Perimenopause Symptoms: First Signs, an Evidence-Ranked Checklist, and the Odd Ones

Quick answer: The first sign is usually a change in your cycle length — a persistent difference of 7 days or more between consecutive cycles. The most common symptom is something else: hot flashes and night sweats. Those are two different questions with two different answers, which is why the lists disagree with each other. And no clinical body defines a fixed number of perimenopause symptoms — the famous "34" comes from a patient mailing list, not a guideline.

Symptom lists for perimenopause tend to compete on length: 25 signs, 34 signs, 48 signs. The problem is that a list of 48 can't tell you much, because half the entries are also true of being forty. What follows is shorter and sorted differently — by how much each sign actually tells you, with a source named for each. If you want the definition and staging behind all of it first, start with what perimenopause is.

The first sign isn't always the most common one

Almost every article on this subject answers one of these questions while appearing to answer the other. They are both answerable, separately.

The usual first sign is your periods. The NHS states it in one line: "One of the first signs of perimenopause is usually a change to your periods. They may happen more often or less often, and bleeding may get heavier or lighter" (NHS). The National Institute on Aging lists "changes in your period" first and adds that "this might be what you notice first" (NIA).

The most commonly reported symptom is vasomotor. The Menopause Society is equally direct: "Hot flashes and night sweats, clinically known as vasomotor symptoms, are the most commonly reported symptoms of the menopause transition" (The Menopause Society). On its symptoms page it puts the same point as "Hot flashes are often the most recognized and reported bothersome symptom" (The Menopause Society).

Both are true. The first one is about sequence; the second is about prevalence. A symptom can be the one most women eventually get and still not be the one most women get first.

Clinical practice uses both at once. NICE's rule for identifying perimenopause in otherwise healthy women aged 45 or over, without laboratory tests, is to look for "vasomotor symptoms that have recently started and any changes in their menstrual cycle" (NICE NG23, recommendation 1.3.1). Neither element alone is the rule; the pair is.

The sequence also isn't fixed. In SWAN, group-based modelling of 1,455 women with non-surgical menopause and a median 15.4 years of follow-up found four distinct vasomotor trajectories, not one. The largest early group — 18.4% of the sample — began having hot flashes roughly 11 years before their final menstrual period, then declined after menopause. Another 29.0% began near the final period, 25.6% had persistently high frequency, and 27.0% persistently low (Tepper et al., 2016). So for close to one woman in five, vasomotor symptoms did arrive first, and arrived very early.

And one answer rarely given at all: for some women the list is almost empty. The Menopause Society notes that "many women who undergo natural menopause report no physical changes at all during the perimenopause years except for irregular menstrual periods" (The Menopause Society).

Where "7 signs" and "34 symptoms" come from

No clinical body defines a fixed number of perimenopause symptoms. Every numbered list in circulation is editorial, not clinical — and both halves of that claim can be checked.

What the guidelines actually do is group. NICE recommendation 1.2.2 says symptoms "may vary from minor to severe", and that "as well as changes in menstrual cycle, symptoms may include" five groups: vasomotor, genitourinary, effects on mood, musculoskeletal, and sexual difficulties (NICE NG23). The NHS symptoms page uses seven headings — periods, hot flushes and night sweats, sleep, mood and memory, weight gain, vaginal problems, UTIs — and then a further list of nine "other symptoms" (NHS). The Merck Manual's professional edition doesn't count either; it has a short "Other symptoms" paragraph for the less common ones (Merck Manual). Five and seven are editorial headings chosen by two different bodies, not a tally of symptoms — and nothing stops a single heading like "mood changes, poor memory and brain fog" being counted as three entries somewhere else.

The "34" has a specific and documented origin. The Power Surge website, which did most to popularise it, says so itself: "There's been a list of the '34 signs of menopause' circulating for years. The list originated with Judy Bayliss' wonderful newsgroup, The Menopaus Listserv (That's Menopaus without the 'e' at the end). I've taken the liberty of adding my own Notes to the original list" (Power Surge, archived 18 August 2006). By early 2005 the same 34 items had their own commercial domain, alphabetised and monetised (34-menopause-symptoms.com, archived 29 January 2005). Neither page cites a source for the number.

