The 36 symptoms of perimenopause

What are the 36 symptoms of perimenopause?

Bulky pads, tampons, and contraceptive methods are part of any woman’s life right up until they reach menopause. And while you probably know this period comes with its changes, you may not expect to experience insomnia, falling hair, or joint pain. Believe it or not, these are only some of the possible 36 symptoms of perimenopause you can experience.

It’s easy to feel alone and anxious during this period, especially if you’re going through “unexpected” symptoms which differ from what your friends experience. But more information in your hands on what to expect will help ease that anxiety.

Here we present you with the 36 symptoms of perimenopause, common and less common, so you know exactly what’s ahead of you and can plan accordingly.

What Is Behind All of These Perimenopause Symptoms?

Perimenopause marks the beginning of a period that eventually leads to the complete stop of menstruation, as your ovaries stop producing eggs. During those years, your female hormone levels become unbalanced, with estrogen slowly decreasing until it becomes almost undetectable.

Unfortunately, this lack of estrogen can cause irregular periods, irritability, digestive problems and even bad smell. Keep on reading to find out more about the possible symptoms you may experience during perimenopause.

Will I Experience All of These Symptoms?

No, that’s not likely to happen. Most women experience only some of these symptoms through the years, though it’s not possible to predict when, how or exactly why they will appear (1). What is clear is that most of these symptoms (not to say all of them) can be linked to unbalanced female hormones, particularly estrogen.

So, let’s dive deep into the 36 perimenopause symptoms you may experience during this stage.

Mental & Behavioral Symptoms

Mood swings. A result of hormone fluctuations that affect your brain receptors, it can cause you to be happy one moment and sad the next without a reason (2).
Brain fog, the inability to think clearly, can make you feel distracted, forgetful and without focus due to hormonal alterations (3).
Anxiety. 23% of perimenopausal women report suffering from anxiety, stress, and feelings of catastrophe (4).
Panic attacks. In extreme cases of anxiety, you can end up having panic attacks (5).
Irritability. The lack of hormones in your body can also make you feel irritable and angered by very simple events (6). Plus, it can be linked to the lack of sleep and fatigue that many times characterises menopause.
Depression. Perimenopause can be an emotional rollercoaster and depression can also become a major symptom during this period (7).
Difficulty concentrating. Closely related to brain fog, you may find it hard to focus on something specific no matter how hard you try (8).

Poor Memory. Similarly, you may see your memory take a turn for the worse during perimenopause (8).

Physical Symptoms

Irregular periods: These can be one of the first indicators you’re starting perimenopause. Shorter, longer, or even missed periods are completely natural during this stage (9).
Hot flashes can leave you sweating, uncomfortable and flushed, especially at night, and can last from a few seconds to several minutes (10). Researchers are not yet sure why they occur, though there seems to be a result of hormonal imbalance affecting your hypothalamus
Night sweats occur as a result of hot flashes (a reaction from your body, which believes you’re too hot and makes you sweat as a result). They can leave you soaked and result in insomnia (11).
Loss of libido. Sexual desire can also take a dive during perimenopause, as you’ll have less testosterone and estrogen in your blood (12). Plus, other typical symptoms like vaginal dryness, fatigue, and insomnia can contribute to a lack of sexual desire.
Vaginal dryness / vaginal atrophy occurs due to a lack of estrogen that makes your vagina less moist and elastic. Of course, this can impact your ability to enjoy sex (13).
Hair loss. Due to the loss of certain hormones, you may notice that your hair is more brittle and fine, making it prone to falling out (14).

Dizziness. Researchers have not yet been able to pinpoint exactly why women get dizzy during menopause, but it seems to be related to a change in the body’s response to insulin and keeping blood sugar levels stable (15).

Sleep problems. Anxiety and depression together with night sweats can keep you awake at night, heightening your other symptoms (16).
Fatigue. Again your hormones are to blame for these feelings of tiredness and fatigue. It’s not laziness! Hot flashes and a lack of sleep can also contribute to fatigue (17).
Weight gain. With the change in estrogen levels, your metabolism is likely to slow down, causing you to gain weight during perimenopause. This means that you could be eating the same healthy diet you have always eaten and still gain weight. In addition, hormonal imbalance can also bring about sugar cravings, which cause you to eat more. On average, women gain around 1-2 kg in this period (18).
UTIs. They can become frequent as a result of thinning vaginal tissue, which makes it prone to infections (19).

Rarer Symptoms

Bloating & digestive problems. Indigestion, constipation, burping… you name it! These digestive problems may be the result of unbalanced cortisol levels, among other factors (20).
Stress incontinence. Waning estrogen may weaken your pelvic muscles, prompting incontinence (21).Strengthening your pelvic floor muscles by doing Kegel exercises, for example, can help with this issue.
Osteoporosis. This is more common during post-menopause due to a lack of estrogen and low ovarian activity that leaves your bones brittle and fragile (22), though research shows that around 10% of women get osteoporosis during perimenopause (23). Targeted exercise, weight management, increasing your intake of calcium and vitamin D can definitely help with osteoporosis (24).

Brittle nails. Similar to what happens with your hair, your nails can also become brittle and fragile during this period, though it’s not common (25).

Irregular heartbeat. This is related to hot flashes, which make your heart beat abnormally faster (26) and also a lack of estrogen, which is commonly associated with heart disease (27).
Heart palpitations. For the same reasons, you may experience heart palpitations, especially at night (27).
Changes in the body odour. Excessive sweating can change your body odour and produce a bad smell (28).
Headaches and migraines are also caused by changing hormone levels, though most women report headaches improving as perimenopause progresses (29).
Breast pain. Again, your hormones are to blame for producing excessive fluid buildup in your breasts, which can cause discomfort and pain (30). Bear in mind that the risk for breast cancer increases as you age, so make sure to consult with your doctor if you experience discomfort or pain to rule out serious conditions.
Joint pain. Believe it or not, your joints have estrogen receptors, so dwindling levels of estrogen can lead to joint swelling and pain (31).

Burning mouth. Taste disturbances and a burning mouth are not very common (and researchers are not sure yet why they happen), but they may occur during perimenopause (32).

Gum problems. Guess what? A loss of estrogen can also result in exposed teeth and receding gums, putting your teeth at a higher risk for decay (33).

Dry and itchy skin. During perimenopause, the moisture in your body generally declines, resulting in dry and itchy skin (34).
Muscle tension. Increased stress and anxiety during perimenopause may lead to muscle tension, aching and pain (35).
Restless legs. This is the result of a loss in iron, which can be triggered by heavy bleeding during perimenopause periods (34). Iron deficiency during perimenopause is common, with 20% of women under 50 years old reporting this problem (36).
Nausea. Similar to what happens during pregnancy, fluctuating hormones can lead to nausea, especially in the morning (37).
Loss of confidence. Not surprisingly, all of these changes in your body can lead to confusion and a loss of confidence in yourself.

Final Thoughts

It’s clear that perimenopause and the subsequent lack of estrogen it brings about can wreak havoc in your life. Unfortunately, you can’t escape perimenopause: it’s something every woman in the world is going to experience at some point or another. So, it’s likely that you’ll experience several of the symptoms mentioned above. But don’t despair: being aware of what’s going on with your body will help you reduce anxiety and make you feel less alone.

Plus, speaking with a doctor as soon as possible will help reduce the impact these symptoms can have on your life, boosting your quality of life and making you feel like yourself again. As you’ve seen in this list, no symptom is “too weird” to talk about with your healthcare provider and receive help!