10 Menopause and Perimenopause Symptoms: When to Seek Advice

Learn about 10 possible menopause and perimenopause symptoms, other causes to consider, and when to contact a GP, NHS 111 or 999.

Changes in periods, hot flushes, sleep, mood or concentration can occur during perimenopause and menopause. However, these symptoms are not specific to menopause and can have other causes. A list on a website cannot diagnose you.

For otherwise healthy people aged 45 or over who were registered female at birth and have menopause-associated symptoms, NICE advises identifying perimenopause from recently started hot flushes or sweats, sometimes called vasomotor symptoms, together with a change in the menstrual cycle, without laboratory tests. The approach differs for some people, including those aged under 45, those using hormonal treatments and those whose symptoms may have another cause.

The 10 sections below describe possible symptoms, not a sequence that everyone will experience.

Key points

  • Menopause-associated symptoms can begin before periods stop and vary between individuals.
  • No single symptom proves that menopause is the cause.
  • Speak to a GP if symptoms persist, worsen, concern you or affect daily life.
  • Some symptoms need a specific urgent or emergency response. The relevant routes are set out below.

1. Changes in periods

Changes in the menstrual cycle are a common feature of perimenopause. Periods may become more or less frequent, and bleeding may become heavier or lighter.

Bleeding can also have other causes. See a GP if heavy periods affect your life, have continued for some time, cause severe pain, occur with bleeding between periods or after sex, or occur with other symptoms such as pain when peeing, pooing or having sex. Postmenopausal bleeding means any vaginal bleeding more than 12 months after your last period and should be reported to a GP, even if it has happened only once, is a small amount, is spotting or pink or brown discharge, or there are no other symptoms.

2. Hot flushes and night sweats

Hot flushes can cause a sudden feeling of heat or cold in the face, neck and chest, sometimes with sweating, a noticeable or pounding heartbeat (palpitations), anxiety or dizziness. Night sweats can disrupt sleep.

Night sweats may have other causes. See a GP if they regularly wake you or worry you, or if they occur with a very high temperature or feeling hot, cold or shivery, a cough or diarrhoea, or unexplained weight loss.

Call 999 for sudden chest pain or discomfort that does not go away, spreads to the arm, neck, jaw, stomach or back, or occurs with sweating, breathlessness, nausea or light-headedness.

3. Sleep problems

Difficulty getting to sleep or staying asleep can occur during perimenopause and menopause and may be worse with night sweats. Sleep problems can also be linked to stress, anxiety, depression, the sleep environment, alcohol, caffeine, medicines and other health conditions.

See a GP if changing your sleep habits has not helped, you have had trouble sleeping for months, or poor sleep is affecting daily life in a way that makes it hard to cope.

4. Mood changes

Mood swings, low mood and depressive symptoms can occur during the menopause transition. They can also have other causes and deserve individual assessment, particularly when they persist or affect daily life.

If you need urgent mental-health help but it is not an emergency, call NHS 111 and select the mental-health option or ask for an urgent GP appointment. Call 999 or go to A&E if someone’s life is at risk or if you or someone else does not feel able to keep themselves or another person safe. Samaritans can be contacted free on 116 123 for confidential emotional support.

5. Memory or concentration problems

Problems with memory or concentration may feel worse when sleep is poor or you are very tired. Memory changes can also have other causes, including stress, anxiety, depression and sleep problems.

Speak to a GP if memory or concentration problems affect day-to-day life. Call 999 or go to A&E if someone suddenly becomes confused. Call 999 if someone develops signs of a stroke, such as facial weakness, arm weakness or speech problems, including if the signs occurred within the last 24 hours and have stopped.

6. Tiredness or low energy

Poor sleep and other menopause-associated symptoms can leave you feeling tired. Tiredness is not specific to menopause and may have many causes, including stress, low mood, illness, medical treatment and some medicines.

See a GP if tiredness has lasted for a few weeks without a clear cause, affects daily life, or occurs with other symptoms such as weight loss or mood changes. A clinician will decide whether an examination or tests are appropriate; a particular test is not guaranteed.

7. Muscle aches and joint pain

Muscle aches and joint pain can occur during perimenopause and menopause. Pain can also follow injury or be linked to arthritis and other conditions.

See a GP if joint pain affects sleep or normal activities, is getting worse or keeps returning, has not improved after home treatment, or causes prolonged morning stiffness. Ask for an urgent GP appointment or contact NHS 111 if you have joint pain and the skin around it is swollen and feels hot, or if you have joint pain and feel generally unwell, have a high temperature, or feel hot, cold or shivery. Go to A&E or call 999 if you have very bad joint pain after a fall or injury, cannot walk or put weight on the joint, the joint has moved out of place, or you have tingling or loss of feeling around it after an injury.

