Fact checked by Nick Blackmer
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- A new study identified the symptoms women most commonly experience during perimenopause.
- Fatigue, irritability, and sleep problems were more common than hot flashes.
- Because perimenopause can be difficult to identify, experts recommend consulting a doctor for an evaluation.
Hot flashes may be one of the best-known symptoms of perimenopause, but it's far from the only physical change many women experience. A recent study, which surveyed more than 17,000 women, found that women in perimenopause more often develop symptoms less commonly associated with this transitional phase, ranging from mental health shifts to joint problems. Here’s a closer look at the findings, which were published in the journal Menopause.
Perimenopause Symptoms By the Numbers
Perimenopause refers to the years leading up to menopause—defined as going a year without a period—and typically begins in the mid-40s, though it can start earlier for some people.
Citing a lack of studies that “systematically compare perimenopause symptoms across diverse cultural and geographic settings,” researchers from the Mayo Clinic and period-tracking app Flo surveyed 17,494 women across 158 countries via the app about perimenopause. Participants ages 18 to 34 were asked about their knowledge of 26 listed symptoms, while those 35 and older were asked about whether they were experiencing any of them.
Of the 12,680 participants in the older group, 21% were in perimenopause—and among them, 10 symptoms were more common than hot flashes:
- Exhaustion (95%)
- Fatigue (93%)
- Irritability (91%)
- Sleep problems (89%)
- Depressive mood (88%)
- Brain fog (87%)
- Digestive issues (86%)
- Anxiety (85%)
- Joint and muscle discomfort (80%)
- Weight gain (79%)
Behind hot flashes, other commonly reported symptoms included headaches, skin and hair changes, and sexual problems. The findings were similar among participants over 35 who did not identify as being in perimenopause.
However, when younger respondents were asked about common perimenopause symptoms, they most often identified hot flashes. Only about 65% recognized sleep problems, fatigue, exhaustion, and irritability as symptoms.
Consequences of a Lack of Awareness
According to the study authors, the findings reveal a disconnect between the symptoms women expect during perimenopause and what they actually wind up dealing with.
“Historically, the conversation around menopause has been narrowly focused on hot flashes,” said Chrisandra Shufelt, MD, senior study author, professor, and associate director of the Women’s Health Research Center at Mayo Clinic in Jacksonville, Florida. “However, perimenopause affects many areas of the body, including the brain, metabolism, sleep, and mood.”
That gap in understanding has real-world consequences: When people don’t recognize their symptoms as hormone-related, it can lead to confusion and delays in care, Shufelt added.
How to Recognize and Manage Perimenopause Symptoms
Unfortunately, there’s no single reliable test for menopause, said Mary Jane Minkin, MD, a gynecologist and clinical professor at Yale School of Medicine. At-home tests that claim to offer insight into a person’s menopausal status by measuring hormones aren’t always accurate. That’s because the hormones they typically assess—most often follicle-stimulating hormone (FSH)—can fluctuate wildly during perimenopause, providing only a snapshot rather than a complete picture.
Instead, if you’re in your late 30s or 40s and experiencing new symptoms, the best next step is to talk to your doctor, Shufelt said.
They can help determine whether your symptoms are related to perimenopause or something else. Heart palpitations, for example, may be hormone-related—but they could also signal a heart issue. “While it may be perimenopause, not everything is, and a proper evaluation matters,” she said.
If symptoms are linked to perimenopause, treatment options are available—so there’s no need to simply push through them, she added.
In the U.S., more health systems now offer specialty centers for midlife women, and physician training around menopause—which has long been lacking—is improving, according to Candice Fraser, MD, a Menopause Society–certified practitioner and OB/GYN at the Carolyn Rowan Center for Women’s Health and Wellness at Mount Sinai.
To find a clinician who has passed a certification exam in menopause care, Minkin recommends using a tool offered by the Menopause Society.
