What are the symptoms of perimenopause?

Bottom linePerimenopause symptoms come from fluctuating estrogen and include irregular periods with lighter or heavier flow (often the first sign), hot flashes and night sweats, sleep problems, mood swings, anxiety, brain fog, vaginal dryness, lower libido, bladder changes, joint aches, and weight changes; they often come and go with hormone swings. Period changes plus hot flashes in your 40s strongly suggest perimenopause, and disruptive symptoms or unusual bleeding warrant a doctor.

Perimenopause symptoms come from fluctuating estrogen and vary widely from person to person. They can start years before your periods stop.

Period changes (often first)

• Irregular cycles - shorter, longer, or skipped
• Lighter or heavier flow
• More variable PMS

Hot flashes and temperature

• Hot flashes - sudden waves of heat
• Night sweats disrupting sleep

Sleep and mood

• Trouble sleeping (with or without night sweats)
• Mood swings, irritability, anxiety, or low mood
• Brain fog and memory lapses

Physical changes

• Vaginal dryness and discomfort during sex
• Lower libido
• Bladder changes and more frequent UTIs
• Joint aches
• Headaches or changes in migraine pattern
• Weight changes, especially around the middle
• Thinning hair, dry skin

The key feature

Symptoms often fluctuate along with hormones, so they can come and go. Period changes plus hot flashes in your 40s strongly suggest perimenopause.

When to see a doctor

• Symptoms disrupting your life
• Very heavy or unusual bleeding (still needs evaluation)
• To discuss treatment options like HRT

Read our perimenopause and menopause guide and what is HRT.

Femora helps you track fluctuating perimenopause symptoms and changing cycles in one place.