How Do I Know if I’m in Perimenopause?

Key Takeaways:

• Perimenopause is the transition leading up to menopause; it lasts 4 to 7 years on average.

• Common symptoms include hot flashes, night sweats, sleep issues, and vaginal irritation. 

• Lesser-known symptoms include joint pain, urinary issues, hair and skin changes, and dry mouth. 

• A healthcare provider can help identify symptoms and suggest treatment options that fit your needs.

Perimenopause has a tendency to sneak up on us. Symptoms can be mild and inconsistent at first, so we often attribute them to other causes. Burnout. Stress. Age. When in reality, we’re riding a hormonal rollercoaster.

Perimenopause is loosely defined as the years leading up to menopause, which officially begins after you’ve gone 12 consecutive months without a menstrual period. 

During this time, estrogen and progesterone levels begin to decline as ovarian function winds down. These hormonal changes are what lead to the symptoms of menopause. And yes, let’s be clear, the symptoms of menopause can begin long before you actually reach menopause. 

So, how do you know if you’ve started perimenopause? We’re digging into the details here and covering the full spectrum of perimenopause symptoms you’ll want to watch out for — from common symptoms to weird changes you never would have expected. 

If you’re at the right age and you’re experiencing symptoms of menopause, then you’ve probably started perimenopause. That said, pinpointing the exact start of perimenopause is nearly impossible. Your hormone levels are constantly fluctuating, so there is no single lab test that can tell you if you’re in perimenopause or not.  

Perimenopause is what’s known as a clinical diagnosis, which means your doctor will look at a variety of factors before making a determination. This typically includes your:

• Age

• Symptoms

• Medical history 

Perimenopause typically starts in your 40s, but the timing can vary. Some women will experience symptoms in their 30s, while others may not notice anything until their early 50s. 

Perimenopause typically lasts several years — about 4 to 7 years on average. And symptoms often continue into the postmenopausal period. 

Perimenopause and menopause can wreak havoc on your body, and your life. It can cause all sorts of symptoms, from the common to the truly odd and unexpected. 

Hot flashes and night sweats, collectively called vasomotor symptoms, are the most common perimenopause symptoms, affecting up to 75 percent of women. 

Meanwhile, genitourinary symptoms like vaginal dryness and urinary incontinence affect more than half of women.

Hot Flashes

Hot flashes can be extremely unpleasant. A typical episode develops suddenly and may include:

• Intense heat in the upper body, especially the face, neck, and chest

• Flushing or redness of the skin

• Profuse sweating, which may leave clothing or bedding damp

• Rapid heart rate or palpitations

• A sense of anxiety or unease, sometimes described as a “rush” of nervous energy

• Chills or shivering after the episode as the body cools down

Episodes typically last around two to four minutes, though some may linger longer.

Night Sweats

The main sign of night sweats is excessive sweating when your room is at a normal temperature. If you’re having night sweats, you may:

• Wake up at night feeling hot and flushed

• Wake up feeling wet and chilly, as sweat begins to evaporate

• Have damp or soaked-through pajamas, bedsheets, or pillowcases 

• Feel sticky or rumpled in the morning 

Because night sweats can wake you up, the issue can also interfere with the quality of your sleep. 

Insomnia and Sleep Issues

You’re not alone if your sleep is suffering: More than 40 percent of women report sleep problems during perimenopause. 

You might experience several different sleep issues during perimenopause, such as:

• Trouble falling asleep

• Trouble staying asleep

• Waking up too early 

• Sleep-related breathing disorders, like sleep apnea

• Movement disorders, like restless legs syndrome and periodic limb movement disorder  

Vaginal and Urinary Symptoms

Vaginal and urinary symptoms can start during perimenopause. They may come on gradually and get worse over time. Without treatment, these symptoms tend to persist into the postmenopause period. You might experience:    

• Vaginal dryness, burning, or irritation

• Vulvar itching or discomfort that can make sitting, walking, or exercising uncomfortable

• Painful sex due to reduced lubrication

• Frequent urination, both during the day and overnight

• Urinary urgency or difficulty holding urine

• Painful urination

• Stress or urge urinary incontinence (leakage of urine with coughing, sneezing, or sudden urges)

• Recurrent urinary tract infections (UTIs)

Some perimenopause symptoms are more well-known than others. You might be surprised to learn about some of these unusual perimenopause symptoms.

