What are the first signs of perimenopause?
Usually a change to your periods. They may come more or less often, heavier or lighter. 45 or over, with new hot flushes and changing periods? NICE says you usually won’t need a blood test.
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What are the first signs of perimenopause?
Usually a change to your periods, the NHS says. They may come more often or less often, and bleeding may get heavier or lighter. In the end they stop.
The other symptoms sit around that. Symptoms can have a big impact on daily life, or hardly any.
Women from a Black ethnic background are more likely to have severe hot flushes that last longer. Pre-menopause is a word often used for this same time.
| Where | What you may notice |
|---|---|
| Periods | Coming more or less often. Heavier or lighter bleeding. |
| Temperature | Hot flushes: your face, neck and chest suddenly feel very hot or cold, often with sweating. At night these are night sweats. |
| Sleep | Trouble getting to sleep or staying asleep. |
| Mood and memory | Mood swings, low mood or depression. Poor memory or concentration (brain fog). |
| Body | Weight gain around the stomach and upper body. Muscle aches, joint pains, worse headaches or migraines. |
| Vagina and bladder | Dryness, burning, irritation or itching. Painful sex. More urine infections (UTIs), or pain or burning when you pee. Needing to pee more, including at night, or leaking. |
| Skin, hair and mouth | Dry, itchy skin. Thinning hair or hair loss. Sensitive teeth or painful gums. |
| Other | Palpitations: a faster, slower or more noticeable heartbeat. Weaker bones. Lower sex drive. |
Seen a list of 34 or 100 symptoms? Those numbers aren’t from the NHS. Its list is the one above.
A doctor may diagnose it from your age and symptoms. So note which ones you have and when they started. The NHS links to a free symptoms tracker on the Rock My Menopause website.
What age does perimenopause start, and how long does it last?
There’s no set age. Perimenopause is the time before menopause, when your periods become irregular. The NHS says menopause usually happens between 45 and 55, but it can happen earlier.
NICE says people from some ethnic minority backgrounds, and people with some lifelong conditions, may reach menopause younger. Menopause between 40 and 44 is called early menopause. Before 40, doctors call it premature ovarian insufficiency.
Symptoms usually last 7 to 9 years, sometimes longer
- 1
Perimenopause
Periods become irregular. Symptoms may start.
- 2
Menopause
No period for 12 months, if you’re not on hormonal contraception.
- 3
Post menopause
Some symptoms, like joint pain and vaginal dryness, can carry on.
Sources: NHS: symptoms; NHS: what are menopause and perimenopause?
Symptoms can change along the way. Hot flushes may ease, then low mood and anxiety take their place.
You can still get pregnant in perimenopause. If you’re 40 to 49, the NHS says to use contraception for 2 years after your last period. If you’re 50 or over, it’s 1 year.
Is there a test for perimenopause?
Usually not. The NHS says there’s no routine test for perimenopause.
If you’re 45 or over, NICE says to identify it without lab tests. That’s if you’re otherwise healthy, your hot flushes or night sweats started recently, and your cycle has changed.
| Your age | What NICE says |
|---|---|
| 45 or over | No lab tests needed if you’re otherwise healthy, with new hot flushes or sweats and a changed cycle. |
| 40 to 45 | Consider an FSH blood test to confirm menopause, if you have symptoms including a change in your cycle. |
| Under 40 | Consider an FSH blood test if menopause is suspected. |
Source: NICE NG23
FSH (follicle-stimulating hormone) is a hormone that helps run your cycle. See high FSH levels for how it’s read.
At 45 or over, NICE also says not to use blood tests for other hormones (oestradiol, AMH or inhibin), or ovary scans, to identify it. So if your GP doesn’t test your hormones at 48, they’re following the guideline.
On combined hormonal contraception, like the combined pill, or high-dose progestogen (a man-made form of progesterone)? NICE says not to use an FSH test to identify menopause. Never stop or change a prescribed medicine without your prescriber.
More detail: perimenopause blood tests and early menopause testing.
Could my symptoms be something else?
Yes. Some common conditions share the tiredness, low mood and brain fog. A blood test can check for them.
| Condition | Symptoms it shares | How it’s checked |
|---|---|---|
| Underactive thyroid | Tiredness, weight gain, low mood, poor concentration, irregular or heavy periods | Thyroid hormone blood test (TSH and T4) |
| Iron deficiency anaemia (too few healthy red blood cells, from low iron) | Tiredness, lack of energy, palpitations, headaches | Full blood count |
| Vitamin B12 or folate deficiency anaemia | Feeling weak or tired, palpitations, headaches, memory problems | Blood test |
Sources: NHS: underactive thyroid; NHS: iron deficiency anaemia; NHS: B12 or folate deficiency anaemia
Periods got heavier? Iron deficiency anaemia is often caused by blood loss, and heavy periods are one cause.
Ask your GP if these are worth checking. See also menopause or thyroid and brain fog that feels like ADHD.
What can I do about perimenopause symptoms?
The NHS says eating well, exercise and looking after your mental wellbeing can help.
Six NHS steps that can ease symptoms
- Keep to a regular sleep routine and get plenty of rest.
- Exercise regularly, including weight-bearing exercise like walking, running or dancing to help protect your bones.
- Eat calcium-rich food like milk, yoghurt and kale, if you can.
- For hot flushes, wear light clothes, keep your bedroom cool and cut triggers like spicy food, caffeine, hot drinks, smoking and alcohol.
- Try yoga, tai chi or meditation.
- Talk to a doctor before you take herbal supplements or complementary medicines.
Source: NHS: things you can do
Low mood or anxiety? CBT, a talking therapy, can help with low mood, anxiety and sleep problems. It can also help with hot flushes.
Thinking about HRT (hormone replacement therapy)? It isn’t contraception, so ask a doctor about both. See also hot flushes and menopause weight gain.
When to speak to a GP
The NHS says to contact your GP if:
- You think you have symptoms of perimenopause and want to know your options.
- You have a fast heartbeat (palpitations).
- You still have periods but you’re bleeding more, not less, than before.
- You haven’t had a period for 12 months or more and you have any vaginal bleeding. Go even if it happened once, or was only a small amount of blood, spotting, or pink or brown discharge. Go even if you have no other symptoms, or you’re not sure it’s blood.
- You’re on HRT and still have irregular or heavier bleeding or spotting after 6 months.
Bleeding after menopause is not usually serious, but it can be a sign of cancer. Cancer may be easier to treat if it’s found early.