Heather Corinna makes the same observation about where the authority appears to come from, describing "a list of the apparent and terrifying thirty-four 'symptoms' of menopause, most often credited to uncited and unnamed 'experts'" (What Fresh Hell Is This?, 2021).

The count itself is unstable, which is the clearest evidence that nobody is counting anything. Checked against Google Autocomplete on 6 October 2026, "34 symptoms of perimenopause", "37 symptoms of perimenopause" and "48 symptoms of perimenopause" are all echoed back as searched phrases, and "37 signs of perimenopause" with them. "27 symptoms of perimenopause" is the exception: Google returns no suggestion containing that phrase and instead reads the 27 as an age — "symptoms of perimenopause at 27", "can you be perimenopausal at 27". So three different totals circulate for the same underlying list. None of "27 symptoms", "34 symptoms" or "37 symptoms" appears in any PubMed title or abstract alongside menopause, with a single exception.

That exception is the one piece of peer-reviewed work on the list, and it studied the method rather than the symptoms. In a study of 257 British Pakistani women aged 39 to 61 in West Yorkshire, participants were asked both to describe menopause-associated changes in their own words and to say whether they associated each of the 34 symptoms on a standard checklist with menopause. The findings: "Women reported a wide range of symptoms, most of which are not on symptom checklists", and "women's beliefs about which experiences were attributable to menopause did not correspond to those of the checklist developers". The conclusion was blunt — "Symptom checklists have serious limitations as a tool for understanding symptom experience, and prior justifications for their use leave much to be desired" (Blell, 2015). The full text is paywalled, so we cannot confirm which instrument supplied those 34 items or whether it is the listserv list.

The caveat matters as much as the origin: a list born on a mailing list is not automatically wrong. Most of its 34 items do appear, in some form, on guideline or government pages — and a handful do not (see the odd ones below). What a listserv list cannot do is tell you how strong the evidence is for any individual entry, which is the only thing that makes a checklist useful.

The one sign that actually defines perimenopause

Perimenopause is defined by what your cycles are doing, not by how you feel. Under the Stages of Reproductive Aging Workshop +10 criteria — STRAW+10, the reference framework specialists use for staging reproductive aging — the early menopausal transition "is marked by increased variability in menstrual cycle length, defined as a persistent difference of 7 days or more in the length of consecutive cycles" (Harlow et al., 2012).

That is the whole threshold. A 27-day cycle followed by a 35-day one clears it. "Persistent" has its own definition in the same paper — "recurrence within 10 cycles of the first variable length cycle" — so one unusual month doesn't count.

A second threshold comes later: the late menopausal transition "is marked by the occurrence of amenorrhea of 60 days or longer" (Harlow et al., 2012).

These two numbers are the only entries on this page with a formal diagnostic criterion attached, which is why the checklist below is ordered the way it is. Everything else commonly accompanies the transition; only the cycle change is the transition. STRAW+10 also sets the boundaries — perimenopause begins at that first stage and ends "12 months after the FMP," the final menstrual period, so the whole first year after your last period is still inside it. Most women begin the transition between ages 45 and 55, though the window is wider at both ends.

The perimenopause symptom checklist

The checklist is split into three tiers by how strong the evidence linking each symptom to the transition actually is. Tier one can stage you; tier two is well documented in the transition specifically; tier three is commonly reported alongside it without being established as caused by it.

Tier 1 — Defining: the signs with a clinical threshold

These two rows are the two cycle thresholds that separate early from late perimenopause. Nothing in the tiers below carries a threshold of its own.

