Weird perimenopause symptoms — or something else? A guide to signs and symptoms

Nothing in this article is or should be construed as medical advice; for any medical questions, consult your healthcare professional. 

Swollen, achy joints. Crushing fatigue. Pulling your hair out in the shower. Struggling to remember the name of the coworker you see every day. What is this? If you’re in your late 30s - 50s, and experiencing variability in your menstrual cycle and strange symptoms with no clear cause, it could be perimenopause. 

Perimenopause is the transitional period before menopause, when levels of estrogen in your body begin to decrease. This phase can last a long time — anywhere from 4–8 years. During perimenopause, you may start experiencing menopause-related symptoms like hot flashes or irregular periods.¹ But there are lesser-known (and, let’s be honest, sometimes weird or concerning) symptoms that can come along with perimenopause as well.

Fluctuating estrogen levels during perimenopause can affect your menstrual cycle, joints, energy levels, hair, skin and even your brain. These changes can be alarming and may overlap with symptoms of other conditions that require medical attention; it’s normal to be concerned and want answers.

Let’s go over some of the stranger symptoms of perimenopause, how they may overlap with symptoms of other conditions and how routine hormonal changes can differ from potential red flags. Whether this information puts your mind at ease or helps you recognize it’s time to talk to your healthcare professional, you deserve to make health decisions with the full spectrum of information available to you — rather than worry without knowing. 
 

Common signs and symptoms of perimenopause (that aren’t hot flashes)

During perimenopause, your ovaries gradually produce less estrogen, leading to hormone fluctuations that can affect multiple systems throughout your body.¹ Estrogen receptors exist all throughout your body² — in your brain, joints, skin, hair follicles and more. As estrogen levels rise and fall during this transition, it can trigger a wide range of symptoms — some expected, others surprising.²

Perimenopause fatigue

• What it feels like: Bone-deep exhaustion that doesn’t improve with rest. You sleep eight or more hours but still wake up tired. Afternoon energy crashes can be intense and hard to recover from.
• Why it happens: Fluctuating hormone levels during perimenopause can disrupt sleep by triggering frequent waking³ and night sweats.⁴ When you’re not getting enough deep, restorative sleep, fatigue can build quickly — no matter how many hours you spend in bed. Add in broader hormonal and metabolic shifts happening in your body, and it’s no wonder your energy feels depleted.³
• When it might be something else: Ongoing fatigue can also be associated with thyroid disorders,⁵ iron⁴ and vitamin deficiencies, sleep apnea,³ depression³ or chronic stress — especially if it’s severe, persistent or worsening.
• What to do: Talk to your doctor about checking thyroid function, iron levels and vitamin D to help rule out underlying conditions. Tracking your sleep patterns can help identify night sweats or other disruptions. Addressing sleep quality, nutrition and stress can also help support energy levels.

Perimenopause joint pain

• What it feels like: Generalized aches and stiffness throughout the body, similar to soreness after intense physical activity, even when your routine hasn’t changed. Joints may feel swollen, tender or stiff.⁶
• Why it happens: There are estrogen receptors all throughout your body, including in your joints. When the estrogen that’s protecting your joints begins to decline, it can cause joint pain and aches throughout your body. You may also experience inflammation.⁶
• When it might be something else: Persistent or severe joint pain may also be linked to osteoarthritis, autoimmune or inflammatory conditions (such as rheumatoid arthritis) or past injuries — especially if swelling, redness or limited range of motion is present.⁷
• What to do: Gentle, regular movement like walking, stretching or yoga can help maintain joint mobility.⁷ If joint pain is ongoing or worsening, a healthcare professional may recommend blood tests or imaging to rule out inflammatory or autoimmune causes.⁷ 

Perimenopause hair loss

• What it feels like: More hair than usual collecting in the shower or brush, or a noticeable decrease in hair volume over time. Hair may appear thinner or lose density rather than falling out in patches.
• Why it happens: Estrogen supports hair growth, fullness and density. When estrogen levels decline, hair may shed more easily or grow more slowly, resulting in thinning or increased hair loss.⁶
• What else it could be: Hair thinning and shedding can also be caused by a variety of factors like pregnancy, thyroid conditions, taking certain medications or supplements, stress or even using harsh hairstyling techniques.⁸
• What to do: A healthcare professional can check for nutritional deficiencies and thyroid function if hair loss feels excessive or sudden. Supporting hair health through balanced nutrition and minimizing harsh styling practices may also help.

