You’ve likely heard that there are 34(ish) menopause symptoms. Surprise! There’s actually more than 40. Don’t worry, though. It’s rare that a woman would experience them all. However, given how little society has talked about perimenopause and menopause in the past, women may not know that what they’re experiencing is due to normal hormonal fluctuations.

40+ Common Menopause Symptoms to Know

The symptoms you experience often depend on where you are in the menopause transition, though every woman’s “constellation” of symptoms is unique.

At Gennev we've developed “menopause types” based on what each stage tends to look like. Perimenopause is a Type 2, and many of these symptoms first appear there. However, menopause symptoms can come and go at different times, some even showing up as a symptom after menopause. No matter where you are in your transition, this information can be helpful.

Quickly review the list or bookmark so you can come back as new symptoms appear. This is your comprehensive perimenopausal symptoms list.

If you are really struggling with symptoms, a Gennev menopause-certified gynecologist can give you a trusted opinion, determine if medication is right for you, and they can provide prescription support. Book an appointment with a doctor here.

Perimenopause starts earlier than most of us realize (as early as the mid-30s for some), and symptoms may not be what we expect, so often women are well into perimenopause before they even realize the transition has begun. Too many women begin this natural process in a state of confusion and fear because there’s not enough education about what can happen as our hormone levels change.

Let’s change that. The more informed we are about what to expect, the better we cam manage symptoms as they come.  

Know more about your body in menopause: take the Gennev Menopause Assessment

A proactive stance for menopause could include: putting out a BOLO (be on the lookout) for these symptoms in your body and mind. This list may prove especially helpful if you are approaching 40, or if you’re curious about perimenopause indicators.

Of course, call your doctor or ours if you suspect something is off or concerning. AND review this list... just so you know better what to expect at the onset of perimenopause.

*Note: This is not a checklist, though it is a comprehensive line up.

Menopausal And Perimenopausal Symptoms List

Again, symptoms are experienced differently for each woman: some may have hot flashes for a month or several months, some women may never experience heart palpitations, spotting, or an itchy vagina. This list is about arming and empowering yourself with knowledge so you can make the best decisions for yourself and your health.


All about the vagina

  • Vaginal Dryness - Thinning and drying of vaginal tissue can make sex painful. Don’t despair, your days of bedroom frolics aren’t over – just be sure to keep your favorite lubricant handy, and use it liberally and often.
  • Itching - You can blame vaginal dryness for this one, too, as the vaginal walls thin and dry out, causing, yes, you guessed it, itchiness down there.
  • Painful sex - The vagina may become shorter, narrower, and less flexible during menopause, leading to pain during intercourse. We recommend vaginal dilators for atrophy.
  • Irregular bleeding - Irregular periods is often a woman’s first clear signal of the onset of perimenopause. Periods may be farther apart and occasionally skipped altogether, then heavy periods when they come. Note: “heavy” does not mean “flooding.” If you’re having truly heavy periods where you feel unsafe leaving your house, please check with your ob/gyn to be sure fibroids or other issues aren’t causing the problem. (Hint: Birth control pills or Mirena IUD can be helpful here.)

More support

Painful sex webinar with panel of experts

Vaginal issues in menopause: q & A with an ob/gyn

Birth control and menopause: what do we need to know?