Tier 2 — Directly attributable and well documented

Tier 3 — Commonly reported, but association rather than established cause

Everything here is genuinely common in midlife. What is not established is that the transition causes it: these changes also track with age, with accumulated sleep debt, and with the life circumstances that cluster in a person's forties and fifties, and untangling those is genuinely hard. The NIA says as much, introducing its own symptom list with the caveat that "some may be part of aging rather than being directly related to menopause" (NIA).

That last row is the one most often explained badly elsewhere; what body composition scans actually show is more interesting than the usual version.

One reassurance deserves pulling out, because the fear attached is disproportionate: in a four-year study of 2,362 women across all seven SWAN sites, the dip in processing speed and verbal memory recovered afterwards, and the authors concluded that "menopause transition–related cognitive difficulties may be time-limited" (Greendale et al., 2009).

Cycle changes: what's normal and what isn't

Cycles typically shorten before they lengthen, then become erratic and start skipping — STRAW+10 describes the stage just before the transition as "subtle changes in menstrual cycle characteristics, specifically shorter cycles" (Harlow et al., 2012), and the Office on Women's Health puts the range of normal plainly: periods "may be longer or shorter than usual," you might "skip a few months," and flow "may be heavier or lighter than before" (OWH). Because skipping is not the same as being infertile — ovulation becomes unpredictable rather than finished — the NIA advises continuing birth control for a full 12 months after your last period if you don't want to conceive (NIA). The month-by-month detail, the expected patterns and the full normal-versus-check comparison are on our guide to what perimenopausal periods typically look like, and which changes need checking.

Period pain itself is a separate question from cycle timing, and the herbs commonly recommended for it have a thinner trial record than most articles suggest — see herbal teas for period cramps.

The bleeding patterns that need a doctor, not a symptom list

Irregular periods are expected here. These specific patterns are not, and the NIA lists each as a reason to see a doctor (NIA):

• Your periods happen very close together
• You have heavy bleeding
• You have bleeding or spotting after sex or between periods
• Your periods last more than a week
• You start bleeding or spotting again after not having a period for more than a year

The NHS adds a sixth to that list for anyone still having periods: contact a GP if "your bleeding pattern has changed and you're bleeding more, not less, than before" (NHS).

This is its own section rather than a footnote because perimenopause supplies a ready-made explanation for almost any bleeding change, and that explanation can absorb a symptom that needed investigating. Cleveland Clinic lists infections, fibroids, polyps, clotting disorders and cancer among the causes of abnormal bleeding a provider would check for (Cleveland Clinic) — none of which is diagnosed by waiting.

Hot flashes and night sweats

Vasomotor symptoms are the most common menopausal symptom, occurring "in up to 80% of menopausal women" according to the 2023 nonhormone therapy position statement from The Menopause Society (Menopause Society, 2023).

The NIA describes an episode concretely: "a sudden feeling of heat, most often in the upper body and face," with the face and neck flushing, red blotches sometimes appearing on the chest, back and arms, and "heavy sweating and cold shivering" able to follow. Most last between 30 seconds and 10 minutes, arriving several times an hour, a few times a day, or once or twice a week (NIA). Night sweats are the same event while you're asleep.

The honest gap here is mechanism: the NIA states that "it isn't clear why hot flashes are so common during the menopausal transition," while noting they are likely related to changing hormone levels (NIA). The most common symptom of the transition is one whose cause is still not settled.

Duration is where expectations tend to be set too low. In SWAN — the Study of Women's Health Across the Nation — 1,449 women with frequent hot flashes and night sweats had a median total duration of 7.4 years, and among the 881 with an observable final period, symptoms persisted a median of 4.5 years past it. For women whose symptoms began while they were still premenopausal or in early perimenopause, median total duration was more than 11.8 years — onset timing was "the best single predictor" of how long they lasted (Avis et al., 2015). If your symptoms have just started and your cycles are only beginning to shift, you are in that longest-duration group, which is an argument for treating them rather than waiting them out. Both threads have their own guides: how long perimenopause and its symptoms last, and what can actually be done about them.

