The in-medium pion properties, i.e. the temporal pion decay constant f t , the pion mass m * π and the wave function renormalization, in symmetric nuclear matter are calculated in an in-medium chiral perturbation theory up to the next-to-leading order of the density expansion O(k 4 F ). The chiral Lagrangian for the pion-nucleon interaction is determined in vacuum, and the low energy constants are fixed by the experimental observables. We carefully define the in-medium state of pion and find that the pion wave function renormalization plays an essential role for the in-medium pion properties. We show that the linear density correction is dominant and the next-to-leading corrections are not so large at the saturation density, while their contributions can be significant in higher densities. The main contribution of the next-to-leading order comes from the double scattering term. We also discuss whether the low energy theorems, the Gell-Mann-Oakes-Renner relation and the Glashow-Weinberg relation, are satisfied in nuclear medium beyond the linear density approximation. We also find that the wave function renormalization is enhanced as largely as 50% at the saturation density including the next-to-leading contribution and the wave function renormalization could be measured in the in-medium π 0 → γγ decay.