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Perimenopause and menopause symptoms: the full list
Perimenopause affects far more than periods and hot flashes, and the popular list of 34 symptoms barely covers it. Symptoms fall into a few groups: temperature, sleep, mood and memory, body aches and energy, skin and hair, and vaginal and urinary changes. Most women get several at once, and the first sign is usually a change in periods. Every symptom below has its own page.
All 40 in one book
The Perimenopause Symptom Atlas covers every symptom on this list and more, each with what else it could be, what helps ranked by evidence, and when to see a doctor.
Perimenopause symptoms: expectation vs reality
What people often expect
“The famous list of 34 symptoms covers it”
What the evidence shows
There's no official count. SWAN tracked 58 symptoms in 3,289 women over 16 years and found six distinct patterns, ranging from highly symptomatic to almost symptom-free.
How common are perimenopause symptoms?
From the studies on this page
get hot flashes or night sweats during the transition
50–75%
Reported range across studies or subgroups
of perimenopausal women report muscle or joint pain
71%
of women in SWAN started out in the group with almost no symptoms
20%
Why perimenopause causes so many symptoms
Estrogen acts on almost every system in the body
Estrogen receptors sit in the brain, blood vessels, bones, joints, skin and urinary tract. As hormones swing and fall, all of these systems react, which is why menopause symptoms range from hot flashes and poor sleep to joint pain, skin changes and bladder problems.
Why perimenopause symptoms differ between women
Your background matters too. Ethnicity, location, stress and general health all shape which symptoms you get and how strongly. SWAN found that symptom patterns appear early in midlife and tend to stay stable, so the symptoms you notice first often set the tone for the transition.
Hot flashes are only one part of perimenopause
Hot flashes are the best-known symptom, but in SWAN they tended to cluster with sleep problems and fatigue and were not what defined the symptom patterns. A quarter of women were already moderately or highly symptomatic across all areas before menopause began. The NHS lists changes to periods, sleep problems, mood changes, brain fog, weight gain, vaginal and urinary problems, palpitations, headaches, joint pain, hair and skin changes and mouth problems among common symptoms.
Browse by body system
50 guides.
A hot flash is a sudden wave of heat, flushing and sweat that usually lasts a few minutes. Why they happen, common triggers, and treatments…
Perimenopause is a common cause in women in their 40s, but medications, infections, thyroid problems and anxiety cause night sweats too.…
Night sweats are hot flashes during sleep. Why falling estrogen triggers them, bedroom and lifestyle fixes, and treatments, from HRT to…
Tiredness that sleep doesn't fix is one of the most common perimenopause symptoms. Hormonal causes, blood tests to rule out (ferritin, TSH,…
Cycles that shift by 7+ days mark early perimenopause; gaps of 60+ days mark the late stage. What's normal, which bleeding needs a doctor,…
Falling estrogen reduces skin collagen, oil and moisture, which can cause itching and crawling sensations. What helps, and when itching…
Midlife hair thinning is often hormonal, but low iron and thyroid problems are common culprits. Tests to ask for, what HRT does for hair,…
Aching, stiff joints are a common and overlooked menopause symptom. How estrogen affects joints, how to tell it from arthritis, and what…
Estrogen spikes in perimenopause can make breasts sore, swollen or lumpy. How it differs from PMS, what eases it, and breast changes that…
Which lubricant types suit menopausal dryness, ingredients to avoid (glycerin, parabens, high osmolality), and when vaginal estrogen works…
It can, but research is thin. The usual routes are migraine, reflux, anxiety and HRT side effects. How to tell it from pregnancy, and what…
Migraines often get worse in perimenopause as estrogen swings, then ease after menopause. Triggers, treatments, HRT and migraine, and…
Sudden heat rising through the chest, neck and face, flushing, sweating, a racing heart, then chills. What a hot flash feels like minute by…
Stronger cramps in perimenopause usually come from heavier periods, fibroids or adenomyosis. What helps, and why cramps after menopause…
Each hot flash lasts a few minutes. Overall, hot flashes continue for about 7 years on average, and over 10 years for some women. What…
Hormone swings slow digestion and cause water retention, so bloating is common in perimenopause. Food and lifestyle fixes, and when…
A racing, fluttering or pounding heart is common in perimenopause and often harmless. What causes it, how to calm it, and warning signs…
Hot flashes, night sweats and hormone shifts change sweat and vaginal odor in midlife. Why it happens, practical fixes, and odors that…
Frozen shoulder typically affects women aged 40 to 60. The suspected estrogen link, how long it lasts, treatments that help, and whether…
Estrogen drops just before a period, which can trigger hot flashes, especially in perimenopause. What it means at your age and when to get…
Periods often get heavier in perimenopause. What counts as heavy, causes like fibroids and polyps, iron deficiency, treatments, and when to…
Genitourinary syndrome of menopause causes dryness, itching, burning and pain. Moisturizers, lubricants and vaginal estrogen, and when to…