Severity is not distributed evenly, either. The NHS notes that "sometimes, ethnic background can affect symptoms of perimenopause and menopause, how severe they are and how long they last," giving the example that "women from a Black ethnic background are more likely to have hot flushes that are severe and continue longer" (NHS). SWAN's trajectory analysis points the same way: Black women were over-represented in both the late-onset and the persistently high vasomotor groups relative to white women (Tepper et al., 2016).

Mood, anxiety and depression

This usually gets one bullet reading "mood swings," which conveys nothing about scale. There are actual numbers, from two longitudinal cohorts published in 2006.

Freeman and colleagues followed premenopausal women with no history of depression for eight years. High scores on the CES-D depression scale "were more than 4 times more likely to occur during a woman's menopausal transition compared with when she was premenopausal (odds ratio, 4.29; 95% confidence interval, 2.39-7.72; P<.001)." A diagnosed depressive disorder was about two and a half times more likely (odds ratio 2.50) (Freeman et al., 2006).

Cohen and colleagues followed 460 women aged 36 to 45 with no lifetime diagnosis of major depression. Those who entered perimenopause "were twice as likely to develop significant depressive symptoms as women who remained premenopausal," after adjustment for age at enrollment and history of negative life events, and the increased risk "was somewhat greater in women with self-reported vasomotor symptoms" (Cohen et al., 2006).

Two notes on precision. Finer adjusted odds ratios from both papers circulate in secondary summaries — a 1.8-fold risk figure for Cohen, plus specific figures for vasomotor symptoms and life events. We could not confirm those against the full papers, which are paywalled, so only what the published abstracts state appears above. Both are also observational cohorts: they show risk elevated across a population, not that perimenopause causes depression in any individual. The NIA is blunt that the mechanism isn't settled — "scientists don't know why this happens," it says of mood changes, listing stress, caring for children and ageing parents, and existing depression among possible contributors (NIA). The Menopause Society frames the leading hypothesis as a "window of vulnerability" in which some women are more sensitive to perimenopausal hormone shifts, and notes that those at greatest risk are women with a history of depressed mood earlier in life (The Menopause Society).

Said plainly: low mood in perimenopause is treatable, and it is not something to wait out. The NIA's advice on mood changes is to talk to a primary care provider or a mental health professional, because "there are treatments available to help" (NIA). Persistent low mood is a reason to make an appointment, not a phase to sit through until your cycles stop.

Sleep

Two different sleep problems get filed under one heading, and they don't have the same answer. The first is sleep broken by something — a night sweat, or needing to urinate. The second is sleep that is difficult independently: not falling asleep easily, waking too early, then not getting back to sleep. The NIA describes both, including that if you wake during the night "you might have trouble going back to sleep" (NIA), and the OWH notes that many women in perimenopause and menopause find it hard to sleep through the night (OWH).

The distinction matters: treating night sweats and treating insomnia are different interventions, and sleep debt feeds back into most of tier three — concentration, mood, aching joints. Working out which one you have comes first.

Less expected symptoms: which are documented

The unexpected symptoms are the ones that send people searching, and they divide cleanly into two groups: those a guideline, government body or professional society actually names, and those that only ever appear on consumer lists. Here is the first group, with the source for each.

One of those rows carries a safety instruction, so it is worth repeating outside the table. The NHS lists palpitations both as a symptom and as a reason to be seen: contact a GP "if you have symptoms like a fast heartbeat (palpitations)" (NHS). A racing heart is a documented perimenopausal symptom and something a clinician should hear about. Both at once.

Brain fog is the row most worth a sentence of reassurance, because the fear attached to it is usually about dementia. The Menopause Society addresses that head-on: midlife women "should be advised that brain fog during perimenopause is very common, changes in cognitive performance are typically mild and within the limits of normal, and dementia at midlife is very rare" (The Menopause Society). Mayo Clinic Press puts a number on the exception: "only around 12% of women in perimenopause have cognitive impairment that's clinically significant" (Mayo Clinic Press).

