33 symptoms of perimenopause: The complete guide

Perimenopause can feel like a puzzle you never signed up to solve. One day you’re fine, the next you’re wide awake at 3am or crying over a TV advert. Is it stress? Burnout? Or could it be perimenopause?

Here’s the tricky part: there’s no simple blood test that confirms it. Diagnosis is usually based on symptoms. That’s why we’ve created this full guide: 33 common perimenopause symptoms, grouped into categories, so you can recognise what’s going on in your body and feel less alone in the process.

Remember: most women don’t experience all of these. Symptoms usually appear in phases, and some pass quickly. But reviewing the list can help you connect the dots sooner.

Table of contents

1. What are the types of perimenopause symptoms?

2. Vasomotor symptoms (hot flushes, night sweats, palpitations)

3. Psychological symptoms (mood swings, anxiety, low self-esteem)

4. Physical symptoms (headaches, joint pain, weight gain, fatigue)

5. Urogenital symptoms (vaginal dryness, bladder issues, pain during sex)

6. Key takeaways

What are the types of perimenopause symptoms?

• Vasomotor: linked to changes in blood vessel function and body temperature regulation

• Psychological: affecting mood, emotions, and mental wellbeing

• Somatic (physical): impacting the body as a whole, from energy levels to how different systems function

• Urogenital: connected to sexual health, bladder function, and pelvic floor strength

Understanding these categories can make the long list below easier to navigate.

Vasomotor symptoms

Hot flushes: A sudden feeling of intense heat that spreads through your body, often with flushing or sweating. They’re one of the most common perimenopause symptoms and can last for years.

Night sweats: The same as hot flushes, but happening while you sleep. Waking up drenched and exhausted is frustrating, and it often worsens other symptoms like fatigue and brain fog.

Heart palpitations: A rapid, pounding heartbeat can be linked to hormone shifts. Often harmless, but worth checking with a doctor to rule out heart conditions.

Psychological symptoms

Mood swings and irritability: Fluctuating oestrogen affects serotonin and dopamine: your “happy hormones”. You may feel up one minute and tearful or angry the next.

Anxiety and panic attacks: Many women describe a constant background tension, sometimes escalating into sudden panic. Progesterone decline plays a role here.

Depression and low self-esteem: For some, perimenopause brings feelings of disconnection, flatness, or self-doubt. Past history of depression can make this more likely.

Crying spells and sensitivity: Even if you’re not usually emotional, tears may come more easily now. But sometimes a good cry is a healthy release.

Brain fog and difficulty concentrating: Forgetting words mid-sentence or losing track of tasks is common - and can be alarming. Hormones plus poor sleep are usually behind it.

Physical symptoms

Changes in your cycle: Irregular, lighter, or heavier periods are often the first sign. Always check with your doctor if bleeding is unusually heavy.

Weight gain: Especially around the waist, due to changes in fat distribution, muscle mass, and insulin sensitivity.

Sleep problems: From difficulty falling asleep to waking at 3am and not getting back to sleep. Often worsened by night sweats.

Fatigue: Hardly surprising given all the above. Many women describe feeling drained despite doing “everything right.”

Headaches and migraines: Hormonal changes can trigger or worsen headaches. Tracking patterns can help spot triggers.

Skin and hair changes: Dryness, itching, acne flare-ups, or thinning hair are common as oestrogen declines.

Joint and muscle pain: Oestrogen protects joints and reduces inflammation, so less of it means more aches.

Digestive issues: Bloating, slower digestion, or new sensitivities often appear in midlife, partly due to hormonal shifts affecting gut health.

Restless legs, tingling, or itching: Strange sensations in the skin or limbs are another lesser-known symptom.

Vision changes and dry eyes: Screen time doesn’t help, but hormones also play a role in dryness and discomfort.

Body odour changes: Hormonal shifts can alter your natural scent - something women often notice during hot flushes.

Urogenital symptoms

Low libido: Hormone changes, stress, and fatigue all combine to reduce sexual desire.

Vaginal dryness and discomfort: Thinning vaginal tissue (vaginal atrophy) can cause pain, tearing, or inflammation.

Pain during sex: Linked to dryness or tightness, but treatable with lubricants, gels, or hormone therapy.

Bladder issues and recurrent UTIs: Weakened pelvic floor muscles can lead to leakage, urgency, or infections.

Vaginal prolapse: Less common but possible as pelvic support weakens with age and hormone decline.

Key takeaways

• Perimenopause symptoms vary widely - no two women have the exact same journey.

• Symptoms fall into four main groups: vasomotor, psychological, physical, and urogenital.

• You may only notice a handful, and many improve with time or treatment.

• Lifestyle changes, therapy, supplements, or hormone therapy can all help manage symptoms.

Bottom line: If you recognise yourself in several of these symptoms, you’re not imagining things. Perimenopause is real, and support is out there - you don’t need to just “push through.”

References:

Aras, S. G., Grant, A. D., & Konhilas, J. P. (2025). Clustering of > 145,000 symptom logs reveals distinct pre, peri, and menopausal phenotypes. Scientific reports, 15(1), 640. https://doi.org/10.1038/s41598-024-84208-3

Hemachandra, C., Taylor, S., Islam, R. M., Fooladi, E., & Davis, S. R. (2024). A systematic review and critical appraisal of menopause guidelines. BMJ sexual & reproductive health, 50(2), 122–138. https://doi.org/10.1136/bmjsrh-2023-202099

Lyndaker, C., & Hulton, L. (2004). The influence of age on symptoms of perimenopause. Journal of obstetric, gynecologic, and neonatal nursing : JOGNN, 33(3), 340–347. https://doi.org/10.1177/0884217504264872

Santoro, N., Roeca, C., Peters, B. A., & Neal-Perry, G. (2021). The Menopause Transition: Signs, Symptoms, and Management Options. The Journal of clinical endocrinology and metabolism, 106(1), 1–15. https://doi.org/10.1210/clinem/dgaa764

Liu, X., Zhang, X., Wang, D., Zhou, J., & Li, Y. (2025). Investigation of the quality of life and influencing factors among perimenopausal women. Archives of gynecology and obstetrics, 312(4), 1253–1265. https://doi.org/10.1007/s00404-025-08116-1