Blog · Perimenopause & menopause
Perimenopause Symptoms: A Checklist of the Common and Less Obvious Signs
From irregular periods and hot flashes to itchy skin, joint aches and brain fog: a plain checklist of perimenopause symptoms, the stages, and when to see your doctor.
Published · Plait Health
Perimenopause is the transition before menopause, when hormone levels start to fluctuate. It often begins in the 40s and can last several years. Hot flashes get most of the attention, but many women notice other changes first and do not connect them to perimenopause for a long time.
Cycle changes
- Periods that come earlier or later than usual
- Heavier or lighter bleeding
- Skipped periods, with longer gaps in the later stages
Vasomotor symptoms
- Hot flashes (hot flushes)
- Night sweats
- Heart palpitations alongside a flash
Sleep, mood and thinking
- Waking in the early hours and struggling to get back to sleep
- Irritability, low mood or sudden anger
- Anxiety, sometimes new for the first time
- Brain fog: losing words, forgetting why you walked into a room
- Fatigue that sleep does not fix
Body changes
- Joint and muscle aches
- Weight shifting towards the middle
- Bloating
- Dry or itchy skin
- Thinning hair
- Headaches or migraines that change pattern
- Breast tenderness
Vaginal, urinary and sexual changes
- Vaginal dryness or discomfort
- Needing to urinate more often
- Lower libido
The stages
Clinicians use the STRAW+10 system to describe the transition. In early perimenopause, cycles start to vary in length by a week or more. In late perimenopause, gaps of 60 days or more between periods are common and vasomotor symptoms are more likely. Menopause is confirmed after 12 months with no period.
When to see your doctor
- Symptoms are affecting your sleep, work or relationships
- Very heavy bleeding, bleeding between periods, or bleeding after sex
- Any bleeding after 12 months without a period
- Low mood that does not lift, or thoughts of self-harm
Keeping a record helps. A few weeks of notes on your cycle, symptoms, sleep and mood gives your clinician far more to work with than "I just don't feel like myself". Plait tracks all of these in one place alongside what you eat, so the pattern is easy to see and share.
This checklist is general information and not a diagnosis. Many of these symptoms have other causes too, so talk to your clinician.
Frequently asked questions
What are the first signs of perimenopause?
For many women the first sign is a change in their cycle, with periods arriving earlier or later than usual. Sleep changes, mood changes and new anxiety are also common early signs.
At what age does perimenopause start?
It most often starts in the 40s, though some women notice changes in their late 30s.
How long does perimenopause last?
It usually lasts several years, and the length varies a lot from woman to woman. It ends 12 months after the final period.
Can perimenopause cause itchy skin and joint pain?
Both are commonly reported during the transition. They can also have other causes, so mention them to your clinician.
Get a plan built around your symptoms
Take the 3-minute quiz. Plait builds meals around your stage, symptoms and conditions, and shows how food and symptoms move together. 3-day free trial.
Sources
- Harlow SD, et al. Executive summary of the Stages of Reproductive Aging Workshop + 10 (STRAW+10). Menopause, 2012.
- National Institute for Health and Care Excellence. Menopause: identification and management (NG23), updated 2024.
- The Menopause Society. 2022 Hormone Therapy Position Statement. Menopause, 2022.