Now the second group — and this is where the famous lists stop being checkable. Two items are the clearest test case, because they appear on both archived versions of the list: electric shock sensation and itchy, crawly skin are entries 13 and 26 on the 2005 commercial version, and both carry over from the listserv original. We searched for them across the thirteen authoritative sources read in full for this page: the NHS symptoms page; four Menopause Society patient pages (perimenopause, symptoms, mental health, hot flashes); the Menopause Society's 2022 hormone therapy position statement; NICE NG23's recommendations; the Merck Manual's menopause chapter; the Mayo Clinic Press article above; the AAD's menopause skin page; the NIA's What Is Menopause?; and both Office on Women's Health menopause pages. The strings "electric", "crawl", "formication" and "tingl" return zero matches in all thirteen. That is not proof the sensations aren't real or aren't reported; it means no authoritative source we read describes them, so nothing here presents them as established.

Mayo Clinic Press ends its own lesser-known-symptoms article with the warning that belongs at the end of any list like this: "Take new symptoms seriously, and don't chalk everything up to hormones or natural aging... other serious conditions can cause some of the same signs and symptoms — mouth pain, vision changes, bruising or joint pain, for example. It's important to rule out other causes of new signs and symptoms, particularly if they come on suddenly or are particularly severe" (Mayo Clinic Press).

Skin changes (and the "low estrogen face")

"Low estrogen face" is not a clinical term. The phrase does not appear on any of the thirteen authoritative sources read for this page, and PubMed holds no record of it: a Title/Abstract search for the exact phrase returns zero results, and PubMed's own response flags the phrase as one it cannot find in its index at all — the same for the British spelling "low oestrogen face". It is a search term and a marketing term. The underlying changes, though, are real and documented.

What the dermatology guidance actually describes, as distinct from the phrase:

• It gets thinner and bruises more easily. The AAD: "As estrogen levels fall, skin becomes thinner. Thin skin bruises more easily" (AAD).
• It gets drier. "In menopause, skin loses some ability to hold water, so skin can get quite dry" (AAD).
• Collagen declines, and firmness goes with it — jowls, permanent nasolabial lines, larger pores, wrinkles that used to need a smile (AAD).

The collagen number everyone quotes deserves a closer look, because it is not a primary measurement. The AAD states: "Studies show that women's skin loses about 30% of its collagen during the first five years of menopause. After that, the decline is more gradual. Women lose about 2% of their collagen every year for the next 20 years" (AAD). That figure should be attributed to the AAD, and to the review behind it, rather than to a trial.

Tracing it back: the 2013 narrative review Estrogens and aging skin states that "Type I and III skin collagen is thought to decrease by as much as 30% in the first five years after menopause", citing two 1980s papers (Thornton, 2013). "As much as" is a ceiling; "about" — the AAD's word — is a central estimate. Those are different claims. Neither of the two cited abstracts contains a 30% figure — one compared treated against untreated postmenopausal women, the other took single biopsies from 32 women aged 28 to 68 (Brincat et al., 1985; Affinito et al., 1999). Neither followed anyone through a five-year window, which is the window the figure describes. Both full texts are paywalled, so we cannot confirm where in them the number sits.

The primary measurement that is readable points lower. A 1987 study of postmenopausal women found skin collagen content, skin thickness, metacarpal index and forearm bone mineral content all "showed a similar decline of between 1-2% per year after the menopause" (Brincat et al., 1987). The two figures don't reconcile arithmetically: a 30% total loss spread over five years is about 6.9% a year compounded, whereas 2% a year compounded over five years comes to roughly 9.6% in total, not 30%. Both cannot describe the same quantity over the same window.

Does hormone therapy help skin? The sources disagree, and the disagreement is about what was measured.

