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The 34 Symptoms of Perimenopause

The 34 Symptoms of Perimenopause

Perimenopause is the stage that occurs before a woman officially reaches menopause. This stage can last nearly a decade for many women, and yet many of us are unprepared for what we may experience during this time. As most people have not even heard of the term “perimenopause,” women have suffered in silence with numerous symptoms often dismissed by health providers.

There are 34 symptoms women can experience when they are in perimenopause. Fluctuating estrogen and progesterone are the primary culprit behind these symptoms.

Women have estrogen receptors all over their bodies, meaning that every organ system can be affected by these changes occurring in your ovaries. When you think of it this way, it’s not that surprising after all that we can experience so many frustrating symptoms!

Here’s a glimpse of what you may encounter in perimenopause.

Most Common Perimenopause Symptoms

1. Irregular Periods - One of the first signs you are in perimenopause is usually a change in your menstrual period. These changes can include spotting, heavy bleeding, and differences in the color and duration of each cycle.

2. Hot Flashes - Perhaps the most well-known menopause symptoms, we actually know very little about what causes these vasomotor symptoms. Likely, it is due to hormonal factors that affect the hypothalamus in your brain. Among many roles, the hypothalamus serves as the body’s thermostat.

3. Night Sweats - Hot flashes can occur at any time of day. Women often find they wake at night drenched in sweat, which leads to interrupted sleep.

4. Loss of Libido - Due to a decrease in sex hormones (like estrogen and testosterone), women often find they have a low sex drive during perimenopause.

5. Vaginal Dryness - Estrogen helps keep your vaginal tissues moist and plump. When estrogen levels begin to decline, it can leave you feeling dry and can thin the tissues. May women experience discomfort during intercourse and even an increase in vaginal infections due to loss of lubrication.

Mental Perimenopause Symptoms

6. Mood Swings - Neurohormones (hormones produced in your brain) are also affected by fluctuating estrogen levels. Most of us are already familiar with this feeling with our regular menstrual cycles. Thus, it comes as no surprise that the sometimes severe estrogen fluctuations in perimenopause can make your mood feel like a rollercoaster.

7. Brain Fog - Estrogen supports cognitive function as well. Therefore, lower estrogen levels can make you feel like your thinking is fuzzy.

8. Panic Disorders/Attacks - Thanks again to changing estrogen levels, anxiety can sometimes escalate into feelings of panic and doom. It is important to note that frequent, severe, or recurring panic attacks are not a sign of perimenopause and should be evaluated by your doctor.

9. Anxiety - Women with a history of anxiety often find it worsens in perimenopause. However, it is also important to note that even women without a history of anxiety may experience a new onset of this mental health condition.

10. Irritability - When you consider there are 34 symptoms of perimenopause, it is no wonder women can feel irritable! However, like all other symptoms, irritability is primarily due to hormone changes.

11. Depression - Having a history of depression (such as postpartum depression) can put you at greater risk of depression in perimenopause. If you feel low or depressed, make sure to connect with your doctor to find a solution.

12. Difficulty concentrating - Because your cognitive functions can be affected by estrogen, many women fund their attention to detail, focus, and patience diminishes.

Physical Perimenopause Symptoms

13. Hair Loss - Estrogen and progesterone help hair grow and stay on your head. Thus, many women find they struggle with hair thinning during this stage.

14. Unexplained dizziness - Episodes of dizziness can sometimes be related to anxiety, fatigue, or hot flashes. However, dizziness is also associated with medical conditions such as high blood pressure, so talk with your doctor if you are experiencing frequent or severe episodes of dizziness.

15. Fatigue - Being exhausted is par for the course when it comes to changing hormones. Indeed, other perimenopause issues like insomnia, anxiety, and night sweats can worsen fatigue during this time.

16. Insomnia - Most women will develop sleep problems at some point during menopause. The circadian rhythm can be affected by hormone changes, and other symptoms can interrupt rest periods as well.