Spotting and brown discharge are common as hormones swing, but bleeding after sex or heavy bleeding between periods needs a check. What's…
Skin collagen and thickness fall by 1–2% a year after menopause. Why skin gets dry and thin, and what has real evidence: sunscreen,…
Discharge changes as estrogen falls, often thinner and lighter. What's normal, colors and smells that suggest infection, and discharge…
Estrogen treats the dryness and pain that kill desire; testosterone is the hormone with evidence for low libido itself. Options, doses and…
Hormone swings, hot flashes, blood sugar dips and anxiety can all make you dizzy in perimenopause. Common causes, quick fixes, and red…
Blood pressure tends to rise through midlife, and for some women menopause speeds it up. Why it happens, how often to check it, and what…
Antidepressants like sertraline and venlafaxine, tamoxifen, opioids and some diabetes drugs can cause sweating. Common culprits and what to…
Night sweats, falling progesterone and anxiety all disrupt sleep in menopause. CBT-I, HRT and other treatments that work, and how long…
Estrogen and progesterone affect gut speed, so bloating, gas, constipation and IBS flares often worsen in perimenopause. Causes, fixes and…
As estrogen falls, androgens have more effect, so chin and upper-lip hair can thicken. Why it happens, removal options, and when to test…
Hormonal acne along the jaw and chin is common in perimenopause. Why it happens, skincare that works on older skin, and prescription…
Sudden anger and irritability are common as estrogen swings affect mood chemistry. Why it happens, how to tell it from depression or PMDD,…
New anxiety or panic attacks in your 40s can be hormonal. How perimenopause affects anxiety, how to tell it apart, and treatments including…
Forgetting words and losing focus is common in perimenopause and usually improves after menopause. Why it happens, when to worry about…
Most ovarian cysts are harmless, but cysts after menopause are monitored more closely. Symptoms, CA-125 and ultrasound, and when surgery is…
Thinner, drier vaginal tissue makes sex hurt for many women after menopause. Lubricants, moisturizers, vaginal estrogen and other…
Hormone shifts, weight gain and stress can all make reflux worse in perimenopause. Common triggers, what helps, and when heartburn needs a…
Fibroids mainly cause problems before menopause and are a common cause of heavy bleeding in perimenopause. Treatment, HRT, and when growth…
Hormone changes reduce tear quality, so dry, gritty eyes are common in midlife. Which drops help, other fixes, and symptoms that need an…
The risk of depression rises in perimenopause, even with no past history. Signs it may be hormonal, treatments including HRT and…
Low estrogen changes vaginal and urinary bacteria, so UTIs become more common after menopause. Vaginal estrogen cuts repeat infections.…
LDL cholesterol typically rises around menopause as estrogen falls. What your numbers mean, diet and exercise that lower them, and when…
Lower estrogen reduces saliva, so dry mouth, burning mouth and changed taste can appear in midlife. What helps and when to see a dentist or…
Spine bone density fell 10.6% over the 10 years around menopause in SWAN, most of it around the final period. HRT, exercise, calcium and…
Some women notice more desire in perimenopause. What SWAN found about desire and sexual activity through the transition, and why it varies…
Hormone swings, nausea, anxiety and low mood can dull appetite in perimenopause. Common causes, what helps, and weight loss that needs…
Some women notice ringing in the ears around menopause. What research says about the estrogen link, other causes to rule out, and what…
Lower estrogen and a weaker pelvic floor make bladder leaks and urgency common around menopause. Pelvic floor training, bladder training…
A–Z
- Anxiety in menopause
- Best lubricants for menopause dryness
- Bladder leaks and incontinence in menopause
- Brain fog and memory loss in menopause
- Can perimenopause cause nausea?
- Cramps in perimenopause and after menopause
- Dizziness in perimenopause
- Dry eyes in menopause
- Dry mouth in perimenopause
- Estrogen and bone health
- Facial hair in menopause
- Fibroids in perimenopause and after menopause
- Frozen shoulder in menopause
- Hair loss in perimenopause and menopause
- Heart palpitations in perimenopause
- Heartburn and acid reflux in perimenopause
- Heavy periods in perimenopause
- High libido in perimenopause
- Hot flashes
- Hot flashes before or during your period
- How long do hot flashes last?
- Irregular periods in perimenopause
- Itchy skin in perimenopause
- Joint pain in menopause
- Loss of appetite in perimenopause
- Low libido in menopause
- Medications that cause hot flashes and night sweats
- Menopause acne
- Menopause and blood pressure
- Menopause and cholesterol
- Menopause body odor
- Menopause insomnia
- Menopause skin
- Night sweats
- Night sweats in perimenopause and menopause
- Ovarian cysts in perimenopause and after menopause
- Painful sex after menopause
- Perimenopausal depression
- Perimenopause bloating
- Perimenopause fatigue
- Perimenopause headaches and migraines
- Perimenopause rage and mood swings
- Perimenopause stomach and digestive problems
- Sore breasts in perimenopause
- Spotting between periods in perimenopause
- Tinnitus and menopause
- UTIs in menopause
- Vaginal discharge in perimenopause and menopause
- Vaginal dryness and vulvar itching in menopause
- What does a hot flash feel like?
