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What are the most common perimenopause symptoms?
What our Clue members are tracking
Part 3 of 5: Perimenopause Awareness Month Series
Perimenopause can bring a wide range of physical and emotional changes, but everyone experiences it differently. Some people have symptoms that significantly affect daily life, while others notice few or no changes.
One of the most common signs is a change in the menstrual cycle. Periods may become shorter or longer, occur more or less often, or become heavier or lighter. Other experiences can include hot flashes, sleep problems, mood changes, vaginal dryness, and changes in memory or concentration.
Tracking your cycle and experiences in the Clue app can help you spot patterns, identify any possible triggers, and understand what might help you manage them.
What perimenopause symptoms do people track most often?
Below are the experiences most commonly tracked by Clue Perimenopause members and what you need to know about each one.*
Tired
58% of Clue Perimenopause members tracked this experience.
Tiredness and fatigue are common during midlife and can have many causes. During perimenopause, poor sleep, night sweats, mood changes, stress, and other health or life factors can also make you feel more tired.
Long-lasting or severe fatigue can also be linked to conditions such as anemia, thyroid disorders, or sleep apnea, so it’s worth discussing with a healthcare provider.
Mood swings
51% of Clue Perimenopause members tracked this experience.
Mood swings, irritability, anxiety, and low mood can occur during perimenopause. Hormonal changes may play a role, but sleep disruption, stress, health, and life circumstances can also affect your mood. Seek support if changes are long-lasting, difficult to manage, or interfere with daily life.
Breast tenderness
50% of Clue Perimenopause members tracked this experience.
Breast tenderness or soreness can occur during perimenopause as hormone levels fluctuate. Breasts may feel swollen, heavy, or more sensitive, and symptoms may come and go. Speak with a healthcare provider if the pain is persistent, affects one specific area, or occurs alongside a lump, nipple discharge, or changes to the skin or nipple.
Trouble falling asleep
40% of Clue Perimenopause members tracked this experience.
Difficulty falling or staying asleep can occur during perimenopause. Hot flashes and night sweats may disrupt sleep, while stress, anxiety, pain, medication, alcohol, and other health conditions can also contribute. Keeping track of when sleep problems happen may help you and your healthcare provider identify patterns and possible treatments.
Brain fog
37% of Clue Perimenopause members tracked this experience.
Some people notice changes in memory, concentration, or word-finding during perimenopause. Hormonal changes may contribute, and other health conditions can cause similar experiences. These changes are often described as "brain fog," although this is not a medical diagnosis.
Night sweats
31% of Clue Perimenopause members tracked this experience.
Night sweats are hot flashes that happen during sleep. Changes in estrogen affect the brain systems that regulate body temperature, making them more sensitive to small temperature shifts.
Feeling withdrawn
30% of Clue Perimenopause members tracked this experience.
Poor sleep, fatigue, anxiety, low mood, or other symptoms can make it harder to socialize or enjoy usual activities. Wanting more time alone is not necessarily a problem, but ongoing withdrawal or loss of interest can also be a sign of depression and is worth discussing with a healthcare provider.
Hot flashes
27% of Clue Perimenopause members tracked this experience
Hot flashes (also called hot flushes or vasomotor symptoms) are sudden sensations of heat, often around the face, neck, and chest. They may involve sweating, chills, a faster heartbeat, or anxiety.
Migraine
27% of Clue Perimenopause members tracked this experience.
Migraine is a neurological condition, not simply a severe headache. An attack may involve throbbing or one-sided head pain, nausea, and sensitivity to light or sound, but symptoms vary.
Fluctuating estrogen levels can make attacks more frequent or severe for some people during perimenopause. Migraines may improve after menopause, although this does not happen for everyone. Seek urgent medical care for a sudden, extremely severe headache or new neurological symptoms.
Dry skin
25% of Clue Perimenopause members tracked this experience. Skin may become drier, thinner, or more sensitive around menopause. Aging, weather, skin conditions, medication, and other health factors can also contribute. Fragrance-free moisturizers and gentle cleansers may help.
Speak with a healthcare provider if dryness is severe, itchy, painful, or accompanied by a rash.
Low sex drive
22% of Clue Perimenopause members tracked this experience.
Sexual desire and arousal can change during perimenopause. Hormonal changes may contribute, but sexual wellbeing is also influenced by mood, relationships, stress, body image, medication, health conditions, and whether sex is comfortable.
There is no single "normal" level of sexual desire. Support is available if a change is distressing to you.
Heartburn
19% of Clue Perimenopause members tracked this experience.
