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.
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.
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.
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.
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!
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.
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.
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
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.