Perimenopause brain fog

• What it feels like: Momentary lapses in memory: forgetting why you walked into a room, mixing up names or dates, or feeling mentally slower than usual.​​⁹
• Why it happens: Estrogen plays a role in cognitive function, including memory, focus and verbal recall. Fluctuating estrogen levels during perimenopause can temporarily affect these processes, leading to brain fog. ​​⁹
• What else it could be: If cognitive changes are severe, progressive or accompanied by personality changes or difficulty performing daily tasks, they may be related to neurological conditions or significant mental health concerns rather than hormonal shifts.​​⁹
• What to do: Getting high-quality sleep, eating a diet of brain-enhancing foods (anything rich in antioxidants) and making time for regular physical activity can help improve cognitive clarity.​​⁹ If brain fog is worsening, persistent or interfering with daily life, talk to your healthcare professional about further evaluation. 

Other common perimenopause symptoms

• Menstrual irregularities: Heavier, lighter, longer, shorter or skipped periods are all common during this transition.¹⁰
• Sleep disturbances: Insomnia, night sweats¹¹ or frequent waking.
• Mood changes: Anxiety, irritability or depression¹¹ — often more intense than typical PMS.
• Skin changes: Dryness, itching, thinning or unusual sensations such as tingling or crawling.¹¹
• Weight changes: Weight gain, especially around the midsection, even without changes to diet or activity.¹
• Heart palpitations: A racing or irregular heartbeat, which is often benign but worth discussing with a healthcare professional.⁶
• Changes in libido: Decreased sexual desire is common.⁶

When to see your healthcare professional

You may want to schedule an appointment with your doctor if you’re experiencing symptoms and:

• You’re in your 40s (or late 30s) and experiencing multiple changes or odd symptoms at once.
• Your periods have become irregular — anything out of the norm for your typical cycle.
• Your quality of life is affected.
• You’ve already had basic tests done (such as thyroid function or routine blood work) but still don’t have clear answers.

When you meet with your healthcare professional, don’t hesitate to ask whether your symptoms could be related to perimenopause. Your doctor can help rule out other underlying conditions before attributing symptoms solely to perimenopause. It can be helpful to document what you’re experiencing — including symptom frequency, severity and timing — to identify patterns and have data to share with your doctor to support informed decisions about testing or treatment.

If your concerns are dismissed as “just stress” or “normal aging” without proper evaluation, it’s appropriate to advocate for yourself, ask follow-up questions or seek a second opinion. Your symptoms are real and deserve careful consideration.

Remember: You deserve answers about unusual perimenopause symptoms

Perimenopause is a full-body transition, and the changes you’re experiencing are very real — the weird symptoms aren’t just in your head. If you notice any of the symptoms discussed above, perimenopause could be part of the picture. At the same time, the point isn’t to shrug these symptoms off as “just perimenopause.” Thyroid disorders, vitamin deficiencies and autoimmune conditions can coexist with perimenopause or produce similar symptoms.

The goal isn’t to diagnose yourself — it’s to advocate for comprehensive care. Track your symptoms. Ask questions. Request testing when something feels off. A supportive healthcare professional will take your concerns seriously and help you rule out underlying conditions. Whether your symptoms are related to perimenopause or something else, getting clear answers can open the door to appropriate treatment and relief.

Related Articles

• What to expect in perimenopause
• 6 surprising myths and facts about perimenopause and fertility 
• Menopause is more than just hot flashes (Yes – there’s more!)