Signs of perimenopause: 15 early symptoms to watch for

Maybe your periods have started showing up early, late, or not at all, and your cycle no longer looks like the one you knew a few years ago. Maybe sleep doesn’t come as easily, or a mood swing hits out of nowhere, and you can’t explain it. You’re not imagining these changes, and you don’t have to just live with them. Here’s what happens during this stage of life and why it can affect so much more than your period.

What is perimenopause, and why does it cause so many different symptoms?

You might not have connected these changes to your hormones yet, and that’s common. In the years leading up to menopause, your estrogen and progesterone levels start to rise and fall unevenly instead of following a steady monthly pattern. That stage is called perimenopause. Because your hormones are swinging up and down rather than tapering off in a straight line, symptoms can show up in one part of your body one week and somewhere else the next.

• It can start earlier than you might expect. As Dr. Sheryl Ross (Dr. Sherry), our Chief Medical Officer of Women’s Health, puts it, “The average age for menopause is 51, which means your 40s are prime time for perimenopause to begin.” Some women notice the first changes as early as their mid-30s.
• It can last a while. Perimenopause lasts about four years on average, and sometimes up to eight.

These changes don’t always mean something is wrong. Many women experience symptoms for months before realizing they may be linked to perimenopause.

15 signs of perimenopause (and why they happen)

These symptoms don’t affect everyone and don’t happen in a specific order. For each one, we’ll explain what it can feel like and how shifting hormones may play a part.

1. Irregular periods

Your periods may not run like clockwork anymore. As hormone levels shift, your ovaries may not release an egg on the same schedule each month, and that can throw your cycle off its usual rhythm. This could mean your cycle might change, not show up each month, or bleeding might be heavier or lighter than usual.

2. Hot flashes

You might feel a sudden wave of heat move through your face, neck, and chest, sometimes with sweating or flushing. That’s a hot flash. The exact cause isn’t settled, but it’s linked to shifting estrogen throwing off your body’s internal thermostat. If hot flashes are getting in the way of your day, our guide to what causes hot flashes also covers ways to manage them.

3. Night sweats

If you wake up sweaty or find your sheets damp in the morning, you may be having night sweats, which are hot flashes that happen while you sleep. They’re linked to the same hormone shifts and can pull you right out of sleep.

4. Trouble sleeping (insomnia)

If sleep has been hard to come by, it may be another sign of perimenopause. Poor sleep often shows up alongside hot flashes or night sweats, but it can happen on its own, too. For some women, it means lying awake long after bedtime. For others, it’s waking up too early, or waking at 3 a.m. and not being able to fall back asleep.

5. Mood changes (irritability, anxiety, low mood)

Maybe you’ve been snapping at people more than usual, or feeling down without a clear reason. The same hormone swings that throw off your cycle can affect your mood, too. About four in 10 women notice mood changes during perimenopause that feel a lot like PMS, but without the predictable timing.

• Irritability and low mood are the mood changes with the most research behind them.
• Anxiety comes up often too, though researchers haven’t studied its link to perimenopause as closely.

If mood swings are hitting hardest, our guide to mood swings during perimenopause goes deeper. If anxiety is the bigger concern, we cover it in menopause and anxiety.

6. Brain fog and trouble concentrating

You might lose your train of thought mid-sentence or blank on a word you use every day, and the first time it happens, it can be unsettling. This kind of brain fog is a common, well-recognized part of perimenopause, and it’s usually not a sign of anything more serious.

7. Fatigue

You might feel tired in a way that rest doesn’t fix. Fatigue during perimenopause rarely has one cause: broken sleep, everyday stress, and the hormone shift itself can all stack on top of each other. In a global survey of more than 17,000 women, 93% of those in perimenopause reported fatigue, even though hot flashes were the symptom people most expected.

8. Vaginal dryness

Vaginal dryness may be difficult to talk about, but it’s a frequent symptom of perimenopause. As estrogen drops, vaginal tissue can lose some of its moisture and stretch, which is often what’s behind everyday discomfort or pain during sex.

9. Lower sex drive

You might notice your interest in sex has dropped without an obvious reason. Lower estrogen can dampen sex drive on its own, and tiredness or vaginal dryness can make the dip feel bigger. There’s less research on this sign than on signs like irregular periods, but it’s a change many women describe.

10. Weight gain and metabolism changes

Your metabolism can shift during this transition because of hormones, so the scale can creep up even if you’re eating and moving the same as always. This shift can also affect cholesterol, nudging LDL (“bad” cholesterol) up and HDL (“good” cholesterol) down for some women.

11. Joint aches and pains

Your joints or muscles might feel stiffer, achier, or weaker than they used to, even without an injury. People talk about joint aches less than hot flashes, but many women notice them during perimenopause. Researchers are still learning exactly how falling estrogen levels affect your joints. If this is bothering you, our guide to menopause and joint pain goes deeper.

12. Headaches and migraines

If your headaches or migraines are tied to hormones, perimenopause can make them show up more often or hit harder than they used to. Headaches tend to ease when estrogen holds steady and flare when it rises and falls, which is what it does during this stage.

13. Hair thinning

You might notice your hair looking thinner or less full than it used to. Estrogen helps keep hair growing and full, so as levels fall and age adds its own effect, your hair can lose some volume, though this sign has less research behind it than irregular periods or hot flashes.

14. Dry, itchy skin

Your skin might feel thinner, drier, or itchier than it used to. Estrogen helps your body make collagen, the protein that keeps skin firm, so when levels fall, skin can lose some thickness and moisture, and itching often follows. Like hair thinning, this sign has less research behind it than others on this list. If you’ve noticed other changes in your skin too, our guide to menopausal skin changes covers them.

15. Heart palpitations

You may notice your heart racing, pounding, or fluttering, even when you’re resting. Some women experience heart palpitations during perimenopause, which may be linked to changing estrogen levels. However, more research is needed to understand this connection.

• Important: Don’t assume heart palpitations are caused by hormonal changes. If they’re new or happen often, talk to a doctor to rule out other causes. If you also have chest pain, fainting, or severe shortness of breath, seek emergency medical care.

When to see a doctor for perimenopause symptoms

You don’t need lab work or a test result to bring this up. A doctor can usually get a clear picture from your age, your symptoms, and how your cycle has changed. If you’ve been told you’re too young for perimenopause, that doesn’t have to be the final word. Symptoms can start earlier than most people expect, and it’s okay to get a second opinion.

Important: Some changes are worth a prompt visit instead of waiting. Reach out to a doctor soon if you notice a new racing or fluttering heartbeat, bleeding that’s much heavier than usual, or symptoms that come on suddenly or feel severe.