• The Menopause Society's 2022 position statement says estrogen therapy "appears to have beneficial effects on skin thickness and elasticity and collagen when given at menopause", graded Level II — which that document defines as "based on limited or inconsistent scientific evidence". Its sole citation for the skin effect is the same 2013 narrative review (The Menopause Society, 2022).
• The randomised evidence on appearance found nothing. In the skin sub-study of KEEPS — women aged 42 to 58 within 36 months of their last period, randomised to oral conjugated equine estrogens, transdermal estradiol with micronized progesterone, or placebo for four years — "neither total wrinkle score nor total rigidity score was significantly different at baseline or over the 4-year follow-up". The authors' conclusion: "HT does not appear to affect skin wrinkles or rigidity at most facial locations", and "race is the strongest predictor of the advancement of skin aging in the 4 years following menopause" (Owen et al., 2016).
• The US regulator is blunter still. Asked "Do hormones protect against aging and wrinkles...?", the FDA answers: "Studies have not shown that hormone therapy prevents aging and wrinkles" (FDA Office of Women's Health).

These are reconcilable, but only if you keep the endpoints apart: thickness, elasticity and collagen content are not the same outcomes as wrinkles and rigidity, and a Level II grade is a statement about weak evidence, not strong benefit. What none of them supports is treating skin as a reason to start hormone therapy — and skin is not among the things it is approved for. The current US label for oral conjugated estrogens lists six indications: moderate-to-severe vasomotor symptoms, moderate-to-severe vulvar and vaginal atrophy, hypoestrogenism due to hypogonadism or castration or primary ovarian failure, palliative treatment of metastatic breast cancer, palliative treatment of advanced prostate cancer, and prevention of postmenopausal osteoporosis. The words "wrinkle", "collagen", "cosmetic" and "photoaging" appear nowhere in that label (prescribing information via DailyMed, label effective 4 June 2026). For what hormone therapy is recommended for in this window, see what the current guidance actually recommends for perimenopausal symptoms.

On creams, one regulatory fact is worth knowing. Estriol comes up often enough in this context that the FDA's menopause Q&A answers it as a standing question — "Is the hormone estriol a 'safer form of estrogen'?" The answer: "There are no FDA-approved drugs containing estriol. Marketed drugs that contain estriol are compounded drugs, which are not FDA-approved," and that it "does not have evidence that drugs containing estriol are safe and effective, or are 'safer forms of estrogen'" (FDA Office of Women's Health). We recommend no products here.

What the AAD does recommend is unglamorous and cheap: a broad-spectrum sunscreen of SPF 30 or higher applied daily, to the face, hands, neck and anything clothing won't cover, even in winter; a product containing retinol or peptides, which "can increase collagen in your skin"; a mild cleanser rather than soap; and moisturiser after bathing, with hyaluronic acid or glycerin if dryness is the main problem (AAD). The same page adds the one piece of advice with real stakes attached: see a dermatologist about any age spot or dark patch before treating it, because skin cancer can look like one.

What these symptoms are not

A symptom list is a poor diagnostic instrument, and this one is no exception. Thyroid disease is the clearest example — the Office on Women's Health states plainly that "sometimes, symptoms of thyroid problems are mistaken for menopause symptoms" (OWH) — but pregnancy, anaemia, sleep apnoea, depression and several uterine conditions all produce overlapping symptoms too, and each is separated from perimenopause by a specific test rather than by a longer list. We set out the conditions that can look like perimenopause side by side, with what distinguishes each one.

This is also where the temptation to order a blood test appears, and the answer is usually no. Cleveland Clinic states that "hormone testing isn't necessary to diagnose perimenopause"; a provider may instead reach the conclusion "based on a physical exam and your symptoms, age and medical history" (Cleveland Clinic). The reason is structural: STRAW+10 characterises follicle-stimulating hormone in the early transition as "elevated but variable" (Harlow et al., 2012), so a single draw samples one moment of a process whose defining feature is that it won't hold still. Whether a perimenopause test is worth taking has its own answer, including the exceptions.

So the useful thing to bring to an appointment isn't a longer symptom list. It's cycle lengths — first day of bleeding to first day of the next, tracked over a year — plus which tier-two symptoms you have, and for how long.