Breast Soreness

Most women have encountered breast soreness at some point, perhaps before a period or during pregnancy.

Breast pain, which healthcare providers call mastalgia, is also common during perimenopause. It happens due to fluctuations in estrogen levels that can occur during this time.

Burning Mouth Syndrome

Burning mouth syndrome is when you feel a burning sensation in your mouth or tongue. It’s estimated to affect 10 to 40 percent of women in perimenopause.

Receptors for sex hormones have been found in the mouth and salivary glands. This suggests hormone fluctuations could lead to altered sensations in the mouth, making it feel like it’s on fire.

Muscle and Joint Pain

Muscle and joint pain may also become more prevalent during perimenopause. In fact, an estimated 71 percent of women in perimenopause experience some sort of musculoskeletal pain.

The increase in muscle and joint pain could be due to the effects of drops in estrogen. Indeed, declines in estrogen lead to lower bone density, boosting the risk of osteoporosis. Progression of osteoarthritis may also contribute to pain during this time.

Digestive issues

Changes in hormone levels may also affect your digestive tract, as female sex hormones can regulate gut motility and pain perception.

As such, you may start to notice an increase in digestive issues like bloating, constipation, or abdominal discomfort during perimenopause.

Heart Palpitations

If you’ve recently felt like your heart is briefly fluttering or racing, perimenopause may be to blame. This sensation is referred to as heart palpitations.

A significant number of women have heart palpitations during perimenopause and early postmenopause. In research, these palpitations aren’t linked to underlying cardiovascular disease.

However, researchers have also observed that changes in body fat and cholesterol often occur during perimenopause and can boost your risk of heart disease later on. That means it’s important to see a healthcare provider if you have any concerns about your heart health during this time.

Changes in Skin, Hair, or Nails

Reaching for your moisturizer more often or wondering if it’s time to look into hair loss treatments could also be signs of perimenopause. That’s because shifting hormone levels can do a number on your skin, hair, and nails.

For example, your skin may become drier and itchier. This drying effect can also lead to brittle nails. In addition to skin itchiness, your skin also starts to lose collagen, which can make it thinner and more prone to sagging.

Drops in estrogen levels can also affect hair health, contributing to a type of hair loss called androgenetic alopecia, or female pattern hair loss. You may also notice changes in hair volume and texture.

Dry Mouth or Eyes

During perimenopause, you may also experience symptoms like dry mouth or dry eyes.

This is due to hormone shifts. For example, estrogen influences the tear film that lubricates your eyes, so lower estrogen levels can make your eyes drier.

A 2025 review also found that dry mouth increases as estrogen levels decrease. Calcium levels in saliva also rise with declining estrogen, boosting the risk of gum disease.

Loss of Libido

If you haven’t been in the mood for sex lately, it could be due to the effects of perimenopause. Many women feel a loss of libido during this time. Symptoms affecting the reproductive and urinary tract, collectively called genitourinary symptoms, could be partly to blame.

Vaginal symptoms like dryness or burning sensations can make sex uncomfortable. One older study found 55 percent of postmenopausal women avoided sex due to pain, and 46 percent avoided it due to reduced libido.

Changes in Body Odor

Changes in body odor have also been reported during perimenopause. There are several possible explanations for this.

One is that vasomotor symptoms like hot flashes and sweating could be affecting the bacteria on your skin, causing more odor. Further, hormone fluctuations could mean there’s more bacteria in your sweat, which can also lead to changes in smell.

Lastly, your sense of smell itself may have changed during perimenopause. That means you may believe your body odor has changed when it actually hasn’t.

