What are the symptoms of perimenopause

Perimenopause symptoms include changes to your periods, hot flashes and night sweats, trouble sleeping, mood changes, brain fog, vaginal dryness and a shift in sex drive. Less obvious ones include joint aches, a noticeable heartbeat, and dry, itchy skin.³,⁴,⁵ They can start in your 40s, sometimes in your mid-30s,³ and they tend to come and go rather than build steadily, because the hormones behind them are swinging, not simply falling.

Perimenopause is often pictured as a slow fade. Clinicians describe something closer to a rollercoaster: hormone levels that "go up and down."³ That is why one week can feel fine and the next can bring three bad nights, a short temper and a period that arrives early. The pattern is not in your head, and it is not a sign you are coping badly.

Why do perimenopause symptoms come and go?

Menopause is the point 12 months after your final period. Perimenopause is the run-up, when your ovaries make hormones erratically and release an egg less often.¹ Estrogen does not drop in a straight line. Levels can swing up and down, which also disrupts its balance with progesterone.³ Both hormones act well beyond your uterus, so when their signals swing, a different part of your body can complain each week. Read more in what estrogen does.

The Menopause Society notes that mood changes may be linked to big swings in estrogen during perimenopause, although the exact mechanism is unknown.² It also notes that many women have no physical changes in perimenopause apart from irregular periods.² Two things follow. A symptom that disappears for a month has not necessarily gone for good. And a rough week does not mean every week will be rough. Symptoms are individual, and they move.

Which perimenopause symptoms are most common?

Hot flashes and night sweats. In one large US study, up to 80% of women had them during the transition, and a hot flash typically lasts one to five minutes.¹ In the SWAN study, compared with women who were still premenopausal, women in early perimenopause had about 1.9 times the odds of frequent hot flashes or night sweats (six or more days in two weeks). In late perimenopause the odds were about 6.6 times.⁷ Heat tends to climb late in the transition.

Sleep problems. Up to 70% of women report them, and waking in the night is the most common complaint.⁶ Night sweats can wake you, but sleep can also fall apart without them.⁹ In Moody data, insomnia rises more than hot flashes or night sweats as women move into perimenopause: the perimenopause sleep tax.

Mood changes. About 40% of women have PMS-like mood symptoms in perimenopause, according to a figure from ACOG quoted by Harvard Health.⁶ The Menopause Society reports roughly double the usual rates of depression during this period.¹ Anxiety, irritability and low mood can all show up for the first time. See perimenopause mood swings and anxiety.

Period changes. A change to your periods is usually one of the first signs.⁴ Cycles often get shorter at first, may vary by seven days or more, and flow can turn heavier or lighter.¹ More in your periods in perimenopause.

Brain fog. Between 40 and 60% of midlife women report it. The Menopause Society describes it as mild and within normal limits.¹ See brain fog in perimenopause.

Vaginal and urinary symptoms. Dryness, pain during sex, burning when you urinate, more frequent urinary infections and leaking can all occur.⁹ These are easy to miss: they are often unnoticed in perimenopause and may appear years after menopause, and unlike hot flashes they tend to worsen without treatment.¹,² Sex drive can shift in either direction.⁹ In Moody data it dips in the late thirties and early forties, then climbs again, with women over 55 reporting the highest desire of any age group: what the textbook gets wrong about desire.

Weight. Weight gain, often around the stomach, is a listed symptom.⁴ Harvard Health attributes part of it to fat being redistributed as estrogen diminishes, and cites an average gain of about 1.5 pounds a year between ages 50 and 60.⁵,⁶

Which perimenopause symptoms do people miss?

The NHS list is longer than most people expect. It includes muscle aches and joint pains, palpitations (a faster, slower or more noticeable heartbeat), dry and itchy skin, headaches and migraines that are worse than usual, hair thinning, and sensitive teeth and painful gums.⁴ Harvard Health adds ringing in the ears and constipation to its list of possible symptoms.⁵ The Menopause Society says estrogen fluctuations may increase hormone-related headaches.¹

Each of these has an easy alternative explanation. Stiff knees are age, or a hard workout. A pounding heart is stress or caffeine. Itchy skin is the weather. So each one gets handled alone, and the link is never made. Low estrogen makes you drier all over, including your skin, which can cause dryness and itchiness.⁶ Why joint aches appear is less settled, so treat any explanation you read with caution.

Digestion is another one. In a survey of nearly 600 women aged 44 to 73, presented at The Menopause Society's 2025 annual meeting, 94% reported digestive symptoms such as bloating, constipation or reflux, and 82% said they began or got worse around perimenopause or menopause.⁸ It was a self-reported survey, so it shows how common the experience is rather than proving the cause, but it fits how often women raise it. More in perimenopause diet and gut health.

A fast heartbeat can also happen during a hot flash.² Because palpitations and headaches have many causes, new ones are worth mentioning to a doctor rather than assuming they are hormonal.

How do you tell if it is perimenopause?

No single symptom decides it. The pattern does: several of these showing up together, in your 40s or so, alongside changes to your cycle.

Because symptoms move around, memory is a poor record. Logging them, even while your cycle is still regular, shows what appears together and when. In the Moody app you can log mood, sleep, flow and physical symptoms, then bring that picture to your doctor. Hormone tests are less straightforward than they sound; see everything you need to know about hormone testing.

When should you see a doctor?

Perimenopause is not a diagnosis you have to wait out. Talk to a healthcare provider if:

• Your symptoms are unbearable or interfering with your quality of life.³

• You are soaking through a pad or tampon every one to two hours.³

• Bleeding lasts more than seven days, happens between periods, or your periods come less than 21 days apart.⁹

• You bleed after 12 months without a period.⁹

• Low mood persists, or you have new palpitations or other symptoms that worry you.

Symptoms that swing are part of how this transition works for many women. They are not a personal failing.

Read next: What is perimenopause? Your hormones and the four stages, Your periods in perimenopause: what changes and when it ends