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If there’s one thing to know about menopause, it’s that it can be different for every person who experiences it. Some women may not have any symptoms, while others have symptoms severe enough to disrupt their daily quality of life.
“The journey through perimenopause is never the same for two people,” says Flow Advisor and OB-GYN Jessica Shepherd. It’s important to talk about all of the symptoms, she adds, so women can understand what to expect and how to navigate all of the options for treatment.
As a reminder, menopause occurs when you’ve gone a full year without having a period, on average at age 51. Perimenopause occurs during the years leading up to menopause, lasting an average of four years, but can be as long as a decade. If you’re experiencing symptoms you think may be a result of perimenopause, reach out to your health care provider. They can rule out other medical causes of your symptoms, such as thyroid issues or anemia.
If your symptoms appear to be due to perimenopause, it’s important know that you don’t need to suffer through them. There are a range of treatments available, from lifestyle changes and over-the-counter remedies to prescription medication and menopausal hormone therapy (MHT), sometimes called hormone replacement therapy (HRT). Talk to your provider to find out what the best options are for you. And if your provider minimizes your symptoms, seek out another provider who will listen and respond to how you’re feeling.
We’ve included the most common 34 symptoms of menopause here, but your symptoms may be due to perimenopause even if it’s not on this list.
“There are a vast number of symptoms that you can have,” says Flow Advisor and OB-GYN Heidi Flagg, co-founder and partner of Spring Ob/Gyn, who says there may as many as 500. So reach out to your provider to find relief.
The 34 Symptoms of Menopause
1. Irregular periods
During perimenopause, nearly all women will experience changes in their menstrual cycle. Over time a woman’s period may become heavier, lighter, and less or more frequent as levels of the reproductive hormones estrogen and progesterone start to drop. There may also be spotting between cycles. “Universally, people will have some sort of period changes,” says Dr. Flagg. It’s important to stay on top of birth control during perimenopause since there’s still a risk of pregnancy.
2. Hot flashes
Hot flashes are a sudden and intense warmth in the face, neck, and chest area. Together with night sweats, they belong to a class of symptoms known as “vasomotor symptoms” of menopause. With declining levels of estrogen, the hypothalamus, a brain area that acts as your body’s thermostat, has episodes during which it goes haywire and tries to cool your body down even when you’re not actually hot. This includes expanding blood vessels and increasing blood flow to get rid of body heat, causing sweating and a flushed look. About 75 percent of American women experience hot flashes, making it one of the most common symptoms of perimenopause.
Lifestyle changes, such as avoiding alcohol and caffeine or reducing stress, may help alleviate hot flashes. Hormone therapy, supplements, or antidepressants may help as well. There is also a new medication to treat hot flashes that was recently approved by the FDA.
3. Night sweats
Like the other vasomotor symptom of menopause, night sweats are as they sound — excessive perspiration at night that’s enough to drench your pajamas or bedding. As mentioned, hormone changes can short-circuit your body’s internal thermostat. Menopause-related night sweats can last as long as 7 to 11 years and can wreak havoc on your sleep, so it’s important to reach out to your provider to learn about treatment options, which are similar to the ones for hot flashes.
4. Difficulty sleeping
Women can have trouble falling asleep or staying asleep at night for a range of reasons during menopause. Hot flashes and night sweats can wake you up at night and affect sleep quality. Mood changes such as depression or anxiety can play a role as well. Declining levels of estrogen can also lead to lower levels of melatonin during perimenopause making it harder to get a good night’s sleeps.
5. Breast soreness
Women with breast soreness may feel achiness, pain, or oversensitivity in one or both of their breasts. Because of hormone changes, it can be unpredictable when it happens.
6. Vaginal dryness
As estrogen levels decline, the lining of the vagina becomes thinner and less elastic. Vaginal lubrication also decreases. Both can cause pain during sex and increase the risk for vaginal infections.
As with all menopause symptoms, you don’t need to suffer through vaginal dryness. The range of treatments mentioned earlier (such as supplements or menopausal hormone replacement therapy) may help, in addition to over-the-counter vaginal moisturizers or lubricants. Your provider can also prescribe an estrogen cream, tablet, ring, or medication to help.
7. Reduced sex drive
Perimenopause can cause a drop in sexual libido as blood flow to the genital area is reduced. This can be due to other menopausal symptoms such as vaginal dryness, mood changes, or sleep issues. Treating these symptoms can help boost sex drive, as can other hormonal and non-hormonal treatments.
