Are You In Perimenopause? Signs, Symptoms, and What to Ask Your Doctor

As confusion and misunderstanding about perimenopause persist, learn how to recognize and manage symptoms of this life transition.

Perimenopause has only recently entered the cultural conversation despite being a transitional life stage experienced by all females.

An estimated 2 million women enter perimenopause each year in the United States, with the average onset occurring during the mid-40s and lasting around 4 to 8 years. 

Common symptoms may include hot flashes, irregular periods, vaginal changes, and psychological effects, such as exhaustion and irritability, that may interfere with daily activities, work, and overall quality of life. 

A recent global study found that perimenopausal women experienced a 1.5-fold increase in psychological symptoms like physical and mental exhaustion.

Yet not everyone experiences perimenopause in the same way. The timing, severity, and symptomology of the menopause transition often differ substantially from one person to the next. 

A 2025 study lists around 145,000 symptoms associated with different stages of menopause, logged by nearly 5,000 individuals. Around 39% of these symptoms, or roughly 56,550, were perimenopausal.

However, experts caution that not all of the associated symptoms may be linked to this complex life stage.

For instance, anecdotal reports of “frozen shoulder” have been linked to perimenopause, since the symptom typically develops during midlife. Yet there is insufficient evidence to suggest the phenomenon is perimenopausal.

“We need to be extremely cautious about bucketing all of this stuff under perimenopause,” said Stephanie Faubion, MD, MBA, director of the Mayo Clinic Center for Women’s Health and medical director of the Menopause Society. 

“Just because it’s a symptom of getting older doesn’t mean it has some hormonal relation,” Faubion said. “We actually don’t know.”

Despite its prevalence, a large-scale survey published in Menopause shows that perimenopause remains an underrecognized and often misunderstood life stage.

Widespread confusion around perimenopause can make it difficult for women to identify what they’re experiencing or receive appropriate care.

Because of this, many women have looked to social media for answers, which may not always be a reliable source of information.

A 2026 report published by Reddit indicates that menopause communities are rapidly growing online. Forums like r/perimenopause experienced a 387% increase in the past year alone. 

“I think it has to do with a lack of education,” Faubion told Healthline. “We all get ‘the talk’ before we start our periods, but women don’t have a specific time or venue where they get ‘the talk’ about what’s going to happen on the reverse side. There’s no ‘Welcome to Perimenopause’ doctor’s visit.”

Healthline spoke with Faubion to learn more about recognizing and managing perimenopause symptoms, why awareness remains low, and when to talk with your doctor. This interview has been lightly edited for clarity and length.

Why are women still confused about perimenopause?

Faubion: I think most women have no idea what defines perimenopause. They don’t even know what defines menopause.

We published a study showing that when you ask a woman whether she’s pre-, peri-, or postmenopausal, it often doesn’t align with what a menopause expert would say; it only lined up about 50% of the time. 

A lot of women had a lack of clarity about which menopause stage they were in. This is not an uncommon thing, and it applies to menopause as well, not just perimenopause. Women don’t know what stage they’re in. 

A lot of women don’t receive the education they need on what is happening to their bodies, what defines some of these changes, and what to expect. It’s not that we want to scare women — because this is a universal life experience that 100% of us are going to experience if we live long enough to reach this time — so we don’t need to pathologize it; it’s not a disease.

Many women will sail through it without any difficulty whatsoever. But at the same time, it would be helpful if women knew what they might expect and what they might do about it if they are struggling with symptoms.

Where could the perimenopause conversation start? 

Faubion: I think women have needed to get this information all along. It shouldn’t be a surprise that when women hit their 40s, this happens. 

It should occur in school. It should occur where you get primary care; if it’s a nurse practitioner, a physician assistant, a nurse, or a physician, any of those people should be able to give you information on this. Your local pharmacist should be able to as well. 

There are a number of resources you could go to — menopause.org, MayoClinic.org, or Harvard or Cleveland Clinic’s websites. There are plenty of reputable sources out there. 

There are plenty of not-so-reputable sources out there, too, which is the bigger issue. The problem is that women are getting information from not-so-reputable sources, and many of them are inaccurate.

On social media, you need to be cautious because many influencers are selling products.

What are the common and not-so-common signs of perimenopause?

Faubion: I’ve seen the long list — but that doesn’t mean those symptoms are all related to perimenopause. 

I would urge caution in throwing all of those symptoms into a perimenopause bucket because all of those symptoms could relate to other things, including serious disease. 

Common symptoms are hot flashes and night sweats, sleep disturbances, mood disturbances, or joint aches. 

Women may start to have vaginal dryness during this time. They might have a change in sexual desire. 

But all the other stuff — the itchy skin, the palpitations — that could relate to menopause, or it could relate to something else. Itching might be lymphoma, and palpitations could be a heart problem.

What is the emotional impact of the menopause transition?

Faubion: The most common symptoms are irritability and anxiety.

Some women may have actual mood issues. If women have had mood issues in the past, they’re at higher risk of having mood issues during perimenopause and early postmenopause. 

If they’ve had premenstrual syndrome-type mood issues, they’re more likely to have a problem now. If they’ve had postpartum baby blues or postpartum depression, they’re more likely to have a problem in perimenopause. 

The same hormonal fluctuations that cause those issues are causing mood issues again or exacerbating them, so we need to screen women for these issues. 

What should women who suspect they’re in perimenopause say to their doctor?

Faubion: “Do you think I’m in perimenopause?” That’s the place to start, and just describe your symptoms. I think that’s the place to start. Just say, “Hey, I’m experiencing these things. Do you think it could be the start of the menopause transition?”

[Treatment] depends on the symptom. If somebody complains of all kinds of irregular bleeding, then we would start with managing the bleeding, and it could be a birth control pill or a progestin-containing IUD. 

If they’re having mood issues, we might try hormones. We might try an antidepressant — in general, treatment of depression and anxiety around that time is the same as they are at any other time, and antidepressants are the first line for treatment of depression during this time, just like any other time. 

Might hormones play a role? Maybe, but they’re not the first-line treatment for a mood disorder.

What can women do to manage perimenopause?

Faubion: The menopause transition is a time of accelerated cardiovascular risk. We tend to gain weight in midlife, not just related to menopause, and in fact, it’s more age-related than it is to menopause. 

But the menopause part is that we put the weight in our midsection, and that’s not good for cardiovascular health. It increases the risk of metabolic syndrome, diabetes, and cardiovascular disease. So, women’s cholesterol levels look worse during the menopause transition. LDL, or “bad,” goes up. HDL, or “good,” may not go down, but it becomes less functional. 

Because we have more visceral fat, it increases the risk for diabetes, sleep apnea, etc.

Blood pressure also goes up during this time. It’s hotly debated whether that’s menopause, age, or a combination of both. But there are a bunch of changes occurring during this time that increase a woman’s risk for cardiovascular disease, which is the number one killer of women. 

This is a great time to take stock of these risk factors, so women need to “know their numbers” — their blood pressure, blood sugar, and lipid levels. These should all be checked during this time.

It’s also a great time to double down on lifestyle efforts. If you’re smoking, stop smoking. If you’re not exercising, time to start a program. 

It’s hard not to gain weight during this time, so adjustments need to be made to your diet and other habits.

Women tell me all the time, “I haven’t changed anything, and I’m gaining weight.” And I said, “Exactly. If you haven’t changed anything, you will gain weight.” 

Women need to hear about this in advance so they’re not surprised by all of these things. 

Lifestyle is key during this time and after this time. We live about a third to a half of our life span after menopause, so this sets people up to live a healthy last third or half of their lives.