8. Vaginal and urinary symptoms

Vaginal dryness, itching or discomfort, pain during sex and urinary symptoms can occur during and after menopause. Similar symptoms can also be caused by infection, irritation or a skin condition.

Speak to a GP if symptoms persist despite self-care, affect daily life, occur with unusual discharge, or occur with bleeding after sex or between periods. Postmenopausal bleeding should always be reported to a GP, even if it has happened only once.

9. Changes in sexual interest

Reduced interest in sex can occur during perimenopause and menopause. It may also be influenced by relationship problems, stress, anxiety or depression, vaginal dryness, some medicines, hormonal contraception, alcohol and long-term conditions.

Speak to a GP if the change worries you, or if a medicine or hormonal contraception may be contributing. Pelvic pain or unexpected bleeding should not be assumed to be part of menopause. Get help from NHS 111 if you have pelvic pain with difficulty peeing or pooing, blood in your urine or stool, unusual vaginal discharge or bleeding, pain when peeing or a need to pee more often, a very high temperature or feeling hot, cold or shivery, vomiting and diarrhoea or feeling sick, or possible pregnancy. Call 999 or go to A&E if pelvic pain is severe or getting worse, hurts when you move or touch the area, or if you feel faint, dizzy or light-headed, pass out, have shoulder-tip pain or breathing difficulty, have heavy vaginal bleeding, or suddenly feel confused.

10. Skin changes

Skin may become dry or itchy during perimenopause and menopause. Skin changes are not specific to menopause and may have other causes.

Speak to a GP if itchy skin affects daily life, does not improve with self-care or keeps returning, is severe or affects your whole body, or occurs with a new rash, lump or swelling that worries you. Call 999 for signs of a severe allergic reaction, including sudden swelling of the lips, mouth, throat or tongue; a tight throat or difficulty swallowing; fast or difficult breathing; blue, grey or pale skin, tongue or lips; sudden confusion, drowsiness or dizziness; or fainting when the person cannot be woken.

How menopause is assessed

For otherwise healthy people aged 45 or over who were registered female at birth and have menopause-associated symptoms, NICE advises identifying perimenopause without laboratory tests when vasomotor symptoms have recently started and there is a change in the menstrual cycle. Menopause can be identified without laboratory tests when a person has not had a period for at least 12 months and is not using hormonal contraception. For someone who has had a hysterectomy, NICE advises identifying menopause from the type and combination of symptoms. A blood test for follicle-stimulating hormone (FSH) may be considered for people aged 40 to 45 with menopause-associated symptoms, including a change in the menstrual cycle, and for people under 40 when menopause is suspected.

Blood tests may still be appropriate when a clinician suspects another cause.

When to seek advice

Speak to a GP if symptoms persist, worsen, concern you or affect sleep, mood, work, relationships or quality of life. A clinician can consider your age, symptoms, menstrual history, medicines and other possible causes before discussing suitable options.

A private menopause consultation does not guarantee that a medicine or treatment will be prescribed.

Frequently asked questions

How do I know whether symptoms are caused by perimenopause?

You cannot tell from a symptom list alone. Clinicians consider age, symptoms, menstrual history, medicines and other possible causes. Tests may be appropriate when another condition is suspected.

Do I need a blood test to confirm perimenopause?

No laboratory test is needed to identify perimenopause if you are otherwise healthy, aged 45 or over, have recently started vasomotor symptoms and have a change in your menstrual cycle. A clinician may still recommend tests if another cause is suspected. NICE recommends a different approach in some circumstances, including for people aged 40 to 45 and those under 40.

Can perimenopause begin before age 45?

Yes. Symptoms can begin before age 45. NICE describes menopause between ages 40 and 44 as early menopause. Menopause-associated symptoms before age 40, including no or infrequent periods, may indicate premature ovarian insufficiency (POI), which means the ovaries stop working normally before age 40, and need specific assessment. NICE advises diagnosing premature ovarian insufficiency from symptoms together with higher FSH levels in 2 blood samples taken 4 to 6 weeks apart, not from a single blood test.

What support is available?

Support depends on your symptoms, medical history, preferences and individual risks. It may include information, lifestyle measures or discussion of treatment options with an appropriate clinician. NICE says menopause-specific cognitive behavioural therapy (CBT), a type of talking therapy, may be considered for sleep problems linked to hot flushes or sweats. It can be used alongside other options, when other options are not suitable for medical reasons, or when the person prefers not to try them.

Sources

Disclaimer: This page provides general information and does not replace individual clinical assessment. Use the specific GP, NHS 111 or 999 routes above according to the symptom and urgency.