Perimenopause marks the phase leading up to menopause, when hormone levels—especially estrogen and progesterone—begin to shift. These hormonal changes can bring a range of symptoms, which often start in a woman’s 30s or 40s and may vary from person to person.
Some of the most common symptoms of perimenopause include irregular periods, hot flashes, night sweats, mood changes, sleep disturbances, and vaginal dryness. Others may experience changes in libido, brain fog, or digestive issues like bloating or nausea.
While not everyone will have the same symptoms—or the same intensity—recognizing what’s related to perimenopause (and what’s not) can help you manage things more effectively.
Common Symptoms of Perimenopause
Perimenopause can involve a wide range of physical and emotional symptoms, driven by fluctuating hormone levels. While your individual experiences will be unique, here are some of the most common perimenopause symptoms:
Changes in your menstrual cycle:
Your period may become shorter or longer, heavier or lighter. Some people notice skipped periods or even more frequent cycles. These irregularities are often the first sign of perimenopause.
Hot flashes and night sweats:
Hot flashes are sudden sensations of heat, often with flushing or sweating. When they happen at night, they can disrupt sleep. These are some of the most common (but still frustrating) symptoms of perimenopause.
Mood changes:
Dr. Nanette Santoro confirms that hormone fluctuations can affect your mood, and that this is one of the four major symptoms. You might notice some increased irritability, anxiety, or low mood. Mood swings—sometimes sharp—are also quite common.
Sleep disturbances:
Falling asleep, staying asleep, or waking up early enough may become more difficult. Night sweats can make this worse, leading to physical and mental fatigue during the day.
Vaginal and urinary changes:
As estrogen levels drop, the vaginal tissue may become thinner, drier, or less elastic. This can cause discomfort during sex and increase your chances of dealing with vaginal or urinary tract infections. Some people also experience more frequent urination or urgency.
Changes in sexual desire:
Many people report a lower libido during perimenopause. However, others may notice an increase! These shifts are often tied to hormonal changes and can vary over time, so this is often dynamic.
Cognitive symptoms:
Some experience “brain fog,” symptoms like forgetfulness, trouble concentrating, or mental fatigue. While incredibly frustrating, these symptoms are very common during perimenopause.
Physical changes:
Hormonal shifts could lead to some weight gain, especially around the abdomen. Thinning hair, dry skin, and itchy skin are also common during this time. These changes may be subtle or more noticeable over time.
Joint and muscle discomfort:
Some people report joint stiffness and pain or muscle aches. Lower estrogen levels may play a role in these symptoms.
Bladder symptoms:
You may notice an increase in urinary urgency, frequency, or even some occasional leakage. This is partly due to changes in the pelvic floor and the tissues around the bladder and urethra.
Less Common Symptoms of Perimenopause
In addition to more familiar symptoms, perimenopause can bring about less obvious, “sneaky” changes that are often misattributed to other causes. These symptoms are still linked to shifting hormone levels and may become more noticeable during the menopause transition.
Heart palpitations:
Some people experience episodes of a rapid, fluttering, or pounding heartbeat. While these palpitations can feel unsettling, they’re usually harmless and often related to hormonal fluctuations. If they become frequent or severe, it’s worth discussing with a healthcare provider.
Headaches or migraines:
Hormonal shifts during perimenopause can trigger new headaches or make existing migraines more frequent or intense. This is especially common in people who’ve had hormone-related headaches in the past.
Worsening PMS symptoms:
Symptoms typically associated with premenstrual syndrome—such as bloating, breast tenderness, and mood changes—can become more pronounced during perimenopause. Some notice that these symptoms last longer or feel more intense than before.
How to Tell if Your Symptoms Might Be Related to Perimenopause
Perimenopause can be difficult to pinpoint because many of its symptoms overlap with other conditions or everyday stress. Still, there are a few clear signs to watch for:
- Track your menstrual changes: Shifts in your period are one of the most reliable indicators. This might mean your cycles are becoming shorter or longer, or your flow is heavier or lighter than usual. Skipped periods or noticeable irregularity over time can also signal the onset of perimenopause.