There are also lesser-known mood symptoms you may not have associated with perimenopause. 

Anxiety

Anxiety is a normal reaction to a stressful situation. However, having anxiety that begins to interfere with your daily life and relationships can signal an anxiety disorder.

Some anxiety disorders you may be familiar with include generalized anxiety disorder, panic disorder, and social anxiety disorder.

Perimenopause can increase the risk of anxiety disorders. This may not only be due to reduced estrogen levels, but also to anxiety surrounding other perimenopause symptoms or life changes happening during this transition.

Depression

Depression, also called major depressive disorder, is a persistent low mood that interferes with your day-to-day activities and relationships with others.

In addition to sadness, people with depression may feel hopeless, irritable, worthless, or restless. They can also lose interest in things that used to bring them joy and have physical symptoms like body aches or digestive issues.

Perimenopause is the menopause stage with the highest risk of depression. This could be due to hormonal fluctuations, as well as coping with the effects of other perimenopause symptoms.

Rage

Heard of perimenopausal rage? It’s totally a thing. Declining estrogen levels can change the balance of chemical messengers like serotonin and dopamine in the brain.

Both serotonin and dopamine are generally considered “feel-good” neurotransmitters. If they’re out of whack, you may be more prone to bouts of irritability or aggression.

In addition to physical symptoms, perimenopause can also cause some unusual neurological symptoms. 

Brain Fog

Brain fog refers to a variety of cognitive issues, such as memory lapses, trouble concentrating, and difficulty making decisions. You may also refer to this as “fuzzy” thinking.

While it may be a lesser-known symptom, brain fog is actually pretty common during perimenopause. One study found that 68 percent of perimenopausal women surveyed reported experiencing symptoms of brain fog.

Dizziness

Menopause-related hormonal changes may also affect the inner ear, which controls your balance. This can lead to feelings of dizziness or even vertigo.

Headache

Perimenopause is linked with an increase in headaches, specifically migraine. This is because hormonal fluctuations can trigger migraine in some people. If you’ve ever had a migraine around that time of the month, you’ve experienced this firsthand.

Essentially, changes in estrogen levels during perimenopause can lead to an increase in migraine frequency. As estrogen levels drop off close to menopause, migraine symptoms tend to improve.

Tinnitus

Perimenopause’s effect on the inner ear may also cause tinnitus. Tinnitus is a persistent ringing, buzzing, or pulsing noise that can happen in one or both ears.

 One 2017 study found symptoms of tinnitus improved in perimenopausal and postmenopausal women who started hormone replacement therapy. This implies that hormonal changes could play a role in tinnitus around menopause.

Electric Shock Sensations

It may seem, well, shocking, but you can also feel electrical shock sensations during perimenopause, sometimes called “brain zaps” or “body zaps”. These can happen anywhere, but you may feel them most in your limbs, head, or neck.

It’s unclear what causes electric shock sensations during perimenopause. It’s possible that hormone shifts, specifically in estrogen, may be involved.

That’s because estrogen regulates multiple functions via estrogen receptors in the brain. Therefore, it’s possible that drops in estrogen could affect nervous system function.

If perimenopause symptoms are bothering you, a great first step is to seek medical advice from a healthcare provider. This is true whether you’re having super common perimenopause symptoms or unusual ones.

There are a variety of treatments available for perimenopause symptoms. They each have their own benefits, drawbacks, and side effects, so be sure to cover these with your healthcare provider.

Your provider may recommend hormone replacement therapy (HRT), which supplements missing estrogen and progesterone. This helps to alleviate many symptoms associated with hormonal changes.

If you’re mainly dealing with mood changes, medications, talk therapy, or both may be beneficial. 

At the end of the day, there’s no one-size-fits-all treatment for strange perimenopause symptoms. Your healthcare provider can help to make recommendations that can address your individual needs and help boost your quality of life, so don’t hesitate to reach out to them to find a treatment plan that’s right for you.