Lower estrogen levels during perimenopause can cause many symptoms, including:

• Irregular periods
• Hot flashes and night sweats
• Trouble sleeping and feeling tired
• Mood changes
• Problems with memory and focus
• Breast tenderness and vaginal dryness, which can make sex painful
• Less interest in sex
• Urinary problems (see Urinary Incontinence)

These symptoms are often strongest during perimenopause. Many women feel better after menopause, but some symptoms, such as hot flashes, may continue.

Last Updated May 2026