Common questions about perimenopause symptoms (FAQ)

What are the first signs of perimenopause? Usually a change in your periods. The NHS puts it plainly: "One of the first signs of perimenopause is usually a change to your periods" (NHS), and the clinical threshold for the early menopausal transition is a persistent difference of 7 days or more between the lengths of consecutive cycles (Harlow et al., 2012). Some bleeding changes are not expected at any stage, though. Heavy bleeding, bleeding between periods or after sex, periods lasting more than a week, and any bleeding after 12 months without one are all reasons to see a doctor rather than consult a symptom list (NIA).

What is the most common first symptom of perimenopause? "First" and "most common" have different answers, which is why the two get confused. The NHS names a change in periods as the usual first sign (NHS); The Menopause Society calls hot flashes and night sweats "the most commonly reported symptoms of the menopause transition" (The Menopause Society). NICE's rule for identifying perimenopause without a blood test in women aged 45 or over requires both at once — recently started vasomotor symptoms and any change in the menstrual cycle (NICE NG23, 1.3.1). In SWAN, 18.4% of women did have hot flashes first, starting about 11 years before their final period (Tepper et al., 2016).

Are there really 34 symptoms of perimenopause? No clinical body defines a fixed number of perimenopause symptoms. The "34" is traceable to a patient mailing list rather than a guideline: the website that popularised it states that "the list originated with Judy Bayliss' wonderful newsgroup, The Menopaus Listserv" (Power Surge, archived 2006). The total isn't even stable — 37- and 48-item versions circulate too — and NICE names five symptom groups alongside changes in the menstrual cycle (NICE NG23, 1.2.2), while the NHS uses seven headings plus nine "other symptoms" (NHS). Most items on the 34 do appear somewhere authoritative — but a list can't tell you how strong the evidence is for any one of them, and a peer-reviewed critique of the 34-item checklist method concluded that such checklists "have serious limitations as a tool for understanding symptom experience" (Blell, 2015).

What does low estrogen do to your face? Skin becomes thinner, drier and less elastic, and collagen declines (AAD) — but "low estrogen face" is not a clinical term, and it appears on none of the authoritative sources read for this page nor anywhere in PubMed's phrase index. The AAD's advice is broad-spectrum SPF 30 or higher daily, a retinol or peptide product, a mild cleanser and a moisturiser. Hormone therapy is not a skin treatment: wrinkle and rigidity scores did not differ from placebo over four years in the KEEPS trial (Owen et al., 2016), and the FDA states that "studies have not shown that hormone therapy prevents aging and wrinkles" (FDA). Creams sold for this often contain estriol, and there are no FDA-approved drugs containing estriol (FDA).

Do perimenopause symptoms come and go? Yes, and the hormone pattern underneath is the reason. STRAW+10 describes follicle-stimulating hormone in the early transition as "elevated but variable," and in the late transition as sometimes elevated into the menopausal range and sometimes back within the earlier reproductive range (Harlow et al., 2012). That erratic pattern, rather than a steady decline, is why symptoms fluctuate.

Medical disclaimer: This article is for informational purposes only. Always consult a qualified healthcare provider before making changes to your health routine.

