Perimenopause symptoms: the full list, and what helps each one

Perimenopause is the stretch of years before menopause, your final period, when hormone levels rise and fall unevenly. Most of its symptoms come from that unevenness, which is why they can come and go, vary month to month, and be hard to recognize as belonging together.

The first sign: your periods change

Changes in the menstrual cycle are the most common sign of perimenopause. According to ACOG, cycles may become longer or shorter than usual, periods may be skipped, and flow may become lighter or heavier.¹ These changes are normal in perimenopause, but ACOG also advises reporting them to your clinician, because abnormal bleeding can have other causes.

The full list of perimenopause symptoms

NICE, the UK guideline body, lists the main groups: changes in the menstrual cycle, hot flushes and sweats, genitourinary symptoms such as vaginal dryness, effects on mood, joint and muscle pain, and sexual difficulties such as low desire.² ACOG adds sleep problems.¹ Here they are in one place:

Why some lists say 34 or 100 symptoms

You will see lists of 34, 50 or even 100 perimenopause symptoms. None of them is an official medical list. They take the same groups above and split them into smaller items, so hot flashes, night sweats and chills become three symptoms, and anxiety, irritability and low mood become three more. The long lists are useful for one thing: recognizing that a symptom you did not connect to hormones might belong here. They do not mean you will have dozens of problems. Menopause symptoms covers what tends to continue after the final period.

How long perimenopause symptoms last

In the Massachusetts Women's Health Study, perimenopause began at a median age of 47.5 and lasted nearly four years.⁴ Hot flashes often last longer than that. In the SWAN study of more than 3,000 US women, frequent hot flashes and night sweats lasted a median of 7.4 years in total, and a median of 4.5 years after the final period.³ Women whose hot flashes started early in perimenopause tended to have them longest.

Perimenopause age covers when it starts, is there a test for perimenopause covers testing, and early perimenopause symptoms covers the first signs in your early forties.

The quiet symptom: body composition

The symptom most lists leave out is a change you cannot feel. In the SWAN study, lean mass began to decline during the transition while fat gain sped up, with differences between ethnic groups.⁵ Weight can stay the same while clothes stop fitting.

NICE now tells clinicians to explain the importance of keeping muscle mass and strength through physical activity during menopause.² Strength training gives muscle a reason to stay, and protein supplies what it is built from. Many women in their forties eat less protein than they think, often under 10 g at breakfast.

Protein Buddy works out a daily protein target from a short quiz on your weight, age, activity and goal, and Home shows how many grams are left today as you log. Typing meals in by hand is free with no limit. Perimenopause weight gain explains the body changes in detail.

Perimenopause symptoms and treatment

Treatment depends on which symptoms bother you most.

• Hot flashes and night sweats. Hormone therapy is the most effective treatment according to the Menopause Society. For women who cannot or prefer not to use it, cognitive behavioral therapy, clinical hypnosis and several prescription medicines are recommended.⁶ Hot flashes has the details.
• Vaginal dryness. Local estrogen, as a vaginal cream, tablet or ring, relieves it well.¹
• Sleep, mood and joints. These respond to a mix of treatment and habits: see menopause insomnia and perimenopause rage. Low mood that is new or getting worse should always be discussed with a doctor.
• Muscle and bone. Strength training, enough protein, calcium and vitamin D.

Supplements sold for perimenopause mostly lack evidence. Perimenopause supplements sorts the few that help from the many that do not.

When to see a doctor

See a clinician about very heavy bleeding, bleeding that lasts much longer than usual, bleeding between periods or after sex, low mood or anxiety that affects your life, or any symptom that stops you working or sleeping. Perimenopause is common and normal, but you do not have to put up with symptoms that effective treatment could relieve.