Health Conditions A-Z Reproductive Conditions Menopause Signs and Symptoms of Perimenopause By Brandi Jones, MSN-Ed, RN-BC Brandi Jones, MSN-Ed, RN-BC Brandi Jones has over two decades of experience as a nurse in an acute care setting. Her clinical background includes pediatrics, medical-surgical, and women's health. She also specializes in professional staff development. health's editorial guidelines Published on February 28, 2024 Medically reviewed by Soma Mandal, MD Medically reviewed by Soma Mandal, MD Soma Mandal, MD, is a board-certified internal medicine physician with a specialty in women’s health. learn more Perimenopause, or the transition phase that occurs right before menopause, develops in your mid-to-late 30s and causes symptoms like irregular periods, hot flashes, and fatigue. Menopause occurs when a person with a uterus stops having a menstrual cycle for 12 consecutive months. It's worth noting that perimenopause can last anywhere from four to ten years. This phase is typically a natural aging process, but perimenopause and menopause can sometimes also develop earlier due to underlying health conditions, treatments, or surgery. Design by Health Period Changes Menstrual cycle or period changes are the most common symptoms of perimenopause. These changes occur due to fluctuations in estrogen and progesterone, the primary female reproductive hormones. These hormones affect ovulation (when the ovary releases an egg) and the thickening of the uterine (womb) lining that sheds during period bleeding. During perimenopause, you may notice the following changes to your period: Shorter or longer time between periods Skipped periods Light or heavy bleeding Cramping Hot Flashes Low estrogen disrupts blood vessel dilation and body temperature regulation, which can cause hot flashes. These are sudden, intense waves of heat, that typically affect your upper body, face, and neck. Hot flashes can last anywhere from a few seconds to several minutes. You may also notice sweating, a rapid heartbeat, or anxiety. Most people who experience hot flashes have them for four to five years, but they can occur for up to 10 years. Night Sweats Night sweats cause you to sweat profusely while you sleep. Severe episodes drench your pajamas or linens. You may also notice a racing heart or anxiety upon waking up. Heart Palpitations Estrogen affects the autonomic nervous system, which regulates your heart rate. Hormonal changes can cause fluctuations in your heart rate, which may result in heart palpitations (or, feeling like your heart is beating rapidly, irregularly, or more forcibly). Stress, anxiety, and caffeine can contribute to heart palpitations during perimenopause. Sleep Disturbances Many people who go through perimenopause experience changes in their sleep patterns. Insomnia, difficulty falling or staying asleep, and restless legs syndrome are common disturbances that can occur during this period. Not getting enough or good quality sleep can also cause fatigue, irritability, and difficulty concentrating. Mood Changes As your hormones fluctuate during perimenopause, mood changes are likely to occur. You may experience more stress, anxiety, emotional sensitivity, irritability, depression, and mood swings when undergoing perimenopause. Fatigue The demands of daily life, lack of sleep, and a decline in estrogen can cause mental and physical fatigue. Your body may feel sluggish and less resilient—even despite getting enough sleep or drinking your daily cup of coffee. Problems with Memory and Concentration Mental fatigue and hormone fluctuations can cause difficulty concentrating, memory lapses, and weariness. You might hear people refer to these symptoms as “brain fog”. Decreased Libido Estrogen plays a large part in your libido (or, sex drive), and having lower amounts of estrogen can decrease your sex drive. But mood changes, stress, and fatigue—all of which are common symptoms of perimenopause—can also reduce your interest in or desire for sex. Vaginal Dryness As estrogen levels decline, your vaginal tissues may become dryer, thinner, and less elastic. This can cause itching and vaginal pain. Left untreated, vaginal dryness can contribute to pain during sexual intercourse, making intimacy less enjoyable. Genitourinary Changes Genitourinary changes are any changes that occur in the female genitalia and urinary tract system. A lower estrogen level can: Changes in the pH (acid-base) balance of the vagina and urethra (the tube where pee comes out) Thin vaginal and urethral tissues Bladder weakness Weakened pelvic floor muscles With genitourinary changes, you may also have a higher risk of: Urinary tract infections (UTIs) Using the bathroom more frequently Urinary incontinence (bladder leakage that worsens with coughing, sneezing, or exercising) Genitourinary Syndrome Genitourinary syndrome of menopause (GSM), vaginal atrophy, or atrophic vaginitis are other names for vaginal and urinary changes. Up to 70% of people with GSM do not discuss their symptoms with a healthcare provider. If you are in this position, consider consulting a provider to get the treatment you need to improve your quality of life. If you have genitourinary syndrome and oral estrogen is not an option for you, it can also help to ask your provider about vaginal estrogen and dilators. Weight Gain Low estrogen reduces your metabolism (how your body burns, stores, and distributes fat). As a