8. Mood changes
As many as four in 10 women report feeling abrupt moods that are similar to PMS during perimenopause. Women may experience prolonged feelings of sadness, anger, or low energy. Mood changes can also be exacerbated by the added life stress that is common during the 40s and 50s. While many of the common treatments for menopause can help with mood changes, your provider may also recommend other types of treatment such as antidepressants.
The stress, insomnia, and hormonal imbalance brought by perimenopause can contribute to perimenopausal anxiety. Anxiety can also intensify other symptoms of perimenopause, such as difficulty sleeping and concentrating. Anxiety may be worse at night due to a rise in cortisol levels. Talk to your provider (or a mental health provider) to discuss treatment options that can provide relief.
In addition to anxiety, menopause mood changes can cause depressive symptoms. Women may experience bouts of unexplained sadness, fatigue, or low energy. While menopausal depression can be temporary, there is also risk of developing a depressive disorder during perimenopause and menopause. Working with a mental health provider can help you find treatment options that can help.
Another mood change women can experience during perimenopause is irritability. The irritability may arise from low estrogen levels affecting brain chemicals regulating mood along with lack of sleep and anxiety.
12. Panic attacks
Hormonal changes can increase the likelihood of having a panic attack. Women may feel intense anxiety that manifests in symptoms such as increased sweating, shortness of breath, and a racing heartbeat. One study found that up to 18 percent of post-menopausal women experienced a type of panic attack with up to 10 percent experiences a full-blown panic attack, usually in response to a stressful life event. As with any menopause-related mood change, seek help from a mental health care provider, who may recommend counseling or medication to help provide relief.
Migraines and tension headaches can become more common during perimenopause. Hormonal shifts may trigger migraine headaches, though many women notice headaches become less frequent once they reach menopause.
Menopause-related fatigue is a loss of energy that can happen at any part of the day. Hormonal imbalance and poor sleep quality — another menopause symptom — can also play a role. Interventions that improve your sleep quality can help, as can lifestyle changes such as exercising regularly and eating a healthy diet.
15. Joint pain
Decreasing estrogen levels can swell up joints and cause inflammation. Joint pain, a common symptom of perimenopause, can feel like a dull ache or a sharp pain shooting through the body. It’s often worse in the morning when joints are stiff from being immobile at night.
16. Muscle aches
Together with joint pain, muscle aches and tension throughout your body is common during perimenopause and menopause. In fact, up to 70 percent of women may experience musculoskeletal pain. Lifestyle changes such as exercising, eating a healthy diet, lowering stress and getting enough sleep can help—and a doctor may recommend over-the-counter pain relievers or physical therapy if more intervention is needed.
17. Digestive issues
Women entering perimenopause may experience a range of gastrointestinal (GI) issues, such as pain after eating, gas build-up, and constipation. There is some research suggesting race may be associated with the severity and type of GI symptoms women experience during menopause. Hispanic women, for example, were more likely to experience constipation while white women reported more nausea, loss of appetite, and diarrhea.
Some women link the “menopause belly” they’re experiencing to bloating. This happens because declining estrogen levels alter the composition of the gut microbiome, affecting gut bacteria involved in digestion. Another cause of bloating can be menopausal women experiencing a higher level of water and gas retention.
19. Weight gain
Women with perimenopause often gain weight around their midsection. On average, perimenopausal women gain 5 pounds, though 20 percent gain 20 pounds or more. If you’re concerned about perimenopausal weight gain, many women have found the Galveston Diet for Menopause to be helpful. It focuses on eating anti-inflammatory foods (similar to the Mediterranean diet), intermittent fasting, and limiting processed carbs, added sugars, and alcohol.
20. Trouble concentrating
Women may feel like their mind is fuzzy, also known as brain fog. Estrogen helps to increase blood flow to the brain. It’s also involved in sugar metabolism, and without it, the brain does not have the energy it needs to function properly. Sleep issues can also be a compounding factor with brain fog, so treating sleep disturbances with lifestyle changes such as sleep hygiene, eating a healthy diet, or medication to decrease hot flashes or night sweats can help.
21. Memory lapses
In addition to difficulty concentrating, women may experience increased forgetfulness and more difficulty taking in and processing new information. The same factors that cause attention deficits can also cause memory problems. Again, working to resolve sleep issues can help resolve memory lapses.
