Sneaky perimenopause symptoms: brain fog, anxiety, aching joints and more

Are you thinking: "Am I losing it?" Forgetting words mid-sentence. Walking into a room and forgetting why. Feeling anxious for no reason at all. Knees and shoulders that ache like you ran a marathon (you didn't). I get it. These are the symptoms almost nobody connects to hormones. Here's what the research says.

Brain fog

If you feel foggier than you used to, you're in good company. In the SWAN study, women in perimenopause didn't improve on repeated memory and processing tests the way they did before and after the transition (Greendale et al., 2009). The good news: their performance bounced back after menopause.

So no, you're not losing your edge. It's often a phase, and there's a lot you can do to feel sharper in the meantime.

Anxiety and panic

This one was mine. Heart racing, palms sweating, panicking on a calm, slow horse on holiday (true story).

Research from SWAN found that women who weren't anxious before the transition were more likely to develop high anxiety during it (Bromberger et al., 2013). If anxiety has crept in out of nowhere in your 40s, hormones are worth looking at.

Aching joints and muscles

Stiff in the morning? Sore shoulders? Aches that weren't there before? Pain in midlife is getting more attention, and the International Menopause Society chose chronic pain in midlife as the theme for World Menopause Day 2026.

Vaginal and bladder changes

This is my specialty, and the symptom group women talk about least. Dryness, discomfort or pain during sex, needing to pee more often, and more urinary tract infections can all be part of genitourinary syndrome of menopause (GSM).

Unlike hot flushes, GSM symptoms usually don't go away on their own and can get worse over time without treatment (The North American Menopause Society, 2020). The good news: they're very treatable.

The bottom line

If something has changed and noone can tell you why, perimenopause deserves a place on the list. Your symptoms are real, and they deserve a proper look.

Next week in Part 3: what you can do about your symptoms, from tracking and doctor prep to the treatments that have evidence behind them.

Sources: Greendale GA et al. (2009), Effects of the menopause transition and hormone use on cognitive performance in midlife women, Neurology. Bromberger JT et al. (2013), Does risk for anxiety increase during the menopausal transition? Study of Women's Health Across the Nation, Menopause. International Menopause Society, World Menopause Day 2026. The North American Menopause Society (2020), The 2020 genitourinary syndrome of menopause position statement, Menopause.