result, this can increase the tendency to store fat in the abdominal area and lose muscle mass—which can contribute to weight gain. Other factors that may influence your weight during perimenopause include: Low estrogen causes an imbalance in your hunger hormones and makes you eat more Fatigue makes it challenging to maintain previous levels of activity Stress and sleep disturbances affect eating patterns Low progesterone causes less regulation of cortisol (the stress hormone), which may cause you to eat more than normal Emotional eating due to mood changes Joint or Muscle Pain Estrogen protects your joints and connective tissues by stimulating collagen production and joint lubrication. Low estrogen can diminish these protective effects, which may cause joint stiffness, muscle pain, and a higher risk of osteoporosis (loss of bone density). You might also experience joint or muscle pain due to: Lack of sleep, which reduces muscle recovery Stress, which causes muscle tension Reduced physical activity levels, which lowers strength and flexibility Low calcium and vitamin D, which affects your overall bone health Skin Changes Estrogen helps maintain collagen and elastin fibers in the skin. Collagen is a protein that provides structural support for your skin and elastin helps with elasticity and flexibility. Less collagen and elastin can cause changes in your skin tone and make your skin less supple or bouncy. Headaches Fluctuating hormones during perimenopause can trigger blood vessel dilation (widening), pain perception changes, and stress—all of which contribute to headaches. Some people can also experience hormonal migraines (headaches with nausea, vomiting, or light sensitivity) as a result of these hormonal fluctuations. Breast Tenderness With hormonal fluctuations, breast pain, sensitivity, tenderness, fullness, or heaviness can occur. It’s often cyclical (occurs in patterns), similar to how breasts can increase or decrease in tenderness throughout your menstrual cycle. When to Contact a Healthcare Provider If you're experiencing persistent, severe, or disruptive symptoms of perimenopause, now is a good time to contact your healthcare provider for support. You should especially talk to your provider if you experience any of the following symptoms during perimenopause: Menstrual bleeding that lasts for more than seven days Soaking through a pad or tampon every hour for several hours in a row Having to use double protection (tampon and pad) Passing large blood clots Needing to change pads or tampons at night while you sleep Cramps that interfere with daily life or last more than three days The following symptoms also warrant a healthcare provider consultation: Persistent pelvic pain Pain during sex Frequent urination Abdominal swelling Severe back or leg pain High blood pressure A resting heart rate that is consistently over 100 beats per minute Frequent heart palpitations Anxiety or depression Seek emergency medical care if you experience: Sudden or intense pelvic or abdominal pain Dizziness, fainting, fever, or chills Severe headaches Chest pain or shortness of breath Blood pressure that is 180/120 or higher Questions to Ask Your Provider Should you choose to consult a healthcare provider, the following questions can help initiate a productive conversation about perimenopause:How do I know if I'm going through perimenopause or menopause?Which treatments are available to improve heavy menstrual bleeding?Are there any lifestyle changes that can help me manage the symptoms of perimenopause?What risks do perimenopause treatments pose to my overall health?How can I maintain heart and bone health during perimenopause? A Quick Review Perimenopause, or the transition phase before menopause can cause a host of symptoms irregular menstrual cycles, hot flashes, night sweats, mood swings, fatigue, sleep disturbances, vaginal dryness, urinary changes, and decreased libido. You may also experience heart palpitations, weight gain, and skin, muscle, or bone changes. If symptoms are affecting your daily life, it's important to talk to your healthcare provider for proper treatment and support. Frequently Asked Questions At what age do perimenopause symptoms start to develop? Perimenopause typically starts in your mid to late 40s and can last up to ten years before you enter menopause. How can I get my energy back during perimenopause? Getting enough exercise (about 150 minutes per week), eating nutritious foods (like fruits, vegetables, and lean protein), prioritizing sleep, and managing stress (such as through yoga or meditation) can help you improve your energy levels. Edited by Sukhman Rekhi Sukhman Rekhi Sukhman is an editor at Health. She currently produces health content about conditions, nutrition, and wellness. She also writes stories covering public health, psychology, and women's issues. learn more Was this page helpful? Thanks for your feedback! Tell us why! Other Submit 12 Sources Health.com 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. Duralde E R, Sobel T H, Manson J E. Management of perimenopausal and menopausal symptoms. BMJ. 2023; 382:e072612 doi:10.1136/bmj-2022-072612 Santoro N, Roeca C, Peters BA. The menopause transition: Signs, symptoms, and management options. The Journal of Clinical Endocrinology & Metabolism. 2021;106(1):1-15. doi:10.1210/clinem/dgaa764 Zhou Q, Wang B, Hua Q, et al. 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