Signs and Symptoms of Perimenopause

A natural part of a woman's life that is beautiful but also filled with change

You’ve probably heard “I’m feeling menopausal” when a woman friend was having, say, hot flashes. But most of the time, having symptoms is actually part of perimenopause, which is the phase leading up to menopause—the moment in time when your menstrual cycles have stopped for 12 months.

Then, once a woman has not menstruated for a year (she has reached menopause), she is said to be postmenopausal.

 While some symptoms of perimenopause may persist into postmenopause, most of them become less frequent and/or less severe. Even so, it's important to note that some women never experience any perimenopausal symptoms—they simply stop menstruating when their bodies decide it’s time.

The Symptoms of Perimenopause

The age when the symptoms of perimenopause occur varies, but in general, most women begin noticing perimenopausal symptoms in their 40s, with the average age being 47 years old. Then, the average age at which a woman reaches menopause (when she hasn't had a period for one year) is age 51.

This list of common perimenopausal symptoms is long, but, remember, each woman experiences a personal “mix” that usually (and thankfully) doesn’t include all of them. 

Symptoms of Perimenopause
Verywell / Madelyn Goodnight 

Period Changes

Menstrual cycle changes are normal during perimenopause. Your periods may be shorter, or they may be longer. You might experience heavy unexpected bleeding or less bleeding during your period. You may even miss some periods. Even so, it's important to talk to your healthcare provider about any changes in your menstrual cycle, as abnormal bleeding can be a sign of another medical problem.

Hot Flashes and/or Night Sweats.

hot flash is a sudden feeling of heat in your chest area and face. Hot flashes are very common in perimenopause but are quite variable in how often they occur and their severity. For instance, some women experience a hot flash here and there whereas other women experience several a day. Likewise, for some women, having a hot flash is a minor interruption in their day whereas, for other women, they can be more debilitating. 

A night sweat refers to a hot flash that occurs during sleep. Night sweats can interrupt a woman's sleep cycle which may lead to daytime fatigue.

Mood Changes

Mood changes and swings are common in perimenopause and may include symptoms of depression and anxiety.

Also, while it's normal to be a bit more irritable than usual, be sure to seek out the advice of your healthcare provider or a mental health professional if you are experiencing persistent symptoms, or if they are affecting your quality of life.

Vaginal Dryness

Vaginal dryness (called vaginal atrophy) is common during perimenopause and is due to your body’s reduced production of the hormone estrogen. Vaginal dryness is one symptom that may worsen as a woman gets older and can make sex uncomfortable.

It's important to talk to your healthcare provider if vaginal dryness is a problem for you, as there are several options for you to try including an over-the-counter vaginal lubricant or moisturizer or even a prescription vaginal medication.

Trouble Sleeping

You may find it difficult to fall asleep (called insomnia) or stay asleep, particularly if you’re bothered by night sweats or hormonal fluctuations.

An Increase in Fat Around the Waist. 

You may notice an expanding waistline in perimenopause. This shift may be in part due to estrogen loss, which experts believe causes fat redistribution in women.

What can you do? Try following a healthy, low-carbohydrate diet and getting regular exercise (at least 30 minutes, three times a week, walking or doing another type of aerobic exercise). 

Pounding Heart (Palpitations)

Heart palpitations are due to hormone fluctuations but can also be signs of anemia or thyroid disease, so be sure to see your healthcare provider for any heart disturbances.

Dry Skin and Hair Loss

Skin and hair changes are also common, and they may begin in perimenopause, as estrogen levels begin declining. For skin changes, women often notice less firmness and drier skin, which is due to a decrease in collagen and a decreased water-holding capacity.

Hair loss in menopause is believed to be caused by an imbalance between estrogen and androgen levels in a woman's body. This may cause hair thinning, mostly at the top of the scalp and the front of the head.

Reduced Sex Drive

Hormonal fluctuations that occur during perimenopause are often behind the loss of interest in sex that many perimenopausal women experience.

Increased Urinary Problems

Just like the lining of the vagina becomes thinner from the drop in a woman's estrogen levels during menopause, the lining of a woman's bladder and urethra also thins. This may lead to an increase in the number of urinary tract infections and/or a higher incidence of urinary incontinence (loss of bladder control).


Memory and concentration problems are common during perimenopause. Don't be alarmed if you find yourself forgetting things or are unable to focus on the task you have at hand. Of course, if the problem is severe or gets worse, you should consult your healthcare provider.