17. Bloating - Many women experience bloating during their regular menstrual cycle. Not surprisingly, estrogen shifts during perimenopause can make you feel bloated quite frequently. Fortunately, bloating due to hormones typically goes away once you stop having periods.

18. Weight gain - Perimenopause makes it easier for your body to store excess fat in the abdomen, and many women notice a general uptick on the scale as well.

19. Stress Incontinence - Several factors can lead to decreased pelvic floor strength, including aging, childbirth, and a reduction in muscle mass. Weakness in the pelvic floor can cause women to leak urine or have a more challenging time holding their bladder.

20. Brittle nails - Lower estrogen levels can lead to a decrease in collagen, elastin, and keratin, which can change both your skin and nails.

21. Osteoporosis - Estrogen has bone-protective qualities, meaning that when your estrogen levels lower, it can make your bones more brittle and prone to fractures.

22. Irregular heartbeat - All symptoms related to the heart can feel very concerning and even scary when they happen. However, some women experience non-threatening heart arrhythmias and an increase in heart rate and palpitations during perimenopause. If you do have heart irregularities, it is important to see your doctor to be sure to rule out other causes.

23. Allergies - Sensitivities and allergies can develop at any point in life. However, they often correlate with times of change. If you find you are becoming sensitive or allergic to certain things, keep a journal to log what you come in contact with and what your reaction is to identify triggers.

24. Change in body odor - You may notice you have a different (and sometimes not-so-pleasant) body odor, which can be caused by increase perspiration and, you guessed it, hormone fluctuations.


25. Headaches and migraines - Headaches and migraines may worsen during perimenopause. However, there is good news: many women find their migraines improve remarkably or go away altogether once they are past menopause.

26. Breast pain - Tender breasts are a direct result of estrogen fluctuations that cause tenderness in your breast tissue. Typically, breast pain resolves once you reach menopause, but if you are worried or notice any abnormal changes to your breast tissue, consult your doctor immediately.

27. Joint pain - Your joints may become more stiff and sore beginning in perimenopause. Adopting habits like regular aerobic exercise, stretching, and using heat and ice can help make joint discomfort more manageable.

28. Burning Mouth Syndrome - BMS is one of those bizarre perimenopause symptoms that we still don’t quite understand. Estrogen may cause a decrease in saliva production, leading to a metallic taste in your mouth. BMS can be caused by other factors aside from hormones, so it is helpful to meet with your dentist and doctor to rule out other causes.

29. Electric shocks - Unpredictable shock sensations can course through your limbs during perimenopause. Often, these shocks precede a hot flash.

30. Gum problems - Changes in your saliva and tooth density can increase your risk for gum disease and tooth decay.

31. Digestive problems - Just like other organ systems, the digestive system also has estrogen receptors. Women in perimenopause can experience nausea, vomiting, diarrhea, stomach cramping, and constipation.

32. Dry, itchy skin - Natural changes to your body in perimenopause can suck moisture away from your tissues and skin. And just like with brittle nails, your skin can change, resulting in a decreased amount of collagen, elastin, and keratin.

33. Tingling extremities - Known as paresthesia, you can have unexplained tingling in your arms and legs during perimenopause. Fortunately, it usually goes away once you reach menopause.

34. Muscle tension - Estrogen serves as a regulator of muscle cell energy. Therefore, with low estrogen levels, your muscles tire and tense more easily due to a heightened presence of cortisol (a stress hormone).

If you have made it to the end of this list of symptoms and believe you may be having some perimenopause symptoms, this is a perfect time to connect with your health provider. While these symptoms can be intense, disheartening, and frustrating, there are so many ways to make this life stage easier and even empowering.

Julia Walker, RN, BSN is a women’s health nurse and advocate. She is a member of the perry team. perry is a social network for women in perimenopause - connecting & supporting like-minded warriors in the same stage of life. The community offers a safe space for women to feel understood, unite and tap into knowledge and resources from menopause experts.

Disclaimer: This is not medical advice, does not take the place of medical advice from your physician, and is not intended to treat or cure any disease. Patients should see a qualified medical provider for assessment and treatment.