Symptoms

Perimenopause can cause more than a dozen symptoms. The earliest is usually a change in your periods; hot flashes and night sweats affect up to 80% of women during the transition, and sleep problems, mood changes, brain fog, fatigue, joint aches and vaginal dryness are also common. They come from fluctuating estrogen and falling progesterone, not just low hormone levels, which is why they can start while periods are still fairly regular. Most are treatable.

Where to start

For an overview of every common symptom and why it happens, begin with the full list of perimenopause symptoms. If one symptom dominates your days, go straight to its guide below; hot flashes in perimenopause is also the best place to compare treatments.

Symptoms at a glance

Symptom	What it feels like	What helps most	Read the guide
Hot flashes	A sudden wave of heat over the face and upper body	Hormone therapy; several nonhormonal options with Level I evidence	Hot flashes
Night sweats	Hot flashes during sleep that wake you	The same treatments as hot flashes	Night sweats
Irregular periods	Cycles that vary by a week or more, then skipped months	Usually none; report bleeding between periods or after sex	Irregular periods
Sleep problems	Waking at 3 or 4 AM and lying awake	CBT for insomnia; treating night sweats	Waking at 3 AM
Brain fog	Losing words, losing your train of thought	Protecting sleep; checking thyroid, iron and B12	Brain fog
Irritability and rage	A shorter fuse, sudden anger	Treating hot flashes and sleep; screening for depression	Irritability and rage
Fatigue	Exhaustion even after a full night in bed	Finding the cause: sleep, low iron, thyroid or mood	Fatigue
Joint pain	Aching, stiff joints, often worse in the morning	Strength training and regular aerobic activity	Joint pain
Headaches	More frequent, less predictable migraine	Migraine treatment within safe limits; steadier estrogen for some	Headaches and migraines
Palpitations	A racing, pounding or fluttering heartbeat	An evaluation first, then treating hot flashes, sleep and stress	Palpitations
Weight gain	Fat shifting to the middle while muscle declines	Resistance training plus enough protein	Weight gain
Vaginal dryness	Dryness, irritation, pain with sex	Moisturizers and lubricants; low-dose vaginal estrogen	Vaginal dryness treatments

Less talked-about changes have their own guides too: belly fat, bloating, dizziness, hair thinning and itchy skin.

What else can cause these symptoms

Many perimenopause symptoms are nonspecific. Thyroid disease, iron deficiency from heavy periods, sleep apnea, depression and anxiety disorders, some medications, diabetes and pregnancy can produce the same picture, and most are found with simple tests. That is why new, persistent symptoms deserve a visit rather than an assumption; how perimenopause is diagnosed explains which tests are useful.

When to see a clinician

See a clinician promptly for very heavy bleeding, bleeding between periods or after sex, any bleeding after 12 months without a period, or chest pain, fainting or palpitations with shortness of breath. If low mood comes with thoughts of self-harm, call or text 988. Make an appointment, too, if symptoms are disrupting your sleep, work or relationships; you do not need to wait until they are severe. The symptom check gives you a summary to bring, and the directory lists clinicians near you.