Perimenopause Symptoms Checklist + Questions to Ask Your Clinician

A plain-language checklist of the symptoms most commonly associated with perimenopause, followed by ten questions worth bringing to a clinician appointment. This is an educational tool, not a diagnostic one — having items on this list does not mean you have perimenopause, and having very few does not mean you do not.

This article is educational and is not medical advice. Consult your clinician before starting, stopping, or changing hormone therapy. Individual responses to HRT vary; the right hormones, doses, and delivery methods for you depend on your medical history and clinical context.

Perimenopause is the transition before the final menstrual period, and it commonly runs four to ten years. Symptoms tend to come and go and to shift over time; a list of what is currently happening, taken to a clinician who knows this material, is one of the most useful inputs you can bring to an appointment. The checklist below covers the symptoms most commonly cited in current menopause-society guidance. None of them, individually, is diagnostic. Many of them can have non-hormonal causes that are worth ruling out.

The checklist

Cycle changes

Cycles getting shorter (commonly the earliest sign)
Cycles getting longer or skipped
Heavier bleeding, clots, or longer periods
Spotting between periods
PMS that feels worse than it used to, or starts earlier in the cycle

Vasomotor

Hot flashes
Night sweats
Sudden flushing without an obvious trigger

Sleep

Trouble falling asleep
Waking at 2–4am and struggling to get back to sleep
Sleep that does not feel restorative

Mood and cognition

New or worsening anxiety, particularly in the second half of the cycle
Low mood or tearfulness that does not match the situation
Irritability that surprises you
Word-finding trouble, "brain fog", losing your train of thought

Genitourinary

Vaginal dryness
Painful intercourse
Recurrent urinary tract infections
Urinary urgency or leaking

Body

Weight gain, particularly around the abdomen, without an obvious dietary change
Joint aches that move around
Hair thinning, particularly at the part
Skin getting drier or itchier
Heart palpitations or awareness of your heartbeat
Migraines or headaches changing pattern

Sexual

Reduced libido
Reduced arousal or sensation
Reduced orgasm intensity

Ten questions worth taking to the appointment

Given my symptoms and history, am I in perimenopause?
What are my options — hormonal and non-hormonal — and what are the trade-offs of each for someone with my history?
If I am a candidate for HRT, which delivery method (patch, oral, cream, vaginal) is most appropriate for me, and why?
If I am still cycling, should progesterone be cyclic or continuous?
Are there any labs you would order before starting therapy, and what would change in the plan based on the results?
What are the specific risks for me, given my personal and family history?
How will we measure whether the treatment is working, and on what timeline?
What should I watch for that would mean I should contact you between visits?
How does this interact with anything else I am taking?
If I am not a candidate for systemic HRT, what is the right approach to my symptoms?

What this list is not

This is not a diagnostic instrument and not a substitute for a clinical encounter. Several of the items on the checklist can be caused by conditions other than perimenopause — thyroid disease, iron deficiency, depression, sleep apnea, and others — and a careful clinician will think about those alongside hormonal causes. The point of the list is to help you describe what is happening clearly enough that the conversation with your clinician can be a good one.

Next step

When you are ready to look at clinicians: compare menopause care providers, or read the side-by-side of the four most-asked services.

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