Skin & body

  • Dry skin texture and hair- Drying and thinning skin and hair are possible. Decreasing estrogen causes not only our skin to become thinner, but our hair, too. Double whammy. Here are some skincare tips for menopausal skin.
  • Body odor changes - Yes, even your body odor can change in menopause. You’ll probably be much more sensitive to it than anyone around you. Whether it’s hormonal changes or higher levels of anxiety (normal during perimenopause and menopause), you may sweat more and your body scent may change.
  • Acne- Oh, estrogen. As it declines during menopause and you experience a relative predominance of androgens (male-type hormones that stimulate oil production), acne takes the opportunity to make an appearance.
  • Hormonal weight gain and body weight redistribution- When you’re younger, estradiol keeps you lean. Guess what happens when you hit menopause? Bingo! Estradiol decreases and estrone takes over--a hormone produced in your fat cells and adrenal glands that stores fat in new, uncomfortable places, like your belly.
  • Dry eyes and dry mouth - These can be unpleasant. Be sure you drink enough water, blink frequently (studies show we don’t blink often enough when staring at screens), and for your mouth, see your dentist regularly. Dry mouth can mean more cavities. Your taste can also change, making you less interested in your formerly favorite foods.
  • Foot pain - There are many culprits to consider here, including a decrease in the production of collagen, lower bone density, and weight gain, just to name a few.
  • Nausea - Though the research is scarce, there’s no denying that nausea can be a symptom for some during menopause. Low blood sugar, progesterone deficiency, and dehydration are all possible causes.
  • Joint pain - Joint pain is the one that makes a lot of us feel old overnight. One thing to know: for many women, this gets better. Don’t stop exercising, and go easy on the ibuprofen, which can cause stomach upset. (Hint: manage weight and take magnesium glycinate.)
  • Gas / Bloating - Feel like a Macy’s parade balloon with enough natural gas in you to energize a mid-sized city? This can be normal during menopause. Really. Excess air and/or water may contribute to this symptom, as can stress, diet, gut flora, and slowing digestion.
  • Constipation - Strictly speaking, if you’re not having at least three bowel movements a week, you’re constipated. It may suddenly seem like no food is “safe.” Don’t panic. Just increase fiber (slowly) and track symptoms. Many women become more sensitive to dairy or grains in this time, so you may be able to identify foods that cause more trouble than others.
  • Urination frequency changes due to urinary system changes, even incontinence - Gotta go, gotta go, gotta go? Unfortunately, this is not surprising. Blame our old friend decreasing estrogen, who starts to fall down on its job related to the bladder during menopause. Pee-rfect! A pelvic physical trainer is your best defense here. Even if you’re not having issues (yet), you can avoid a lot of problems by learning how to strengthen your pelvic floor (but not too much). Do not dehydrate yourself, assuming you won’t have to pee as often. (Hint: pelvic PT, tracking food and drinks that irritate your bladder)
  • Sense of taste may change - Many women report foods simply don’t taste the same during menopause--and some even experience a constant metallic taste in their mouths. You’d think this would aid in losing the newly deposited belly fat. And yet...
  • Heart palpitations- Your heart may race, skip a beat, flutter. These are perfectly normal — usually. Since we don’t like to leave heart things to chance, check in with your doc or ours, explain what you’re experiencing, and follow instructions. If ever you feel the symptoms of a heart attack, however, get help immediately.
  • Numb or tingling fingers (paresthesia) - (tingling or burning sensation in your fingers, hands, feet, etc.) Some women even feel they have insects crawling under their skin. Again, it’s annoying as heck, but it’s not life threatening, you’re not crazy, and it’ll likely reduce as you get further past menopause.
  • Ringing ears or tinnitus- Experiencing a roaring or ringing in your ears? Could be tinnitus, yet another super annoying menopause symptom. There’s really not a good treatment for it. It does tend to subside over time, however.

More support

Skincare tips for menopausal women

The mindful approach to weight management at menopause


Hot flashes: Your internal volcano is now active

  • Hot flashes- In an era of COVID, we’ve had lots of women ask if they’re experiencing hot flashes or a fever. Hot flashes are generally pretty short in duration, are often felt first in the chest, neck, and face, and may come with accelerated heart beat. (Hint: hydrate! Drink lots of cool water to help reduce it. Better: talk with your doctor about hormone replacement therapy for hot flashes.)
  • Flushing - When a sudden feeling of heat comes from nowhere and spreads throughout the body… It isn't uncommon to start sweating, palpitations and flushing of the face.
  • Night sweats... even day sweating too

More support

Four ways to get rid of hot flashes

Menopause cold flashes: yes, that’s a thing- cold flashes can be caused by menopause or perimenopause. These are pretty unpleasant and can last a long time. Further, they tend to happen at night and are resistant to blankets and fleece pajamas. If you get these, try taking magnesium glycinate at night before bed, and when they happen, warm from the inside out by drinking warm water.

