Perimenopause

What Are the 34 Symptoms of Perimenopause?

Clara Siegmund

This comprehensive guide covers the 34 symptoms of perimenopause, from irregular periods and hot flashes to mood swings and brain fog, plus practical strategies for finding relief during this transition.

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Jul 29, 2025

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What Are the 34 Symptoms of Perimenopause?

Perimenopause can come with tons of physical and emotional symptoms. Here’s your complete guide to the 34 symptoms of perimenopause, plus some tips on how to manage your journey and find relief.

Perimenopause is the period of biological transition moving you into menopause and your postmenopause years.

Your hormones fluctuate unpredictably throughout perimenopause, which can last ten years or more. That can lead to lots of physical and emotional symptoms, ranging from uncomfortable, to distressing, to downright horrible.

This guide to perimenopause symptoms covers some of the most common, and lesser-known, symptoms of this transition, plus how to manage your journey. Read on to learn about the 34 symptoms of perimenopause, across five symptom categories.

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Category 1: Menstrual cycle and reproductive symptoms of perimenopause (5 symptoms)

First up on our list of the 34 symptoms of perimenopause are the impacts on your menstrual cycle. As your reproductive hormones fluctuate including estrogen, progesterone, and luteinizing hormone (LH) your cycle and period change.

Here’s how:

1. Changes in cycle length

During perimenopause, your cycle length becomes increasingly irregular. Cycles may be shorter than usual one month, then longer the next.

Near the beginning of perimenopause, you may experience variations of seven days or more from cycle to cycle. As perimenopause progresses, your cycles will become longer and longer until they stop altogether.

2. Irregular periods

With perimenopause cycle changes come irregular periods, a natural inevitability, no matter how regular your periods were before!

As perimenopause progresses, your periods will likely:

Become heavier or lighter
Last longer or shorter
Become more unpredictable
Skip cycles altogether (amenorrhea)

By mid to late perimenopause, you may even go 60 days or more between periods. Eventually, you’ll have your final period, menopause will be retroactively diagnosed, and you’ll be in your postmenopause years.

3. Heavy menstrual bleeding (menorrhagia)

During your reproductive years, progesterone and estrogen work in tandem to regulate uterine lining growth and your period. But as these two hormones fluctuate during perimenopause, they’re no longer able to function together as before.

As a result, the uterine lining becomes less stable and more prone to shedding each cycle. This often leads to heavier and longer periods, as well as unpredictable period timing.

4. Anovulation

Perimenopause also impacts ovulation. Throughout your life, the number of eggs that you have naturally decreases. As you approach the end of your cycles during perimenopause, you’re also reaching the end of your eggs.

This means that you’ll likely experience anovulation during perimenopause, or cycles where you don’t ovulate at all and your ovaries don’t release an egg.

5. Declining fertility

Fertility declines during perimenopause. When you reach menopause, you can no longer conceive.

During perimenopause, though, pregnancy is still possible because you still ovulate (albeit infrequently). But factors like irregular ovulation, anovulation, and lower egg quality all make conceiving more difficult, which makes fertility tools all the more important!

If you’re trying to conceive during perimenopause, consider using an at-home fertility kit, like the Oova kit. Oova measures your unique hormone levels so you can pinpoint when you’re ovulating and most fertile. Knowing when you’re most fertile helps you optimize your chances of conceiving, even during perimenopause.

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Category 2: Physical symptoms of perimenopause (15 symptoms)

Next up on our list are the physical effects of perimenopause. There are so many, in fact, that these symptoms make up the bulk of the 34 perimenopause symptoms.

Here are some of the physical symptoms you may experience:

6. Hot flashes (vasomotor symptoms)

Hot flashes are one of the most well-known symptoms of perimenopause. They’re incredibly common, too. p to 80% of women experience hot flashes.

Also called vasomotor symptoms (VMS), hot flashes are sudden, intense bursts of heat in the head, face, neck, chest, and upper back, often accompanied by sweating, flushing, blotches, and a faster heartbeat. Some people experience chills after hot flashes.

7. Night sweats

When hot flashes happen at night, they’re called night sweats. Night sweats are like daytime hot flashes, with the added frustration of interrupting your sleep and making it hard to get quality rest.

