The 100 Symptoms of Perimenopause

Perimenopause is the transitional stage before menopause, often beginning in a woman’s late 30s or 40s. Women and doctors usually identify the transition to menopause by menstrual irregularities and hot flushes, however, many perimenopause symptoms, such as low mood and sleep issues can appear well before. Over 3 in 4 women experience psychological or physical perimenopause symptoms, it’s therefore important to be aware of the potential signs and symptoms as here we share the 100 symptoms of perimenopause, some you may not know about.

While hot flushes are the most well-known symptom, research shows perimenopause can cause dozens of physical, psychological, and cognitive changes.

Many women experience perimenopause symptoms for 4–10 years, often without realising hormones are the cause. It is driven by fluctuating oestrogen and progesterone levels, which affect nearly every system in the body — not just the menstrual cycle.

Studies show perimenopause symptoms and signs manifest from complex physiological changes in the body including central nervous system related disorders; metabolic, weight musculoskeletal and cardiovascular changes; sexual dysfunction; and urogenital and skin atrophy.

Below is a comprehensive, research-informed, recognised list of the 100 symptoms of perimenopause, grouped by body system.

Hormonal & Menstrual Symptoms

Irregular periods
Shorter cycles
Longer cycles
Missed periods
Heavier bleeding
Lighter bleeding
Clotting
Spotting between periods
Worsening PMS
New-onset PMS
Increased cramping
Reduced fertility

Hormonal fluctuations — particularly declining progesterone — are responsible for cycle instability in early perimenopause.

Studies show ovulation becomes less predictable years before menopause occurs.

Vasomotor Symptoms (Temperature Regulation)

Hot flushes
Night sweats
Chills
Cold sensitivity
Sudden flushing
Excessive sweating

Vasomotor symptoms are linked to changes in hypothalamic temperature control due to oestrogen withdrawal.

Up to 75% of women experience these types of perimenopause symptoms during the transition.

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Sleep Disturbances

Difficulty falling asleep
Night waking
Early morning waking
Non-restorative sleep
Insomnia
Vivid dreams
Night-time anxiety

Sleep disruption is one of the earliest and most under-reported perimenopause symptoms and is strongly associated with mood changes.

Mood & Emotional Symptoms

Anxiety
Low mood
Irritability
Mood swings
Tearfulness
Reduced stress tolerance
Panic attacks
Loss of confidence
Social withdrawal
Depression-like symptoms

Large cohort studies show hormonal volatility — rather than low hormone levels alone — increases vulnerability to anxiety, low mood and and depressive symptoms during perimenopause.

Cognitive & Neurological Symptoms

Brain fog
Poor concentration
Memory lapses
Word-finding difficulty
Reduced mental clarity
Headaches
Migraines (new or worsening)
Dizziness
Tingling sensations
Sensitivity to noise or light

Neuroimaging studies indicate oestrogen plays a key role in brain glucose metabolism, explaining cognitive changes during hormonal transition.

Energy & Fatigue

Chronic fatigue
Morning exhaustion
Post-exertional fatigue
Reduced stamina
Lack of motivation

Fatigue often results from a combination of sleep disruption, cortisol imbalance, and fluctuating oestrogen levels.

Musculoskeletal Symptoms

Joint pain
Muscle aches
Stiffness
Reduced muscle strength
Slower recovery from exercise
Frozen shoulder
Back pain

Oestrogen has anti-inflammatory effects and supports collagen production, which explains the rise in joint and connective tissue pain.

Weight & Metabolic Changes

Weight gain
Abdominal fat gain
Difficulty losing weight
Blood sugar instability
Increased cravings
Reduced metabolic rate

Research shows insulin sensitivity can decline during perimenopause, even without changes in diet or exercise.

Declining oestrogen also shifts where the body stores fat, accumulating more abdominal fat.

The loss of oestrogen can see women change from fat storage around the hips and thighs (during childbearing years) shift to becoming more ‘apple’ shape post menopause.

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Cardiovascular Symptoms

Heart palpitations
Racing heart
Blood pressure changes
Shortness of breath
Exercise intolerance

Palpitations are common and usually benign but can be distressing.

As oestrogen levels and it’s protective effect decline, women’s risk of heart disease increases (a leading cause of death in women post menopause).

Digestive Symptoms

Bloating
Constipation
Diarrhoea
Acid reflux
Food sensitivities
Slower digestion

Oestrogen influences gut motility and the gut microbiome, which may explain digestive changes.

Skin, Hair & Nails

Dry skin
Itching
Thinning hair
Hair shedding
Brittle nails
Acne
Changes in skin texture

Collagen production declines rapidly during the menopausal transition, affecting skin elasticity and hair growth.

Sexual & Urogenital Symptoms

Vaginal dryness
Reduced libido
Pain during sex
Reduced arousal
Recurrent UTIs
Urinary urgency
Stress incontinence

Genitourinary symptoms are caused by declining oestrogen affecting vaginal and urinary tract tissues.

Immune & Sensory Changes

Increased allergies
Sensitivity to smells
Changes in taste
Burning mouth sensation
Dry eyes
Dry mouth

Other Common Perimenopause Symptoms

Jaw pain
Gum problems
Tinnitus

100. Feeling “not like myself”

Why Perimenopause Symptoms Vary So Widely

No two women experience perimenopause the same way. Studies show symptom severity and type can be influenced a woman’s personal history, current health status (especially obesity).

Factors can include:

Genetics
Stress levels
Nutritional status
Gut health
Lifestyle factors

Many women experience clusters of perimenopause symptoms, which can vary month to month.

When to Seek Support

If symptoms:

Interfere with daily life
Affect work or relationships
Cause persistent low mood or anxiety

It’s important to speak with a healthcare professional knowledgeable about menopause care.

Conclusion: The 100 symptoms of Perimenopause

Perimenopause is a whole-body hormonal transition, not just a reproductive one. The manifestation of some perimenopause symptoms may also be partially associated with the aging process – as menopause seems to accelerate the ageing process.

Some of the 100 symptoms of perimenopause can also be linked to the onset of other conditions. For example several studies indicate severe vasomotor symptoms and sleep issues may increase cardiovascular risk, whereas severe vasomotor symptoms and depression might affect cognitive function.

It’s therefore important to be aware of the list of the 100 symptoms of perimenopause, so if you’re feeling symptom No. 100 – and just not feeling quite right, your body could be signalling changes are happening and they could just be predictors of your future health too.

No two woman’s symptoms, severity and duration will be the same, so, an understanding of the full spectrum of potential symptoms helps women recognise changes earlier, seek appropriate support, and avoid unnecessary misdiagnosis.