As long as this list is, there are still other perimenopausal symptoms you may experience. You should also be aware that symptoms of different conditions, such as thyroid disorders, can mimic those of perimenopause. As a precaution, check with your healthcare provider whenever you experience unfamiliar symptoms. 

Understanding Postmenopausal Symptoms

Studies show that some perimenopausal symptoms are especially likely to improve once you’re postmenopausal, including depression, irritability, and difficulty sleeping.

On the other hand, symptoms linked to the new lower estrogen levels in your body, such as vaginal dryness and incontinence, tend to linger on and may become more of a problem with age.

Treatment During Perimenopause

If your symptoms are annoying but don’t stop you from getting through your daily routine, you may not need treatment. On the other hand, if your perimenopausal symptoms are making you uncomfortable, your healthcare provider can provide treatment that may help you feel better. Or, he or she may suggest treatment with both medication and lifestyle changes.

Medication for Perimenopause Symptoms

If your healthcare provider recommends medication to relieve your perimenopausal symptoms, he or she may suggest hormone replacement therapy (estrogen or a combination of estrogen with progestin, the synthetic form of the hormone progesterone). Hormone replacement therapy can be taken systemically (for example, a skin patch) or locally (for example, vaginal estrogen to treat dryness).

Hormone replacement therapy cannot be taken by all women, and it does carry some health risks, even for healthy women. This is why if hormone replacement therapy is prescribed, it's taken for the shortest period of time needed (usually no more than five years). 

Depending on your unique symptoms, your healthcare provider may consider another prescription medication like an antidepressant to help stabilize your mood or even to treat your hot flashes. 

Lifestyle Changes That May Help 

Many women choose the “natural” route for perimenopausal symptom relief or simply decide to try it first to see if they can get relief without medication. But whether you use medication or not, you can still benefit from making the following lifestyle changes:

  • Eat a healthy and well-balanced diet that includes a variety of fruit, vegetables, and whole grains.
  • Get at least 1,000 to 1,200 mg of calcium per day, and if you aren’t getting enough calcium in your food (which is the best way) consider a calcium supplement under the guidance of your healthcare provider. 
  • Exercise regularly
  • Keep a food diary to find out if what you eat is making your symptoms worse (or, hopefully, better!). 

A Word From Verywell 

It's important to mention that some women don’t experience natural perimenopause. For example, women who have total abdominal hysterectomies with both their fallopian tubes and ovaries removed usually experience immediate surgical menopause (also called induced menopause).

Menopausal symptoms, especially hot flashes, can be quite intense for women who have undergone induced menopause, which is why many women go on hormone replacement therapy (if they can) under the guidance of their gynecologist.

Lastly, besides surgery, there are other causes for induced menopause like if a woman has pelvic radiation or takes a certain type of chemotherapy. 

4 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Santoro N. Perimenopause: From Research to Practice. J Womens Health (Larchmt). 2016;25(4):332-9. doi:10.1089/jwh.2015.5556

  2. Santoro N, Epperson CN, Mathews SB. Menopausal Symptoms and Their Management. Endocrinol Metab Clin North Am. 2015;44(3):497-515. doi:10.1016/j.ecl.2015.05.001

  3. Greendale GA, Derby CA, Maki PM. Perimenopause and cognition. Obstet Gynecol Clin North Am. 2011;38(3):519-35. doi:10.1016/j.ogc.2011.05.007

  4. Fan T, Nocea G, Modi A, Stokes L, Sen SS. Calcium and vitamin D intake by postmenopausal women with osteoporosis in Spain: an observational calcium and vitamin D intake (CaVIT) study. Clin Interv Aging. 2013;8:689-96. doi:10.2147/CIA.S41335

Additional Reading
  • Ahsan M, Mallick AK, Singh R, Prasad RR. Assessment of menopausal symptoms during perimenopause and postmenopause in tertiary care hospital. J Basic Clin Reprod Sci 2015;4:14-9.
  • American College of Obstetrics and Gynecologists. (2015). Frequently Asked Questions: The Menopause Years.
  • American Congress of Obstetricians and Gynecologists Education Booklet. (2010). Midlife Transitions: Perimenopause to Menopause.
  • Brubaker M. University of California, San Diego (2016). Menopause Health Program First of Its Kind in San Diego.
  • The North American Menopause Society. (2014). The Menopause Practice: A Clinician’s Guide, 5th ed. Mayfield Heights, OH: The North American Menopause Society.

By Tracee Cornforth
Tracee Cornforth is a freelance writer who covers menstruation, menstrual disorders, and other women's health issues.