8. Joint pain and muscle aches

Estrogen is integral to joint and muscle health. As this hormone fluctuates and declines over time, joint pain and muscle aches can develop. It’s estimated that 71% of women experience this perimenopause symptom.

Aches and pain in the knees, hips, hands, feet, and spine are common. You may feel anything from dull throbs and discomfort to sharp bursts of pain.

9. Bone loss

Estrogen is also essential to bone health. As estrogen decreases, bone loss can speed up, which increases the risk of developing conditions like osteoporosis.

10. Breast pain (mastalgia)

Many people also experience perimenopause breast pain (also called mastalgia). Breasts may feel sore, heavy, tender, or achy, or pain may be more of a sharp throb. You may experience symptoms in both or one breast.

Talk to your doctor if you’re concerned about any breast pain or changes in your breasts.

11. Migraines

If you have migraines, they may get worse with perimenopause. Menstrual migraine attacks, in particular, may occur more frequently and be more severe during perimenopause.

12. Headaches

Migraines aren’t the only source of perimenopause head pain. You may find yourself getting more headaches than usual as your hormones change. Cluster and tension headaches, in particular, can ramp up in frequency and severity during perimenopause.

13. Sleep disturbances

Perimenopause can also lead to sleep disturbances. Lots of perimenopause symptoms make it hard to rest, like night sweats, headaches, muscle aches, digestive issues, and emotional symptoms.

During perimenopause, you may:

Have trouble falling asleep
Sleep fitfully
Wake up often at night
Have trouble falling back to sleep after waking up

14. Insomnia

While menopause insomnia tends to be more well-known, it’s also possible to experience insomnia during perimenopause. Perimenopause insomnia impacts sleep quantity and quality, too.

15. Fatigue and low energy

With all this poor sleep, combined with the physical and emotional fatigue of your changing body and fluctuating hormones, perimenopause can leave you feeling exhausted. You may find that your energy levels are lower and you feel tired during the day.

16. Weight gain

Perimenopause can also come with weight gain, driven by factors like a slower metabolism, increased stress, altered sleep patterns, and genetic and biological influences.

17. Bloating

Bloating is yet another perimenopause symptom. Fluctuating hormone levels can lead to factors like fluid retention or excess gas, which can leave you feeling bloated and too full. Your stomach may feel tight or swollen, and you may experience abdominal pain and discomfort.

18. Digestive issues

Decreasing progesterone and estrogen levels can also impact digestive and bowel function. If you experience digestive issues like heartburn, indigestion, acid reflux, nausea, and abdominal discomfort, your symptoms could be related to perimenopause.

19. Hair changes

As you move through perimenopause, you may notice hair loss or thinning on your head. You may also experience increased hair growth on your face and/or body.

20. Skin changes

Decreasing estrogen impacts skin, too. During perimenopause, skin may become drier, thinner, and less elastic, and you may develop more wrinkles.

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Category 3: Emotional and cognitive symptoms of perimenopause (6 symptoms)

Perimenopause doesn’t just impact your body physically; your mental health may also feel the effects.

Here are the emotional and mood symptoms that figure in the 34 symptoms of perimenopause.

21. Anger and irritability

Perimenopause can cause irritability, rage, and other feelings of anger. These feelings are very common, affecting up to 70% of perimenopausal people!

22. Anxiety

Anxiety is another perimenopause symptom. Perimenopause anxiety can come with other physical and emotional effects, like an accelerated heartbeat, sweating, and feelings of restlessness and tension.

23. Depression

Depression and depressive symptoms can also appear in perimenopause. In fact, the risks of developing depressive symptoms or experiencing worsening depression are higher during perimenopause.

24. Brain fog

Perimenopause can take a toll on cognition, too. Perimenopause brain fog, as these cognitive effects are commonly known, can leave you feeling mentally cloudy and forgetful, making it hard to concentrate and complete tasks.

25. Low self-esteem

All the changes that come with perimenopause may make your confidence and self-esteem take a hit. This can feel hard to overcome, but know that you’re just as amazing as you’ve always been!

26. Mood swings

Have you ever felt angry one moment then tearful the next? Or calm and relaxed, then suddenly overwhelmed with anxiety? That’s because perimenopause can cause mood swings!

