25 Perimenopause Symptoms You Might Not Expect

Dee
Aug 1
5 min read

Updated: 4 days ago

As one can imagine, perimenopause involves hormonal changes that result in various physical and emotional symptoms. While hot flashes and irregular periods are most known, there are many other unexpected symptoms that may take you by surprise. Let’s explore 25 perimenopause symptoms you might not know about.

Mood Swings

Mood swings are often associated with teen years, but they can resurface during perimenopause. Hormonal shifts, particularly in estrogen and progesterone, can lead to feelings of heightened irritability, increased anxiety, rage, and bouts of depression. For some women, these changes can lead to intense emotional fluctuations on a daily basis, affecting all aspects of their lives. If a perimenopausal woman tells you they feel crazy, they mean it.

Fatigue

If you're feeling more fatigued than usual, hormonal fluctuations may be disrupting your sleep patterns. It's not simply a matter of getting enough sleep; your body is working harder to adjust to these hormonal changes.

Weight Gain

Weight gain, particularly around the abdomen, is common during this stage. Hormonal fluctuations slow metabolism and trigger cravings, which can lead to unwanted and unexpected weight gain. Some research indicates that women can gain between 5 to 10 pounds during perimenopause, even without significant changes to diet or activity levels.

Hair Changes

Thinning hair is expected as we age, but changes in hair quality can also occur during perimenopause. Some women notice their hair becoming drier and more brittle, while others may experience increased hair growth in areas such as the chin or upper lip.

Memory Issues

Memory lapses often become more frequent for women during perimenopause. The so called “brain fog” can result in difficulty recalling memories, finding the right words, and overall increased forgetfulness. I personally feel like Dory from Finding Nemo.

Night Sweats

Similar to hot flashes, night sweats can be both annoying and disruptive, often causing excessive sweating at night. This can leave you feeling uncomfortable and awake, making it difficult to sleep at night.

Changes in Libido

Sexual desire may fluctuate significantly during this time. Hormonal changes can either increase interest in sex or lead to a reduced libido. It is also common to experience changes in sensitivity which can further affect libido.

Joint Pain

Are you experiencing unexpected joint pain or stiffness? Hormonal changes can lead to inflammation affecting your joints, which may cause arthritis-like discomfort in areas such as the hands, hips, knees, and lower back.

Skin Changes

Your skin may become drier and more vulnerable to irritation and eczema, leading to increased itchiness or breakouts. A decrease in collagen production contributes to these changes, making hydrating moisturizers and SPF crucial.

Heart Palpitations

Feelings of a racing or irregular heartbeat may arise during perimenopause. While often benign, it’s important to discuss this symptom with your healthcare provider, especially if it’s new. Please note that this symptom can be misdiagnosed. Oprah Winfrey recently discussed how her own doctors dismissed her heart palpitations as a perimenopausal symptom and prescribed her heart medications she did not need. Please, talk to your doctor.

Digestive Issues

Increased bloating, gas, or changes in bowel habits may occur as hormonal shifts impact digestion. This can be particularly frustrating especially when dealing with IBS type symptoms and sudden chronic constipation.

Increased Allergies

Your immune system may react differently during perimenopause, making you more susceptible to allergies or worsen existing conditions. Some women report experiencing seasonal allergies for the first time during perimenopause.

Concentration Issues

Do you find yourself struggling to focus and constantly looking for your phone? Difficulty concentrating is a common complaint linked to hormonal changes affecting cognitive function. It’s experienced by approximately half of women going through perimenopause and is also one of the most misdiagnosed symptoms, as it can mirror adult ADHD patterns and worsen existing ADHD symptoms.

Breast Tenderness

Hormonal shifts can lead to breast tenderness, similar to premenstrual symptoms or early pregnancy.

Cold Sensitivity

Are you feeling colder than usual? This can also occur due to changing hormone levels that affect blood circulation and temperature regulation in the body. Like hot flashes, cold flashes can be equally uncomfortable.

Changes in Periods

This has been mentioned in previous posts, but it's important to remember. As you enter perimenopause, your menstrual cycles may become noticeably irregular, accompanied by changes in flow, color, and duration. Brown spotting between periods may also become a common occurrence.

Heightened Anxiety

Hormonal fluctuations can amplify your stress response, leaving you feeling overstimulated, overwhelmed, and anxious—sometimes without obvious cause. Many women report experiencing panic attacks for the first time during their menopausal transition.

Increased Urinary Issues

Frequent urination or incontinence can become more common as pelvic muscles weaken due to hormonal changes. This is a great time to remember the importance of pelvic floor exercises.

Insomnia

Struggling to fall or stay asleep? Hormonal fluctuations, nighttime anxiety, and a drop in melatonin (the hormone that regulates sleep) can all contribute to insomnia. Do your best to follow a nightly routine that promotes sleep.

Changes in Taste and Smell

Some women notice changes in taste and smell that affect their appetite and food preferences. This symptom can be particularly disorienting and varies widely among individuals. Track any changes in appetite to share with your healthcare provider.

Tooth Sensitivity & Gum Health

Hormonal changes may affect your overall teeth and gum health. Dry mouth can lead to swollen gums, which may cause tooth sensitivity and decay. This can result in discomfort when consuming hot or cold food and drinks.

Changes in Vision

Your eyesight may undergo changes, including dryness and variations in clarity. Schedule regular visits with your eye care provider, especially if you are experiencing any changes.

Decreased Muscle Mass

Loss of muscle mass is a common symptom associated with hormonal changes during menopause. These hormonal shifts can make it more challenging for women to maintain strength naturally as they age. Incorporating strength training during this phase is crucial, as it helps preserve and even build necessary muscle mass.

Frequent Headaches

Many women experience an uptick in headaches, including migraines, directly linked to hormonal changes. Some reports indicate an increase in headache frequency in nearly 30% of women in perimenopause.

Skin Tags and Age Spots

During perimenopause, the appearance of skin tags and age spots can become more frequent. These changes are often attributed to hormonal alterations affecting skin regeneration. Exfoliate weekly and use a daily moisturizer with the proper SPF.

Increased Noise Sensitivity

Some women may find that they become more sensitive to sounds during this time, which can lead to discomfort in loud or noisy environments. Sound overstimulation can also trigger irritability, anxiety, and headaches.

Outer Fatigue

This unusual symptom is characterized by persistent exhaustion that is not alleviated by sleep or rest. It may also present itself as dark under eyes, pale skin, or an overall rundown physical appearance, suggesting deeper levels of fatigue beyond regular tiredness. While fatigue is a common menopause symptom, please consult with your doctor to rule out other potential causes.

Understanding the symptoms of perimenopause can help you adjust to your changing body with some peace of mind. You are not imagining things, and you are not alone. If you experience any of these symptoms, track them and consider discussing them with your healthcare provider as soon as possible.