Hot flashes may be the symptom everyone talks about, but they’re far from the only sign that your hormones are changing. Trouble sleeping, brain fog, mood shifts, changes in energy, and even subtle changes in your period can all show up during perimenopause.
And these changes can start earlier than many women expect. Understanding the lesser-known symptoms of perimenopause and menopause can help you recognize what may be happening in your body, track changes over time, and know when it may be helpful to talk with your healthcare provider.
Perimenopause is the transition period leading up to menopause, and for many women, it can last for several years. During this time, hormone levels begin to shift, which can cause changes in your period, sleep, mood, energy, and other symptoms.
Menopause marks the point when your ovaries stop releasing eggs and your menstrual periods permanently end. You’re considered to have reached menopause once you’ve gone 12 consecutive months without a period.
For many women, perimenopause begins sometime in their 40s, although symptoms can start earlier. In the United States, the average age of menopause is around 51.
But menopause doesn’t happen at the same age for everyone. Early menopause occurs before age 45 and affects about 1 in 20 women, while premature menopause occurs before age 40 and affects about 1 in 100 women. Knowing these age ranges can be helpful if you’re noticing changes that seem earlier than expected and wondering whether hormones may be playing a role.
Early menopause can happen for a number of reasons. In some cases, it may be linked to something that affects the ovaries or changes the body’s ability to produce estrogen.
Possible causes and contributing factors can include:
In many cases, though, there isn’t a clear explanation. Up to half of women who experience early or premature menopause may never know exactly what caused it.
It’s also important to remember that irregular or missed periods don’t automatically mean you’ve reached menopause. Stress, pregnancy, thyroid conditions, certain medications, and other health changes can sometimes cause similar symptoms, which is why it’s a good idea to talk with your healthcare provider if your cycle changes unexpectedly.
Breast cancer treatment can sometimes bring on menopause earlier than expected, particularly for women who were still having periods when treatment began.
Chemotherapy may affect the ovaries and cause periods to become irregular or stop completely. For some women, ovarian function may return after treatment ends. For others, the change may be permanent and lead to early or premature menopause.
Hormone therapy used to treat hormone-receptor-positive breast cancer can also reduce or block estrogen in the body. While this doesn’t always mean menopause has permanently occurred, it can cause many of the same symptoms, including hot flashes, sleep changes and mood shifts.
If you notice changes in your menstrual cycle or new menopause-like symptoms during or after breast cancer treatment, talk with your healthcare team. They can help you understand whether the changes are temporary, treatment-related, or a sign that you’ve entered menopause.
Hot flashes and irregular periods may be the symptoms most often associated with perimenopause and menopause, but they’re not the only changes you may notice. Hormonal shifts can affect your body in ways that are easier to miss, from changes in sleep and concentration to mood, energy, and more.
Perimenopause does get better once your body completes the transition into menopause and your hormone levels stop fluctuating.
The symptoms below are sometimes associated with perimenopause and menopause, but they aren’t proof on their own that you’re going through either stage. Many can have other causes, so it’s important to talk with your healthcare provider if you’re experiencing new, persistent, or concerning changes.
If you’ve found yourself losing your train of thought, struggling to find the right word, or feeling more forgetful than usual, hormonal changes may be playing a role. Shifts in estrogen during perimenopause and menopause can affect attention, memory, and concentration, which may contribute to what many women describe as “brain fog.”
Sleep can also become more disrupted during perimenopause and menopause. You may have trouble falling asleep, wake up several times during the night, or find yourself waking earlier than usual and struggling to fall back asleep.
These changes can happen even if night sweats aren’t waking you up, and poor sleep can sometimes make other symptoms, such as fatigue, irritability, and difficulty concentrating, feel more noticeable.
Menopause can affect more than the symptoms you can feel. As estrogen levels decline, some women may experience changes in their cholesterol levels, including an increase in LDL, often referred to as “bad” cholesterol.