Unsurprisingly, hormones are to blame. As estrogen and progesterone levels fluctuate, the resulting imbalance makes it hard for these hormones to regulate neurotransmitters and the brain signals that influence mood. That can leave you feeling like you’re no longer on solid ground.

What’s more, lots of other perimenopause symptoms make it hard to feel good, which doesn’t help. Plus, it can’t be understated that you’re experiencing major life changes;that impacts mental health, too!

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Category 4: Genitourinary symptoms of perimenopause (6 symptoms)

Perimenopause can also lead to a condition called vaginal atrophy, also referred to as genitourinary syndrome of menopause or GSM. Vaginal atrophy is a chronic condition caused by decreased estrogen levels affecting the genital and urinary tissues.

Vaginal atrophy causes vaginal and urinary symptoms (aka genitourinary symptoms) that may affect as many as 7 out of 10 women.

In the 34 symptoms of perimenopause, here are the genitourinary symptoms.

27. Vaginal dryness

Low estrogen causes the vagina to produce less moisture, which can leave the vagina drier than before. 75% of people experience vaginal dryness during perimenopause.

28. Vaginal itching

During perimenopause, decreased vaginal secretions and vaginal pH changes can also cause vaginal itching, leading to discomfort.

29. Vaginal burning and irritation

As vaginal lubrication decreases, you may also experience burning and irritation ranging from uncomfortable to very painful.

30. Overactive bladder and urinary incontinence

Perimenopause also impacts the bladder. You may have to pee more often, or feel sudden and urgent needs to pee and have a harder time holding it. Up to 2 out of 5 women may have symptoms of frequency and urgency.

31. Discomfort while peeing (dysuria)

Alongside the need to pee more often, you may also experience discomfort or pain while peeing (also called dysuria).

32. Recurrent urinary tract infections (UTIs)

Perimenopause-driven changes in vaginal pH, vaginal flora, and vaginal lubrication levels can make you more susceptible to getting UTIs. On top of that, UTIs may come back often and take longer to get rid of.

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Category 5: Sexual symptoms of perimenopause (2 symptoms)

Last but certainly not least, sexual symptoms make up the end of our list of 34 symptoms of perimenopause.

33. Uncomfortable or painful sex (dyspareunia)

Vaginal changes can cause discomfort or even pain around sex (also called dyspareunia). 40% of perimenopausal women report that sex is uncomfortable or painful, whether during or after. Some people also experience bleeding after sex. Naturally, this can negatively impact marriages or intimate relationships.

34. Low sex drive

Lots of people also experience a low sex drive during perimenopause.

Decreased libido can result from lots of different factors. Hormone changes impacting vaginal lubrication can cause painful sex, while other perimenopause symptoms can make it hard to feel like yourself and get in the mood.

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How to get relief from the 34 symptoms of perimenopause

Many perimenopause symptoms aren’t permanent and may improve on their own once you reach menopause. But that doesn’t mean you need to suffer through perimenopause.

Adopting perimenopause-friendly lifestyle strategies, to the best of your ability, may help offer relief from symptoms:

Eat a balanced diet
Exercise regularly, focusing on both cardio and strength-training activities
Practice good sleep hygiene, with a regular sleep schedule
Try perimenopause vitamins
Reduce stress
Do activities you enjoy

Your healthcare providers can also offer support. Talk to your doctor about medical strategies for easing perimenopause symptoms, including:

Combined hormone replacement therapy (HRT)
Estrogen-only HRT
Vaginal lubricants and moisturizers
Certain antidepressants

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The 34 symptoms of perimenopause: The bottom line‍

Perimenopause can come with a wide range of physical and emotional symptoms, beyond even the 34 in this list. Some people experience lots of symptoms, while others only experience a handful (or even none at all). Talk to your doctor about ways to ease and manage symptoms so you can find relief. Whatever your case, know that your perimenopause journey and your symptoms are valid, you’re not alone, and you can (and should!) take pride in the power of your changing body.

