria, and tissue thinning.
29. Joint pain: Estrogen and testosterone are crucial for maintaining bone density. As levels drop, bones can become weaker, increasing joint pain and the risk of osteoporosis.
30. Gum problems: Some women experience bleeding gums or increased sensitivity, as hormonal changes can affect gum health.
31. Changes in taste: You may notice changes in your taste preferences or a metallic taste in your mouth, possibly due to hormonal shifts.
32. Tingling extremities: Some women report a tingling or “pins and needles” sensation in their hands and feet, which may be related to hormonal changes affecting circulation or nerve function.
33. Burning Mouth Syndrome (BMS): A less common but troubling symptom, burning mouth syndrome, involves a persistent burning sensation in the mouth, lips, or tongue.
34. Anxiety and depression: Finally, emotional well-being can be significantly impacted during perimenopause. Anxiety and depression may arise or worsen, often linked to the various physical and hormonal changes occurring during this time.

Perimenopause treatments

Perimenopause is a natural and unavoidable stage of life, but that doesn’t make it any less overwhelming. Luckily, there are treatments available to help you minimize any uncomfortable symptoms and stop perimenopause from affecting your quality of life. 

Hormone replacement therapy

Hormone replacement therapy (HRT) involves taking synthetic forms of hormones, mostly to replace your body’s natural hormones. It can be taken in the form of a pill, patch, implant, gel, or cream. HRT is considered the most effective treatment for the symptoms of menopause. 

A healthcare provider can prescribe HRT to help relieve symptoms like hot flashes, vaginal dryness, and night sweats.

HRT is safe for most women, but HRT is not recommended if you have a history of:

• heart disease
• blood clots
• stroke
• estrogen-dependent cancer
• liver disease.

Vaginal hormones

Vaginal hormones are a type of therapy designed to provide hormones specifically to the vaginal tissues. Vaginal estrogen or vaginal DHEA, which is converted to estrogen and testosterone in the vagina, is commonly prescribed to women going through perimenopause and menopause to help with symptoms of vaginal dryness. 

Using vaginal hormones can really make a difference by replenishing the homrone levels in the vaginal area. This helps improve the health and condition of the vaginal tissues, restoring moisture, elasticity, and thickness, and easing the uncomfortable symptoms associated with vaginal dryness.

Vaginal hormones come in different forms like creams, tablets, rings, and suppositories, so women can choose the method that suits them best. Because it's applied directly to the affected area, vaginal hormones usually have minimal systemic absorption, which means it has a lower risk of side effects compared to oral hormone therapies. This makes it a great option for women mainly experiencing localized symptoms who want effective relief with minimal risk.

Non-hormonal medication

In the U.S., several non-hormonal medications are prescribed to help manage the symptoms of perimenopause, especially for women who cannot or prefer not to use hormone therapy. 

• Antidepressants: Some medications like venlafaxine (Effexor), paroxetine (Paxil), and fluoxetine (Prozac) can help with hot flashes, mood swings, and depression. They work by regulating your mood and body temperature.
• Gabapentin: Originally designed for seizures, gabapentin (Neurontin) can also help reduce hot flashes, especially if you have trouble sleeping. It has calming properties that may help with night sweats.
• Clonidine: Primarily used to treat high blood pressure, clonidine (Catapres) can also reduce the severity and frequency of hot flashes by affecting blood vessels and temperature regulation.
• Ospemifene: Prescribed for vaginal dryness and discomfort during intercourse, ospemifene (Osphena) is specifically designed not as hormone therapy but to treat vaginal atrophy.

Therapy

Dealing with perimenopause can be tough, especially when it comes to the emotional and psychological symptoms. Therapy can make a big difference in helping you manage these challenges effectively. Some forms of therapy include:

• Cognitive Behavioral Therapy (CBT) is a popular choice for women going through perimenopause. It focuses on changing negative thought patterns and behaviors that can contribute to symptoms like anxiety, depression, and sleep problems. CBT is effective in reducing the impact of issues like hot flashes and night sweats on your quality of life.
• Mindfulness-Based Stress Reduction (MBSR) teaches you to stay present in the moment and develop a non-judgmental awareness of your thoughts and feelings. It's great for managing stress and anxiety, and can also help improve your sleep and handle hot flashes.
• Supportive counseling can provide a safe space for you to talk about the changes you're experiencing. It offers emotional support and can help you process feelings of loss, fear, or frustration that might come up during perimenopause.
• Support groups can be really reassuring, as you connect with other women who are going through similar experiences. It gives you a sense of community and shared understanding, offering practical advice and emotional support.
• Psychotherapy can provide deeper, long-term support for more intense emotional issues. It involves exploring the underlying causes of emotional distress, developing coping strategies, and working through past or present issues that might be exacerbated during perimenopause.

Lifestyle changes 

Although they won’t treat symptoms, lifestyle changes can play a significant role in managing the symptoms of perimenopause.

• Regular exercise can help improve mood, reduce stress, and enhance sleep quality. It's especially beneficial to do weight-bearing exercises like walking or strength training to support bone health as estrogen levels decline.
• Focus on building strength and flexibility. Weight gain is a common and frustrating part of menopause due to the change in metabolism. Activities that promote strength training and flexibility like weight lifting, yoga, pilates, or HIIT are great ways to help manage your weight and benefit your overall health. 
• Making changes to your diet is important too. Eating a balanced diet with plenty of fruits, veggies, whole grains, and lean proteins can support your overall health and help manage symptoms. Making sure to get enough calcium and vitamin D is crucial for bone health.
• Cutting back on caffeine and alcohol can minimize hot flashes and night sweats. Keeping hydrated and eating smaller, more frequent meals might also help with symptoms like bloating and energy ups and downs.
• Stress management techniques, like mindfulness, meditation, breathwork, or yoga can help ease anxiety, improve sleep, and boost your emotional well-being during this transition.
• Lubricants and over-the-counter vaginal moisturizers help improve your sex life by reducing vaginal dryness and discomfort during sex.

FAQ

What are the worst symptoms of perimenopause?

Going through perimenopause can be tough because of the variety of symptoms it brings. Each person's experience with perimenopause is different and what one person finds challenging, another may not. Some of the most intense symptoms can be hot flashes, mood swings, trouble sleeping, and vaginal dryness. Hot flashes can be disruptive, causing sudden discomfort and affecting daily activities and sleep. Mood swings can bring irritability, anxiety, and sadness, which can take a toll on relationships and mental well-being. Difficulty sleeping, often worsened by night sweats, can lead to chronic tiredness, further impacting mood and overall health. Dealing with vaginal dryness is not only uncomfortable but can also affect your sex life and libido.

How do I know if I’m in perimenopause?

Determining if you’re in perimenopause involves paying attention to a mix of symptoms (such as irregular periods, hot flashes, and vaginal dryness) and understanding the typical age range for this transitional phase. It's important to remember that perimenopause is a gradual transition, and there's no single test or sign that can confirm if you've entered this stage. Your healthcare provider will consider different factors, such as your age, menstrual history, and the symptoms or body changes you're experiencing. Some doctors might order tests to check your hormone levels, but apart from checking thyroid function, hormone testing isn't usually necessary or helpful for evaluating perimenopause.