I think I had my first hot flash

Brain and mood

  • Fast, and intense, mood changes - Though we’re not precisely certain of its cause (most likely a mix of declining estrogen, physical changes, and external factors), there’s no denying that menopause brings on unwanted mood changes.
  • Rage - When your estrogen levels are wildly fluctuating and progesterone (a natural antidepressant and anxiety reliever) seriously declines, your serotonin and other mood- and stress-moderating brain chemicals take a big hit.
  • Brain fog / memory lapses or concentration difficulties - Suddenly you lose a word, or a name, or just don’t feel as sharp as usual. While many women worry about early onset dementia, chances are, it’s perimenopause. Talk to a doc if you’re not comfortable, absolutely, but this isn’t cause for panic. (Hint: Omega 3 supplements can help here.)
  • Increased clumsiness - Yes, becoming more clumsier is a thing. Why? Well, when your estrogen levels drop, it can be harder to concentrate and also hold onto things comfortably. On top of that, the blurred visions, cataracts, and dizziness can make it harder to be coordinated.
  • Tiredness/fatigue - This isn’t due to sleepless nights, this is tired that literally starts with a tired brain. As estrogen decreases, the brain loses its “master regulator,” and you feel fatigue that is bone deep. Again, this will likely recede with time. (Hint: Omega 3s, lowered expectations, self-care)
  • Sleep disturbances – aside from night sweats - You know the expression, “I slept like a baby”? Well, this is the reality: waking up every two hours, wanting to cry. Now is the time to start being truly dedicated to good sleep hygiene. (Hint: Sleep hygiene, meditation, CBD, and magnesium glycinate.)
  • Restless leg syndrome (RLS) - Experiencing sensations of tingling, electric shock, itching, crawling, throbbing--plus an irresistible urge to move--in one leg or both, especially when you’re falling asleep? Welcome to RLS, where the cause isn’t certain, but the symptoms sure are!
  • Stress - We’re not going to define stress here, because we understand you’d like to finish this article at some point. Just know that during menopause, your stress levels might go up. And with everything going on during this life transition, both internally and externally, it’s easy to understand why.

More support

Menopause and mental health: finding yourself in isolation

Depression in perimenopause: we really need to talk

How to get good sleep


What about your regular, cycle-sparked PMS symptoms?

The truth is, every woman’s experience is different. So, it could be that your regular cycle’s symptoms show up and intensify (going from PMS into PMDD), or not. You might also experience new PMS symptoms (yeah, sorry), or not.

Our best suggestion is to be on the lookout so you can quickly identify, accept, and act to diminish discomfort and stress.

  • Breast tenderness - Our breasts are capable of great things, like providing vital nutrients to our children. They’re also heavily influenced by hormones, so when menopause throws everything out of whack, your breasts can get in on the action, becoming more tender and sensitive.
  • Migraines - More intense than your average headache, migraines might hit you during menopause whether you have a history of them or not.
  • Light or sound sensitivity - Did you know that estrogen plays an important role in how the brain processes sound? And that fluctuating hormones may cause eye changes? You know where I’m going with this, right?
  • Water retention - Not to sound like a broken record, but those wild and crazy hormones of yours might lead to unwanted water retention.
  • Cramps - The pain associated with cramps might intensify during perimenopause--even months when you skip a period. We know what you’re thinking and yes, this is really not fair.
  • Mood swings - As we mentioned earlier, mood swings, whether mild or fierce, may become part of your day-to-day. Getting mad easily and feelings of sadness are the most common emotional symptoms of menopause.
  • Anxiety and depression - If you have a history of emotionally challenging PMS, post-natal depression, PMDD, anxiety, depression, or other hormonally related emotional issues, be aware that these can come back and be even more severe in perimenopause. If you’ve never had these concerns, they can still erupt during peri, so be aware of the possibility and get help if you need it. (Calming apps and exercise will help with mild cases; seek help for the more serious.)
  • Lower back pain - Yes, hormones can play a role in lower back pain. So can a whole host of other issues, including incorrect exercise form, poor stability, and even poor breathing.
  • Heavier flow periods - Occurring most commonly during perimenopause, heavier flow periods are typically defined by twelve to sixteen or more soaked sanitary products during a period.