About the author

Clara Siegmund is a writer, editor, and translator (French to English) from Brooklyn, New York. She has a BA in English and French Studies from Wesleyan University and an MA in Translation from the Sorbonne. She is passionate about literature, reproductive justice, and using language to make information accessible.‍

Sources

Avis N E, et al. (2018). Vasomotor Symptoms Across the Menopause Transition: Differences Among Women.
Born L, et al. (2008). A new, female-specific irritability rating scale.
Carlson K & Nguyen H. (2024). Genitourinary Syndrome of Menopause.
Endocrine Society. (2022). Menopause and Bone Loss.
Lu C-B, et al. (2020). Musculoskeletal Pain during the Menopausal Transition: A Systematic Review and Meta-Analysis.
MacGregror EA. (2020). Menstrual and perimenopausal migraine: A narrative review.
Joffe H, et al (2020). Impact of Estradiol Variability and Progesterone on Mood in Perimenopausal Women With Depressive Symptoms
Jones K & Sung S. (2025). Anovulatory Bleeding
Peacock K, et al. (2023). Menopause.
Stachenfeld N S. (2008). Sex hormone effects on body fluid regulation.
Heitkemper M M & Chang L. (2009). Do Fluctuations in Ovarian Hormones Affect Gastrointestinal Symptoms in Women With Irritable Bowel Syndrome?
Wharton W, et al. (2012). Neurobiological Underpinnings of the Estrogen - Mood Relationship

perimenopause-periods

Should I still see my gynecologist if my periods are just "weird" but not painful?

Yes. Annual visits remain important during perimenopause. Your provider can help determine if your "weird" periods are typical perimenopause changes or something requiring attention. They can also discuss management options to improve your quality of life.

perimenopause-periods

How long do irregular periods last before menopause?

Irregular perimenopause periods typically last 4 to 8 years before your final period, though this varies greatly. Some women experience irregularity for just a few months, while others have irregular periods for over a decade before reaching menopause.

perimenopause-periods

Is it normal to have two periods in one month during perimenopause?

Yes, this can happen, especially in early perimenopause when cycles shorten. You might have a 21 day cycle, meaning you could have a period at the beginning and end of the same calendar month. Track these patterns to distinguish between short cycles and abnormal bleeding.

perimenopause-periods

Why are my periods suddenly so heavy in my 40s?

Heavy perimenopause periods often result from estrogen dominance. When progesterone drops but estrogen remains high, your uterine lining builds up more than usual, causing heavier bleeding when it sheds. This is common in perimenopause but should be evaluated if it affects your daily life.

perimenopause-periods

Can I still get pregnant if my periods are irregular during perimenopause?

Yes. As long as you're having periods, even irregular ones, you may still be ovulating. Pregnancy is possible until you've gone 12 full months without any period. If you don't want to become pregnant, continue using contraception throughout perimenopause.

perimenopause-and-weight-gain

Can you prevent perimenopause weight gain completely?

While you may not prevent all weight changes during perimenopause, you can minimize gain through proactive strategies. Starting strength training before perimenopause, maintaining consistent sleep habits, and managing stress can help your body adapt to hormonal changes more smoothly. Remember, some body changes during this transition are normal and healthy.

perimenopause-and-weight-gain

At what age does perimenopause weight gain typically start?

Perimenopause weight gain can begin in your late 30s or early 40s, often coinciding with the first hormonal changes. Many women notice gradual changes starting 5 to 10 years before their final period. The timing varies greatly based on genetics, lifestyle, and overall health.

perimenopause-and-weight-gain

Does everyone gain the same amount during perimenopause?

No. Perimenopause weight gain varies significantly. Some women gain 5 pounds, others 20 or more, and some maintain their weight. Factors include genetics, starting weight, activity level, stress, sleep quality, and how dramatically hormones fluctuate. Your experience is unique to your body.

Is perimenopause weight gain different from regular aging weight gain?

Yes. While metabolism naturally slows with age, perimenopause weight gain has distinct characteristics. The hormonal shifts cause fat redistribution to the midsection, even if overall weight doesn't change dramatically. This abdominal weight gain pattern is specifically linked to declining estrogen and progesterone, not just aging.

perimenopause-and-weight-gain

Will the weight come off after menopause?