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17. Cleveland Clinic. Perimenopause — Health system disease reference. https://my.clevelandclinic.org/health/diseases/21608-perimenopause
18. Freeman EW, Sammel MD, Lin H, Nelson DB. Associations of hormones and menopausal status with depressed mood in women with no history of depression. Archives of General Psychiatry, 2006;63(4):375–382 — Peer-reviewed journal article via PubMed. https://pubmed.ncbi.nlm.nih.gov/16585466/
19. Cohen LS, Soares CN, Vitonis AF, Otto MW, Harlow BL. Risk for new onset of depression during the menopausal transition: the Harvard study of moods and cycles. Archives of General Psychiatry, 2006;63(4):385–390 — Peer-reviewed journal article via PubMed. https://pubmed.ncbi.nlm.nih.gov/16585467/
20. Greendale GA, Huang M-H, Wight RG, et al. Effects of the menopause transition and hormone use on cognitive performance in midlife women. Neurology, 2009;72(21):1850–1857 (SWAN) — Peer-reviewed journal article via PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC2690984/
21. Carpenter JS, Cortés YI, Tisdale JE, et al. Palpitations across the menopause transition in SWAN: trajectories, characteristics, and associations with subclinical cardiovascular disease. Menopause, 2023;30(1):18–27 — Peer-reviewed journal article via PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC9797427/
22. Brincat M, Kabalan S, Studd JW, Moniz CF, de Trafford J, Montgomery J. A study of the decrease of skin collagen content, skin thickness, and bone mass in the postmenopausal woman. Obstetrics and Gynecology, 1987;70(6):840–845 — Peer-reviewed journal article via PubMed. https://pubmed.ncbi.nlm.nih.gov/3120067/
23. Thornton MJ. Estrogens and aging skin. Dermato-Endocrinology, 2013;5(2):264–270 — Peer-reviewed narrative review via PMC; the source of the "as much as 30% in the first five years" figure. https://pmc.ncbi.nlm.nih.gov/articles/PMC3772914/
24. Owen CM, Pal L, Mumford SL, et al. Effects of hormones on skin wrinkles and rigidity vary by race/ethnicity: four-year follow-up from the ancillary skin study of the Kronos Early Estrogen Prevention Study. Fertility and Sterility, 2016;106(5):1170–1175.e3 (KEEPS, NCT00154180) — Randomised controlled trial via PubMed. https://pubmed.ncbi.nlm.nih.gov/27393520/
25. Blell MT. Menopausal symptoms among British Pakistani women: a critique of the standard checklist approach. Menopause, 2015;22(1):79–87 — Peer-reviewed journal article via PubMed; abstract only, full text paywalled. https://pubmed.ncbi.nlm.nih.gov/24824643/
26. US Food and Drug Administration, Office of Women's Health. Menopause & Hormones: Common Questions, 2019 — Government consumer fact sheet (PDF). https://www.fda.gov/media/130242/download
27. Brincat M, Moniz CJ, Studd JW, Darby A, Magos A, Emburey G, Versi E. Long-term effects of the menopause and sex hormones on skin thickness. British Journal of Obstetrics and Gynaecology, 1985;92(3):256–259 — Peer-reviewed journal article via PubMed; abstract only, full text paywalled. One of the two papers cited for the 30% figure. https://pubmed.ncbi.nlm.nih.gov/3978054/
28. Affinito P, Palomba S, Sorrentino C, Di Carlo C, Bifulco G, Arienzo MP, et al. Effects of postmenopausal hypoestrogenism on skin collagen. Maturitas, 1999;33(3):239–247 — Peer-reviewed journal article via PubMed; abstract only, full text paywalled. The second paper cited for the 30% figure. https://pubmed.ncbi.nlm.nih.gov/10656502/
29. US Food and Drug Administration. PREMARIN (conjugated estrogens) tablets — prescribing information, label effective 4 June 2026; accessed via DailyMed and the openFDA drug-label API. Cited for the approved indications. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=258e1602-a3cf-4ccc-ca80-73dbbfb812ff
30. Power Surge. 34 Signs / Symptoms of Menopause — Consumer website, cited only as evidence of the list's origin; Internet Archive capture of 18 August 2006. https://web.archive.org/web/20060818200853/http://www.power-surge.com/educate/34symptoms.htm
31. 34-menopause-symptoms.com. 34 Menopause Symptoms — Commercial website, cited only as evidence of the list's early circulation; Internet Archive capture of 29 January 2005. https://web.archive.org/web/20050129065531/http://34-menopause-symptoms.com:80/

Sources 1–2, 7–10, 15, 17–21 accessed 2 August 2026; all others accessed and re-verified 6 October 2026.

Claire Whitfield

Women's Health Specialist

A women's health specialist more interested in which symptoms are actually attributable than in how many of them she can list.

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