A Complete List of Perimenopause Symptoms

In the time that I have been writing Hot Flash, I have received one type of question more than any other: Is “fill-in-the-blank” a perimenopause symptom? There are some symptoms so notorious that everyone knows about them. Hot flushes, for example, are the quintessential symptom of perimenopause. But other symptoms don’t get as much attention. When was the last time you chatted with your friends about burning mouth syndrome?

I thought it would be helpful to amass a comprehensive list of perimenopause symptoms, along with how common they are and the evidence regarding treatment options. Much of what we know about perimenopause symptoms comes from longitudinal studies like the Study of Women’s Health Across the Nation (SWAN), but no single study offers a totally comprehensive picture, and some symptoms are better understood than others. As we continue to study the perimenopausal transition, we may identify even more symptoms.

Vasomotor symptoms

Many of the symptoms that have come to define perimenopause have done so because so many women experience them. Hot flushes and night sweats — collectively known as vasomotor symptoms — appear to be the most common perimenopause symptom. Vasomotor symptoms occur because the temperature-sensing centers in the brain become very sensitive. If the core body temperature rises even a little, the brain tells the blood vessels to dilate to cool the body. We experience this as a rising feeling of heat. Upward of 80% of SWAN participants reported vasomotor symptoms.

Treatment options

The most effective treatment for vasomotor symptoms is hormone therapy. But there is a growing list of non-hormonal medications that can effectively treat these symptoms. The latest addition to the group is expected to get FDA approval in the second half of 2025.

Sleep disruption

Other common symptoms SWAN participants reported were subjective increases in sleep disruption. Estimates of how many women are affected vary widely, from just 15% to more than 70% of women reporting sleep disruption. SWAN participants reported taking longer to fall asleep, having more trouble staying asleep, and waking before they wanted to. In many cases, poor sleep is associated with night sweats. If you have ever experienced night sweats, you will understand why. They are often drenching sweats that soak pj’s and bedding, which quickly becomes uncomfortable.

Poor sleep can lead to a whole host of other symptoms that are commonly associated with menopause, including fatigue, brain fog, memory changes, and mood changes like anxiety, depression, and panic attacks.

Treatment options

To the degree that sleep disruption is due to night sweats, both hormone therapy and non-hormonal perimenopause treatments may help.

Mood and cognitive changes

About 23% of SWAN participants had depressive symptoms, based on their scores on a validated depression scale. This may be because of sleep disruption or may be an independent symptom, depending on the person. Anxiety symptoms are also common and seem to peak in the late-perimenopause years before subsiding slowly after the last menstrual period in most cases.

Upward of 60% of women report changes in memory and cognition during perimenopause. Many worry that these are early signs of dementia, but the data suggests that cognition improves after their last menstrual period for the vast majority of women.

Treatment options

Anecdotally, some women report that hormone therapy improves their mood symptoms. This would make sense, particularly if mood changes are related to sleep disruption triggered by vasomotor symptoms. Mood symptoms can also be treated directly with antidepressant medications such as selective serotonin reuptake inhibitors (SSRIs).

Genitourinary symptoms

The authors of SWAN also looked at symptoms associated with vaginal dryness. Here again, the initial symptom can lead to myriad other problems, including discomfort, pain with sex, more urinary tract infections, and more vaginal infections like yeast infections and bacterial vaginitis. Nearly 35% of SWAN participants experienced vaginal dryness.

Along with vaginal dryness comes changes in sexual function. Certainly the dryness itself may play a role. It is hard to get excited about sex if you are worried it isn’t going to feel good. Women’s libido is poorly understood, but beyond vaginal dryness, changes in testosterone levels may lead to decreased desire for sex too. Similarly, if sex isn’t pleasurable, it may be less likely to result in orgasm. When I asked you about sex, the overwhelming sentiment was that you just wanted to want to have sex again.

And to add insult to injury, urinary incontinence affects a majority of women. Fully 68% of SWAN participants experienced incontinence at least once per month. Sadly, less than 40% of participants sought treatment for their urinary incontinence.

Treatment options

Hormone therapy can be effective for many women. Vaginal estrogen alone or in combination with an estrogen patch or pill can relieve vaginal dryness and all the unpleasant symptoms that can come with it. Many women who may not be able to use an estrogen patch or pills can safely use vaginal estrogen, and vaginal estrogen can be used safely in women over age 60 and indefinitely if needed. Additionally, testosterone replacement has shown promise for treating sexual dysfunction, although there is no formulation of testosterone approved by the FDA for use by women.

Weight gain

Many women’s biggest complaint during perimenopause is that it is harder to maintain their body size. About 20% of women gain 10 pounds or more during perimenopause. On average, women see an increase of 14% in body fat and a 10% increase in waist circumference. They also lose about half a pound of muscle.

Treatment options

The cause of this weight gain is not fully understood, and so as a result it’s difficult to treat. Certainly the loss of estrogen plays a role, but hormone therapy does not significantly reduce perimenopausal weight gain. In recent years, researchers have become interested in how follicle-stimulating hormone might affect perimenopausal shifts in body composition. Some women with overweight and obesity in perimenopause have found GLP-1 agonists like semaglutide (Ozempic/Wegovy) to be very effective in helping them lose weight.

Palpitations

More than 50% of women experience palpitations during perimenopause and menopause. Defined as an awareness of the heart beating rapidly or irregularly, palpitations cause perimenopausal women a lot of anxiety. More than 85% of women think their palpitations need to be treated, but there is no evidence suggesting that it typically needs to be treated. This is likely because palpitations aren’t associated with health problems that predispose people to heart disease, such as metabolic syndrome or Type 2 diabetes.

Treatment options

In some cases, palpitations occur with vasomotor symptoms. As a result, treating vasomotor symptoms could reduce the number of palpitations a woman experiences and the anxiety she may have about them. However, like many symptoms of perimenopause, palpitations have not been extensively studied.

Gastrointestinal changes

Perimenopause can affect the gastrointestinal tract, from your mouth all the way to your anus — from increased tooth sensitivity, dry mouth, burning mouth syndrome, and more dental problems overall, to bloating, heartburn, and constipation. In the past, these types of symptoms were not recognized as being perimenopausal, but shifts in hormone levels could certainly contribute to these types of changes. Hormonally triggered changes in gut bacteria may also explain some of these symptoms; research on this is in its infancy.

Treatment options

Because the link between these symptoms and perimenopause is just beginning to be understood we don’t have great evidence for treatment options.

Systemic body changes

Recently, more attention has been paid to symptoms of perimenopause that affect the whole body. These symptoms are nonspecific, which is why they are hard to study. Dry skin, for example, might be due to perimenopause, but it might also be due to new hypothyroidism or just seasonal changes.

These types of symptoms include dry, itchy skin, brittle nails, hair loss and change in hair texture, joint and muscle aches, headaches, breast tenderness, body odor changes, and numbness or pins and needles sensations. Because these types of symptoms are harder to study, there isn’t much reliable data regarding how many women experience them in perimenopause.

Treatment options

There is some anecdotal evidence that hormone therapy helps relieve many of these symptoms but it isn’t well studied.

Closing thoughts

Perimenopausal symptoms are numerous. Some are exceedingly common; others are less so. Many are linked to one another — night sweats disrupt sleep, which in turn leads to fatigue, brain fog, and mood changes. The source of other symptoms is less clear. In many cases, we don’t know just how many women are affected and what treatments are most effective. But it is helpful to understand which symptoms might be related to perimenopause so you can have a productive conversation with your doctor about your symptoms and your best options for treating them.