Perimenopause symptoms: the early signs, when it starts and what helps

What is perimenopause?

Perimenopause is the time leading up to menopause. Your ovaries gradually produce less oestrogen, and levels can rise and fall unpredictably, which is what causes many of the symptoms.

Menopause itself is a single point in time: 12 months after your last period. The average age for menopause in the UK and US is around 51. Perimenopause often starts in your mid-40s and usually lasts a few years, but for some people it starts in their late 30s or lasts much longer. Everyone's experience is different.

Early signs of perimenopause

For many people, the first sign is a change in their periods. They might become:

• more or less frequent
• heavier or lighter
• irregular, with skipped months

Other common symptoms include:

• Hot flushes and night sweats
• Sleep problems, even without night sweats
• Mood changes such as irritability, low mood or anxiety
• Brain fog — trouble concentrating or remembering words
• Vaginal dryness, discomfort during sex or lower libido
• Joint aches, headaches or heart palpitations
• Needing to pee more often or more urinary infections
• Tiredness and lower energy

You might have several symptoms or very few. Because they can come and go, many people don't connect them to perimenopause at first.

How is perimenopause diagnosed?

If you're over 45 and have typical symptoms, a doctor can usually recognise perimenopause based on your symptoms and periods alone — you often don't need a blood test. Hormone levels go up and down so much during this time that a single test can be misleading.

If you're under 45, your doctor may suggest blood tests to check for other causes, such as thyroid problems, and to look into early menopause.

A simple symptom diary — noting your periods, sleep, mood and hot flushes — can help you and your doctor see the pattern.

What helps with perimenopause symptoms?

You don't have to just cope. Options include:

• Hormone replacement therapy (HRT) — the most effective treatment for many symptoms, including hot flushes and night sweats. For most people the benefits outweigh the risks, but it's not suitable for everyone, so it's worth a personalised conversation with your doctor.
• Vaginal oestrogen for dryness and discomfort, which can often be used even if you don't take other HRT
• Non-hormonal medicines for hot flushes, if HRT isn't right for you
• Cognitive behavioural therapy (CBT), which can help with low mood, anxiety, sleep and hot flushes
• Lifestyle changes — regular exercise, a balanced diet, cutting back on alcohol and caffeine, and stopping smoking

Also keep in mind that you can still get pregnant during perimenopause. Doctors generally advise using contraception until you've had no periods for two years if you're under 50, or one year if you're over 50.

Looking after your long-term health

Lower oestrogen after menopause affects bone strength and heart health. Weight-bearing exercise, strength training, enough calcium and vitamin D, not smoking and keeping an eye on your blood pressure and cholesterol all help protect you in the years ahead. This is a good time for a general health check.

When to see a doctor

Talk to a doctor if:

• your symptoms are affecting your work, relationships or wellbeing
• you're under 45 and think you're having perimenopause symptoms
• your periods are very heavy, last much longer than usual, or come very close together
• you have bleeding between periods or after sex
• you have any bleeding after you've gone 12 months without a period
• you feel persistently low, anxious or hopeless

If you have thoughts of harming yourself, seek urgent help straight away from emergency services or a crisis line.