Red flags

Consider talking with your doctor about these if they appear:

  • Bleeding after menopause - If you’ve been period-free for a year, then suddenly experience post-menopausal bleeding, it’s time to talk to your doc. Possible causes include tearing of the vaginal tissue and fibroids--concerning, but less scary than a third possible cause, cancer of the lining of the uterus.
  • Newly inverted nipples - Apparently, this is somewhat commonplace and can run in families. Still, another possibility is cancer, so don’t ignore the nipples!
  • Unintended weight loss - We know this one might feel more like something to celebrate, but when the cause could be infection, hyperthyroidism, depression, and even cancer, it’s best to consult an expert.
  • Skin breaks - A drop in estrogen causes dryness, age spots, or a tendency for the skin to bruise. The drop in estrogen can also prompt acne breakouts.

Less-known symptoms of menopause

You may hear about the common menopause symptoms from women in your friend circle who are of similar age, but less-common (or at least, not-as-well-known) symptoms are the ones driving women to the ER or their psychiatrist.

Know that menopause is very different for every woman, so if your transition looks different than your friends’ or your sister’s, that’s OK. Symptoms vary in appearance, frequency, and intensity, but all can be “normal.”

There are a LOT of menopause symptoms, and chances are, if you’re the right age, that bizarre tummy rumble or tingling finger is hormonal. However, there are other possible causes, some serious, so you don’t want to assume it’s menopause. We always recommend you check in with a doctor (preferably a menopause specialist) to verify. And if symptoms are severe, sudden, overly painful, or interfering with your life, please see a medical health professional ASAP.

And please, do your buddies a favor. Pass this article along. No woman needs to lie awake at night, scared she’s having a heart attack but reluctant to do anything about it because she’s been dismissed before. Every woman who lives long enough will go through this, so let’s help each other have the easiest, healthiest transition possible.

I’m only 40; why do I need to know the common symptoms of menopause?

However, given how little our society has talked about perimenopause and menopause in the past, women may not know that what they’re experiencing is due to normal hormonal fluctuations. It’s not just hot flashes.

First, some definitions: symptoms usually start in perimenopause, the years before menopause when hormones first start fluctuating (menopause is just one day – the one-year anniversary of your last period; everything after that day is post-menopause). Some women may experience few or mild or no symptoms early in perimenopause or assume they’re due to stress, bad PMS, or other factors.

Perimenopause can start as early as the mid- to late-30s but commonly becomes noticeable in mid-40s. Poor sleep, mood changes, irregular periods, heart palpitations, and more can occur during this time, and we hear from a lot of women that it took several doc visits and possibly even a trip to the ER before anyone diagnosed them correctly.

Given that perfectly normal symptoms can cause a lot of fear and anxiety (and expense!), we would like everyone who may be experiencing or who will experience menopause to know what could be coming.

By the way, you’ll see the words “talk with your doctor” a lot in this article. We highly recommend you get a menopause specialist OB/GYN in your life, as you’ll maximize your chances of getting the most complete information.

More aware, better care

Looking ahead, this is a time for more self-care and self-support, not less. Improving your comfort and managing these symptoms with excellent self-care (eating good, healthy foods; hydrating, making sleep and fitness bigger priorities, quitting smoking or vaping) will actually improve your health, inside and out.

Absolutely get into the spirit of research and talk with your doctor (or ours) about best options for hormone management or therapies, alternative health practices for menopause symptom relief (e.g. acupuncture or chiropractic), and even hemp-sourced CBD options. AND! Talk with like-minded new friends on our community forums.

Arm yourself with the information you want and need so you’ll recognize perimenopause indicators when (and if) they show up. Take control of your health and enter this part of your life path with confidence and power.

Are you ready to understand your body better & take control of your health in menopause? Take Gennev's ob/gyn-created Menopause Assessment now.



Stefanie Hargreaves

December 10, 2019

Medically Reviewed By

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