Heartburn may be more common in perimenopause. Diet, alcohol, smoking, stress, medication, and other digestive conditions can all contribute. Talk to a healthcare provider if heartburn is frequent, worsening, disrupts sleep, or occurs with trouble swallowing, persistent vomiting, unexplained weight loss, or chest pain.
Vaginal dryness
16% of Clue Perimenopause members tracked this experience.
Lower estrogen levels can make vaginal and vulval tissue drier, thinner, or more sensitive. This may cause burning, irritation, or pain during sex. Vaginal moisturizers can provide ongoing relief, and lubricants can reduce friction during sexual activity. Local vaginal estrogen and other prescription treatments may also help. A healthcare provider can help you choose an appropriate option.
Hair loss
14% of Clue Perimenopause members tracked this experience.
Hair can become thinner, finer, or more prone to breakage around menopause. Genetics, aging, stress, nutrition, thyroid disorders, iron deficiency, medication, and other conditions may also contribute. A healthcare provider or dermatologist can help assess sudden, patchy, or distressing hair loss.
*This data comes from Clue Perimenopause members who were active in the last 30-days and consented to the use of their health data for analytics. The percentages show the proportion of these members who tracked each experience at least once over the 12-month period analyzed. This data does not show how often or severely members experienced each symptom, and should not be interpreted as estimates for everyone going through perimenopause.
What other changes can occur during perimenopause?
Other possible changes include:
Heavier, lighter, or less predictable periods
Joint or muscle pain
Palpitations
Urinary urgency, discomfort, or recurrent urinary tract infections
Pain during sex
These symptoms are not specific to perimenopause. New, persistent, or worrying changes should be assessed rather than automatically attributed to hormonal changes.
What can help during perimenopause?
The right approach depends on which symptoms you have, how much they affect you, your health history, and your preferences. Some options include:
Track what you notice. Recording changes in your cycle, symptoms, sleep, and possible triggers can help you identify patterns and explain what is happening to a healthcare provider.
Support sleep. A regular sleep schedule, a cool sleeping environment, and reducing factors that disturb your sleep may help. Persistent insomnia may benefit from cognitive behavioral therapy (CBT) for insomnia or treatment of contributing symptoms.
Move regularly. Physical activity supports cardiovascular, bone, muscle, and mental health. Choose forms of movement that are accessible and sustainable for you, including weight-bearing and resistance exercise where possible.
Eat regularly and include a variety of foods. A balanced eating pattern that includes enough protein, calcium, vitamin D, fiber, and other nutrients can support general, bone, and cardiovascular health.
Reduce stress where possible. Relaxation techniques, CBT, social support, or adjustments at home or work may help with coping and well-being.
Limit smoking and alcohol. Stopping smoking supports bone, heart, and overall health. Alcohol can worsen sleep, hot flashes, migraines, or mood for some people.
Ask your healthcare provider about treatment. Menopausal hormone therapy (MHT) is the most effective treatment for hot flashes and night sweats and can help with some other symptoms. Local vaginal estrogen can treat vaginal and some urinary symptoms. Evidence-based non-hormonal options are also available. A healthcare provider can help you weigh the benefits and risks based on your needs and medical history.
Lifestyle changes can support health, but they are not a substitute for medical care when symptoms are severe or long-lasting. They may not be enough to manage symptoms on their own. Pregnancy is still possible during perimenopause. Menopausal hormone therapy is not contraception, so talk with a healthcare provider about contraceptive options if you want to avoid pregnancy.
A note about weight
Body composition and fat distribution often change during midlife. Hormonal changes may contribute to a shift towards storing more fat around the abdomen, while aging, sleep, stress, medication, activity, and other factors can also influence weight.
Advice to “just lose weight” is rarely a complete or helpful response to perimenopause symptoms. Weight loss does not treat every symptom, and making it the main goal can overlook a person’s wider health and add stress or stigma. It is usually more useful to focus on sustainable behaviors—such as sleep, movement, nourishment, and stress management—and on treating the symptoms that are affecting you.
When to speak to a healthcare provider about perimenopause
Consider seeking care if symptoms are affecting your sleep, relationships, work, or quality of life, or if you are unsure whether they are related to perimenopause. A healthcare provider can help rule out other causes and discuss hormonal and non-hormonal treatment options.
Bleeding patterns often change during perimenopause, but very heavy bleeding, bleeding between periods, bleeding after sex, or any bleeding after 12 months without a period should be assessed.
Seek urgent help for chest pain, a sudden extremely severe headache, or new neurological symptoms.
Up next → Part 4: Managing symptoms & finding the right perimenopause treatment options.