Full list of perimenopause symptoms by body system
Temperature
Periods
Sleep and energy
Mood and memory
Body and heart
Digestion
Skin, hair and eyes
Perimenopause symptoms: questions women ask
What are the first signs of perimenopause?
Usually a change in your periods: they come more or less often, or get heavier or lighter. Hot flashes, sleep problems and mood changes often follow.
What are the 34 symptoms of perimenopause?
A popular list, not a medical one. It gathers symptoms from hot flashes and brain fog to itchy skin, tinnitus and body odor. Research has tracked more: SWAN followed 58.
Can you have perimenopause symptoms with regular periods?
Yes. Hot flashes, sleep and mood changes can start while cycles still look regular. Over 45, NICE identifies perimenopause from new hot flashes plus any change in your cycle, without blood tests.
How long do perimenopause symptoms last?
The transition can last more than a decade. Frequent hot flashes alone last a median of 7.4 years. Many symptoms ease after menopause, but vaginal and urinary symptoms often continue without treatment.
What does perimenopause feel like?
It varies a lot. Many women first notice periods that come closer together or further apart, heavier or lighter bleeding, trouble sleeping, and hot flashes or night sweats. Others notice mood swings, anxiety, brain fog, aching joints or tiredness before anything else. Symptoms can change over the years, with hot flashes easing and low mood or anxiety taking their place.
What are the most unusual perimenopause symptoms?
Symptoms that surprise many women include heart palpitations, dizziness, tinnitus, itchy or crawling skin, dry eyes, a burning mouth or metallic taste, body odor changes, frozen shoulder and more UTIs. They are less talked about but linked to hormone changes in research or listed by the NHS. Because they overlap with other conditions, they are worth a doctor’s check.
Can perimenopause start at 35?
It is uncommon but possible. Perimenopause usually starts in your 40s, and menopause usually happens between 45 and 55. Symptoms such as period changes and hot flashes before 40 can mean premature ovarian insufficiency, which NICE advises diagnosing with FSH blood tests taken 4 to 6 weeks apart. If you are under 40 with these symptoms, see a doctor.
Is heartburn a symptom of perimenopause?
It can be. The NHS lists increases in hormones such as progesterone and estrogen among the causes of heartburn and acid reflux, and gut symptoms tend to flare when ovarian hormones fall. Weight gain and stress in midlife add to it. Heartburn most days, trouble swallowing or weight loss needs a doctor.
Which perimenopause symptoms are the worst?
It depends on the woman. In SWAN, about a quarter of women were moderately or highly symptomatic across all symptom areas before menopause, while others had almost no symptoms. For many, broken sleep from night sweats is the hardest, because it drives fatigue, low mood and brain fog. The good news is that the most disruptive symptoms are also the most treatable.
Sources
- NHS. Symptoms of menopause and perimenopause.
- Monteleone P, Mascagni G, Giannini A, et al. Symptoms of menopause - global prevalence, physiology and implications. Nat Rev Endocrinol. 2018;14(4):199-215.
- Harlow SD, Karvonen-Gutierrez C, Elliott MR, et al. It is not just menopause: symptom clustering in the Study of Women's Health Across the Nation. Womens Midlife Health. 2017;3:2.
- Crandall CJ, Mehta JM, Manson JE. Management of Menopausal Symptoms: A Review. JAMA. 2023;329(5):405-420.
- Lu CB, Liu PF, Zhou YS, et al. Musculoskeletal Pain during the Menopausal Transition: A Systematic Review and Meta-Analysis. Neural Plast. 2020;2020:8842110.
- NHS. Postmenopausal bleeding.
- NICE. Menopause: identification and management (NG23). Updated 2024.
- NHS. Heart palpitations.
- National 911 Program. 911.gov.
- Santoro N, Roeca C, Peters BA, et al. The Menopause Transition: Signs, Symptoms, and Management Options. J Clin Endocrinol Metab. 2021;106(1):1-15.
- Avis NE, Crawford SL, Greendale G, et al. Duration of menopausal vasomotor symptoms over the menopause transition. JAMA Intern Med. 2015;175(4):531-9.
- Carpenter JS, Cortés YI, Tisdale JE, et al. Palpitations across the menopause transition in SWAN: trajectories, characteristics, and associations with subclinical cardiovascular disease. Menopause. 2023;30(1):18-27.
- Torgerson RR. Burning mouth syndrome. Dermatol Ther. 2010;23(3):291-8.
- NHS. Irregular periods.
- NHS. Heartburn and acid reflux.
- Heitkemper MM, Chang L. Do fluctuations in ovarian hormones affect gastrointestinal symptoms in women with irritable bowel syndrome? Gend Med. 2009;6 Suppl 2(Suppl 2):152-67.
- Kravitz HM, Zhao X, Bromberger JT, et al. Sleep disturbance during the menopausal transition in a multi-ethnic community sample of women. Sleep. 2008;31(7):979-90.