- Pay attention to symptom patterns: If you’re noticing hot flashes, mood changes, sleep disruptions, or other new symptoms that seem to follow a pattern, especially alongside changes in your cycle, perimenopause may be the cause.
- Consult a healthcare provider: If your symptoms are frequent, disruptive, or difficult to manage, it’s worth checking in with a clinician. They can help confirm whether hormonal changes are driving your symptoms and guide you through treatment options if needed.
How to Manage Perimenopausal Symptoms
Perimenopause is a natural phase, but the symptoms can be disruptive. There are a few different ways you could try to manage them—from lifestyle changes to medical treatments—depending on the severity of what you’re experiencing.
Start With the Basics
Simple lifestyle adjustments can often make a meaningful difference.
Regular exercise, a balanced diet, consistent sleep habits, and stress management techniques can all help regulate hormone fluctuations and ease frustrating symptoms.
For mood-related concerns like anxiety or irritability, cognitive behavioral therapy (CBT) is one of the most evidence-based approaches you could take.
Consider Medical Treatment if Needed
If your symptoms are more intense or interfere with your daily life, medical treatment may be the right step to take.
Hormone therapy is one of the most effective options for relieving symptoms like hot flashes, night sweats, and vaginal dryness.
Other possibilities include low-dose birth control pills, or non-hormonal medications targeting specific symptoms. A healthcare provider can help you weigh the benefits and risks based on your own health and history.
Explore Other Options Carefully
Some people find relief with over-the-counter supplements, though the evidence behind them varies.
Options can include:
- Phytoestrogens (plant-based compounds that mimic estrogen)
- Black cohosh
- Vitamin D
- Magnesium
- Omega-3 fatty acids
Certain adaptogens—like ashwagandha or rhodiola—are also marketed for hormone balance, though research is still emerging.
Before starting any supplement, it’s important to speak with a healthcare provider. Some may interact with medications or have side effects, and not all are appropriate for every health profile.
Get Support
Perimenopause isn’t one-size-fits-all. If your symptoms are affecting your quality of life, seek out a clinician who has experience managing this stage of life.
A provider who understands hormonal changes and midlife health can help you find an approach that fits your needs, whether that’s lifestyle-based, medical, or a combination of both.
Making Sense of Perimenopause
Perimenopause can bring a wide range of symptoms, some more disruptive than others. Knowing what’s typical—and what’s not—can give you some peace of mind about the process and help you make more informed decisions about how to manage things.
There’s no single “right” way to approach this transition. What works well for one person may not be helpful for another. The key is to track your symptoms, adjust your habits where possible, and consult a healthcare provider if symptoms start to interfere with daily life.
With the right information and care, most symptoms can be managed effectively. Keep things simple, stay consistent with what helps, and don’t hesitate to ask for expert input when needed.
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Frequently Asked Questions (FAQ):
How do I know if I am in perimenopause?
Perimenopause often begins with subtle changes like irregular periods, mood shifts, or disrupted sleep. Other common symptoms include hot flashes, night sweats, and vaginal dryness.
What are the seven stages of perimenopause?
There’s no universally agreed-upon staging system, but perimenopause typically unfolds in phases. Early on, you might see minor shifts in your menstrual cycle. As hormone levels fluctuate more dramatically, symptoms like hot flashes, sleep issues, and mood changes often become more noticeable. Perimenopause ends when you’ve gone 12 consecutive months without a period—that marks the start of menopause.
What is the average age for perimenopause?
Most people enter perimenopause in their mid to late 40s, but it can begin earlier or later. Some may notice changes as early as their late 30s, while others don’t experience symptoms until their early 50s. Genetics, health history, and lifestyle can all influence timing.
What not to do during perimenopause?
Some habits can make symptoms worse. Limiting alcohol and caffeine can help reduce hot flashes and improve sleep. It’s also a good idea to avoid smoking and manage stress where possible.