Perimenopause weight gain often stabilizes after menopause when hormones level out, but the weight doesn't automatically disappear. The metabolic and body composition changes that occur during perimenopause tend to persist. However, with consistent healthy habits, weight management becomes more predictable post menopause than during the fluctuating perimenopause years.

https://www.oova.life/blog/progesterone-supplementation-guide

Can I take progesterone if I'm breastfeeding?

Yes, progesterone is generally safe while breastfeeding and doesn't significantly affect milk supply. However, always discuss with your healthcare provider before starting any hormone supplementation while nursing.

https://www.oova.life/blog/progesterone-supplementation-guide

Is it safe to take progesterone throughout pregnancy?

Yes, when prescribed by your healthcare provider. Progesterone supplementation in early pregnancy is safe and can reduce miscarriage risk in women with low progesterone or a history of pregnancy loss. Most providers continue supplementation through the first trimester (weeks 10-12) when the placenta takes over.

https://www.oova.life/blog/progesterone-supplementation-guide

Can progesterone supplementation cause weight gain?

Progesterone can cause temporary water retention and bloating, which may show up as a few pounds on the scale, but it doesn't cause true fat weight gain. Most women don't experience significant weight changes from progesterone supplementation.

https://www.oova.life/blog/progesterone-supplementation-guide

Can I switch from pills to suppositories or vice versa?

Yes, but only under your doctor's guidance. The dosing and timing may need adjustment when switching between forms since they're absorbed differently. Never switch on your own, especially if you're pregnant or undergoing fertility treatment.

https://www.oova.life/blog/progesterone-supplementation-guide

Will progesterone supplementation delay my period?

Yes, progesterone keeps the uterine lining intact, so if you're not pregnant and continue taking progesterone, your period will be delayed. Once you stop taking it, your period should start within 2-10 days. If you are pregnant, progesterone helps maintain the pregnancy and you won't get a period.

https://www.oova.life/blog/progesterone-supplementation-guide

Should I take progesterone pills orally or vaginally?

For fertility and pregnancy support, vaginal progesterone is usually preferred because it delivers higher concentrations directly to the uterus. For perimenopause or general hormone balance, oral progesterone often works well and is more convenient. Your doctor will recommend the best route based on your specific needs.

https://www.oova.life/blog/progesterone-supplementation-guide

When should I start taking progesterone after ovulation?

Typically, progesterone supplementation for luteal phase support starts 2-3 days after ovulation (confirmed by LH surge or temperature rise). Your doctor will give you specific timing based on your protocol. Some women start immediately after a positive ovulation test.

https://www.oova.life/blog/progesterone-supplementation-guide

What's better: progesterone cream or pills?

Pills (oral micronized progesterone) are generally more effective and reliable than creams because absorption from creams is inconsistent. For medical conditions like fertility issues, low progesterone, or HRT, prescription pills or suppositories are strongly recommended over over-the-counter creams.

https://www.oova.life/blog/low-vs-high-progesterone-symptoms

How can I tell if I have low or high progesterone?

The only definitive way to know is through hormone testing via blood tests or at-home urine tests that measure progesterone metabolites. However, symptom patterns can provide clues: anxiety and irregular periods suggest low progesterone, while bloating and extreme fatigue suggest high progesterone.

https://www.oova.life/blog/low-vs-high-progesterone-symptoms

When during my cycle should I test progesterone levels?

Test progesterone levels during the luteal phase, typically 7 days after ovulation or around day 21 of a 28-day cycle. This is when progesterone should be at its peak, making it easier to identify if levels are too low or too high.

https://www.oova.life/blog/low-vs-high-progesterone-symptoms

What are the main differences between low and high progesterone symptoms?

Low progesterone typically causes irregular or heavy periods, anxiety, hot flashes, and sleep issues. High progesterone causes bloating, fatigue, intense breast tenderness, and depression-like mood changes. Low progesterone symptoms persist throughout your cycle, while high progesterone symptoms are most intense during the luteal phase.

https://www.oova.life/blog/low-vs-high-progesterone-symptoms

Can you have symptoms of both low and high progesterone?

Some symptoms like breast tenderness and mood changes can occur with both low and high progesterone, making it confusing. However, the timing, intensity, and accompanying symptoms differ. Hormone testing is the best way to determine which imbalance you're experiencing.