Because these changes usually don’t cause noticeable symptoms, they can be easy to overlook. However, changes in cholesterol can affect cardiovascular health over time, making routine checkups and conversations with your healthcare provider especially important during and after the menopausal transition.
Have you ever noticed your heart suddenly racing, pounding, fluttering, or feeling like it skipped a beat? Heart palpitations can occur during perimenopause and menopause, and changing hormone levels may play a role.
However, hormones aren’t the only possible explanation. Stress, anxiety, caffeine, certain medications, thyroid conditions, and other health issues can also cause heart palpitations. Because changes in your heartbeat can have many causes, talk with your healthcare provider if palpitations are new, frequent, persistent, or concerning.
Urinary changes often happen due to fluctuations in your estrogen levels. This causes the tissues in your urinary tract to become thinner and less elastic. This may contribute to needing to urinate more frequently, leaking urine while coughing or exercising, waking up at night to urinate and more frequent urinary tract infections.
You may notice that your body starts to change shape during perimenopause and menopause, even if your eating or exercise habits haven’t changed much. As hormone levels shift, fat may be stored differently, with more weight settling around the abdomen instead of the hips and thighs.
Muscle mass also naturally declines with age, and hormonal changes may contribute to that process. At the same time, your metabolism may become less efficient, which can make it harder to maintain your usual weight or lose weight as easily as you once did.
These changes are common, but they can vary from person to person. Regular strength training, balanced nutrition, adequate sleep, and other healthy habits can help support muscle mass and overall health during this transition.
During perimenopause, you may notice several changes in your menstrual cycle, including:
Menopause is reached once you have gone 12 consecutive months without a menstrual period. If you experience any bleeding after menopause, you should visit your health care provider, even if it only happened once or is light.
Feeling a little more stiff or achy than usual? Some women notice changes in their joints and muscles during perimenopause and menopause, including stiffness, soreness, muscle aches, or taking longer to recover after exercise.
Hormonal changes may play a role, but age, activity level, injuries, and other health conditions can also contribute to joint and muscle discomfort. If pain is persistent, worsening, or interfering with your daily activities, it’s a good idea to talk with your healthcare provider.
Perimenopause and menopause symptoms are easy to overlook because they may not always look like what people may expect. Not everyone experiences obvious symptoms like hot flashes or night sweats. Symptoms may also look like other health issues. Some may think of their symptoms as just another part of growing older.
Other life changes like work stress, raising children and caring for family members may also be happening at the same time, making it difficult to recognize that hormone changes may also be occurring.
Instead of trying to self-diagnose whether you're going through perimenopause or menopause from one single symptom, it is better to look out for patterns and changes from how you normally feel.
You don’t have to simply “deal with” perimenopause or menopause symptoms. Regular exercise and a consistent sleep routine can support sleep and mood, while limiting afternoon caffeine and alcohol near bedtime may help you sleep better.
Pelvic floor exercises can also help with certain types of bladder leakage. More targeted treatments are available, too: cognitive behavioral therapy for insomnia can help with persistent sleep problems, and hormonal or nonhormonal medications can relieve hot flashes and night sweats.
The right approach depends on your symptoms and medical history, especially if you’ve had breast cancer. Keep a simple symptom diary and bring it to your doctor’s appointment with a specific question: “What are my options for treating the symptoms affecting my daily life?”
Perimenopause and menopause can be a good time to take a closer look at your overall health, including keeping up with routine preventive care and recommended breast screenings.
Breast ultrasound is one imaging option that can provide additional information about breast tissue. It uses sound waves to create images of the breast and does not involve radiation. For some women, including those with dense breast tissue, ultrasound may be used as an additional screening tool alongside mammography.
Breast ultrasound does not replace mammography, and it is not used to evaluate hormonal changes associated with menopause. However, when appropriate for your individual screening plan, it can provide another way to stay proactive about your breast health.
At your next healthcare visit, consider discussing your personal breast cancer risk factors, including your family history and breast density, as well as which screening options may be appropriate for you. Staying consistent with recommended screening can help improve the chances of finding breast cancer at an earlier stage, when it may be easier to treat.