The 4-1-1 on Perimenopause Symptoms

January 23, 2020.

Women go through different stages as they progress through their menopausal years. There are four different stages: premenopause, perimenopause, menopause, and postmenopause. Perimenopause can feel like a rocky road to menopause because it is met with some intense perimenopause symptoms. Typically, women are more prepared for menopause because it is talked about more openly compared to perimenopause. Unfortunately, many women are caught off guard by how they feel and what they feel for almost a decade before reaching menopause.

What is perimenopause?

Perimenopause marks the beginning of a woman’s transition into menopause. The word itself means “around menopause.”

Some people refer to perimenopause as premenopause. However, premenopause is a stage of its own that refers to the time before a woman enters perimenopause. Most women in premenopause do not notice any significant changes in their symptoms. As a woman gets closer to perimenopause she may notice subtle changes in her period. A woman’s premenopause symptoms age varies and she may even be asymptomatic until perimenopause.

In perimenopause, your hormones start to change. Rather than a gradual and slow decline to menopause, estrogen and progesterone levels can jump around erratically. This can lead to a number of frustrating symptoms caused by hormone fluctuations. Many women start to notice a change in their menstrual periods that signals the start of perimenopause. With changing hormone levels, your menstrual cycle will begin to change. Many women start to notice irregularities in their periods which can include changes in flow, duration, and time between periods.

Perimenopause ends when a woman reaches menopause. A woman is considered menopausal when she has been period-free for at least one year. Once women reach menopause, many perimenopause symptoms decrease in the severity or greatly improve. However, menopausal women can still experience symptoms that are related to low estrogen including hot flashes and vaginal dryness. Indeed, once a woman is post-menopausal, she will have to manage symptoms and even health conditions related to low estrogen, including vaginal dryness and osteoporosis.

When does perimenopause start?

Every woman is different and her perimenopause age of onset will likely differ from the woman next to her. Perimenopause most commonly starts in your 40’s but can begin as early as your 30’s. Also, it lasts roughly 8-10 years and is usually accompanied by menopause symptoms.

The average age a woman reaches menopause is 51. Like perimenopause, the age of onset for menopause can vary. Many women experience an increase in the severity of their symptoms as they approach menopause. Fortunately, once menopause is reached, many symptoms resolve.


Symptoms of perimenopause

Your symptoms can vary based on your age and can get more severe as you get closer to reaching menopause. For example, perimenopause symptoms age 48 may be more severe than your symptoms of perimenopause at 44.

There are many symptoms that you might expect in perimenopause because it is associated with changes in your menstrual cycle, However, many women are caught off guard and even surprised by many of the symptoms that women in perimenopause can experience.

Women in perimenopause can experience 34 perimenopause symptoms to be exact. Here is the rundown of all the symptoms that are related to perimenopause: (Don’t worry – they are categorized!)

Most Common Perimenopause Symptoms

  • Irregular periods
  • Hot flashes
  • Night sweats
  • Loss of libido
  • Vaginal dryness

Physical Perimenopause Symptoms

  • Hair loss
  • Dizziness (unrelated to other health conditions)
  • Fatigue
  • Difficulty sleeping
  • Perimenopause bloating
  • Weight gain
  • Stress incontinence
  • Brittle nails
  • Osteoporosis
  • Irregular heartbeat
  • Allergies
  • Changes in body odor

Painful Symptoms

  • Headaches and migraines
  • Breast soreness
  • Aching joints
  • Burning mouth
  • Electric shocks
  • Gum problems
  • Digestive problems (including perimenopause nausea and constipation)
  • Dry, itchy skin
  • Tingling extremities
  • Muscle tension

Mental Symptoms

  • Mood swings
  • Brain fog
  • Panic disorders
  • Anxiety
  • Irritability
  • Depression
  • Difficulty concentrating

There are many symptoms that women are likely already aware of such as perimenopause periods closer together and hot flashes, but what about those symptoms that are less often talked about but are equally debilitating like depression, anxiety, brain fog, and irritability? Women who are unprepared for these symptoms in perimenopause can feel lost, frustrated, and even isolated. Some women have worried their mental symptoms are early signs of dementia. Other women have worried their breast soreness is related to cancer.

If you are experiencing any of the above symptoms, they may be related to perimenopause. No matter what is causing your symptoms, it is important to meet with your doctor to rule out other health conditions and to help you manage your symptoms so you can fully enjoy life during your perimenopausal years.




How to treat perimenopause symptoms

Perimenopause is a natural transition that, unlike diseases, does not require treatment. However, we know that sometimes the symptoms can be debilitating. Therefore, women often try a number of different methods to manage their perimenopause symptoms.

Some women opt for hormonal stabilization through hormone replacement therapy (HRT) whereas others turn to herbal supplements to help diminish their symptoms. Many symptoms can be improved with lifestyle changes such as decreasing stress, improving sleep hygiene, increasing exercise, and watching your diet. But oftentimes your symptoms can get in the way of you being able to make certain lifestyle changes. Commonly, women try a combination of remedies to help alleviate their perimenopause symptoms.


Perimenopause is a natural transition that, unlike diseases, does not require treatment. However, we know that sometimes the symptoms can be debilitating.

Related: These are the top rated products for perimenopause 

How do I know if I am in perimenopause?

There is no medically-proven perimenopause test that can confirm if you are in perimenopause. Indeed, there are many perimenopause tests on the market but none to date are supported by the medical community. Rather, perimenopause is diagnosed with your doctor by looking at your symptoms and your age. Hallmark symptoms of perimenopause such changes in your menstrual period, vasomotor symptoms such as hot flashes and night sweats, mood instability, and breast tenderness can signal both you and your doctor that your hormones are changing.


Every woman’s journey to menopause is different. Some women enter menopause naturally whereas others reach menopause abruptly such as if they have a hysterectomy with ovary removal. No matter your journey to menopause, there can many physical and emotional hurdles in this season of life.

Disclaimer: This is not medical advice, does not take the place of medical advice from your physician, and is not intended to treat or cure any disease. Patients should see a qualified medical provider for assessment and treatment.


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Julia Walker
perry expert Julia (RN, BSN, BA) is a registered nurse based in Colorado. Julia's nursing background in women’s health has ranged from neonatal and postpartum care to labor and delivery, to outpatient gynecological medicine for both adolescent and adult populations. She specializes in helping women optimize their health during perimenopause and beyond.

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