The reason behind dizziness during perimenopause is unclear. One theory is that estrogen impacts blood sugar levels and the reduced levels deprive cells of their food source, resulting in lightheadedness and vertigo. Another theory is that the drop in estrogen somehow impacts the central nervous system to cause dizziness.
23. Bladder problems
As many as 40 percent of women may experience incontinence during perimenopause. That’s because age can decrease pelvic function and weaken the pelvic floor, making accidents more likely. Women may feel the need to use the bathroom more often or leak some urine when coughing, laughing, or doing physical activity. There are a range of treatments available in addition to the menopause-specific options. Lifestyle changes such as limiting alcohol and caffeine can help, as can seeing a pelvic floor specialist who may recommend pelvic floor therapy.
24. Thinning hair
Hair grows more slowly as hair follicles start to shrink. And while the average person sheds 50 to 100 hairs a day, perimenopausal women often lose more than that. A dermatologist can provide guidance about managing hair loss during perimenopause and there are a range of hair loss products that can help.
Research suggests perimenopausal women experience an increase in histamine, the chemical responsible for allergies. Drops in estrogen and progesterone also affect immune activity, resulting in more inflammation that could promote more sneezing, itching, and hives — or even being diagnosed with allergies for the first time during perimenopause.
Perimenopausal women may feel like their heart skipped a beat. While irregular heartbeats are usually a sign of underlying cardiovascular issues, it’s common in perimenopause with 42 percent of women reporting this symptom.
Osteoporosis occurs when you have a decrease in bone mass and bone mineral density, making your bones weaker and more prone to fractures. Women can experience up to 20 percent of bone loss during menopause, due to the drop in estrogen. Weaker bones increase the risk of severe injuries after falls. Exercising regularly (in particular doing weight-bearing exercise like walking), quitting smoking, limiting alcohol, and eating a diet rich in calcium and vitamin D can help reduce the risk of osteoporosis.
28. Burning mouth
On the list of surprising symptoms of menopause, the loss in estrogen results in less saliva production and a drier mouth. “Burning mouth” is a painful discomfort around the roof of your mouth, tongue, and lips. This sensation is often described as hot, tender, or numbing — as if you burned your mouth on coffee. In addition to the “burning mouth” senstation, hormonal changes can also affect how you perceive flavors. Some women have also described a bitter or metallic taste to food.
29. Tingling sensations
As hormone levels in the body fluctuate, it can affect the central nervous system. Some women experience a pins and needles sensation in their arms, legs, hands, and feet. The tingling in these extremities can happen abruptly but usually only last for a few minutes.
Lower levels of estrogen can cause a decrease in the production of collagen and natural oils. The result is dryer and less elastic skin. Perimenopausal women also become more sensitive to certain skin products, which can further irritate or inflame their dry skin. If moisturizing doesn’t help, a dermatologist can may be able to prescribe other topical treatments.
In the same way that hormonal changes caused acne during puberty, perimenopause can cause unexpected skin changes and acne. Stress and lack of sleep can also play a role. While treating other symptoms of menopause using hormonal or non-hormonal methods may improve menopausal acne, a dermatologist can provide additional treatment options, such as topical antibiotic treatments that can help reduce inflammation and breakouts.
32. Electric shocks
In the department of unexpected symptoms, it’s possible to experience what feels like a zap of electricity during perimenopause. Feeling like a rubber band snapping at your skin, the electric shock sensations is likely because of changes in estrogen impacting the signaling between nerves.
33. Weak nails
Perimenopause can also cause cracked or chipped nails. Estrogen is important in regulating the amount of water in the body, and the drop in this hormone can lead to dehydration, and in turn, brittle nails. Estrogen is also important in producing a protein called keratin that’s made in the nail bed. Without as much keratin, nails can become weaker and more brittle. Staying hydrated, eating a healthy diet, and using moisturizer can help.
34. Body odor
Even your usual body odor can change as your enter perimenopause. Excessive sweat from hot flashes and night sweats can play a role, as can hormonal fluctuations. Talk to your provider if it’s anything that a shower and some antiperspirant can’t handle.
As you’re probably realizing, all symptoms are on the table when it comes to perimenopause and menopause. These 34 symptoms of menopause are some of the most common, but you know your body best. If there’s something that seems off, talk to your doctor and push to get answers. Menopause may cause a wide range of symptoms, but there are also a wide range of treatments to help you find relief.