Perimenopause affects people differently. Symptoms can overlap with other health conditions, and no single symptom confirms that perimenopause is the cause.
For otherwise healthy people aged 45 or over who were registered female at birth and have menopause-associated symptoms, NICE NG23 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.
Ten possible changes
1. Changes to periods
Periods may become more or less frequent, and bleeding may become heavier or lighter. A change in period pattern is usually one of the first signs of perimenopause.
2. Hot flushes and night sweats
The face, neck or chest may suddenly feel hot or cold. Sweating, dizziness, anxiety or a noticeable heartbeat can occur. Episodes at night may disturb sleep.
3. Sleep problems
Some people have difficulty getting to sleep or staying asleep. Sleep may be worse when night sweats are also present.
4. Mood changes
Mood swings, low mood, anxiety or irritability can occur. These symptoms can also have other causes and should be assessed in context.
5. Memory or concentration difficulties
Some people notice forgetfulness, difficulty concentrating or “brain fog”. Sleep problems and tiredness can make these symptoms feel worse.
6. Weight or body-shape changes
Weight gain can occur during perimenopause and menopause, often around the stomach or upper body. Weight change can have several causes and does not prove the cause.
7. Muscle aches and joint pains
Muscle aches and joint pains can occur, but new, persistent or severe pain may need separate assessment.
8. Reduced sex drive
Reduced sexual desire can occur during perimenopause and menopause.
9. Vaginal symptoms
Dryness, burning, irritation or itching can occur and may make sex painful. Similar symptoms can have other causes, so seek advice if they are new, persistent or concerning.
10. Palpitations
A heartbeat may feel faster, slower or more noticeable. Palpitations have many possible causes and should not automatically be attributed to perimenopause.
When to contact your GP
Contact your GP if you think you have symptoms of perimenopause and want to discuss your options, or if symptoms are affecting daily life. Contact your GP about palpitations, bleeding that is becoming heavier, or any vaginal bleeding after 12 months without a period.
Heavy periods may include needing to change a pad or tampon every one to two hours or bleeding for more than seven days. Seek GP advice if heavy periods affect your life, persist, cause severe pain, or if you bleed between periods or after sex. See NHS guidance on heavy periods.
If menopause is suspected under age 40, arrange a GP assessment. NICE NG23 uses a specific assessment and blood-test process for possible premature ovarian insufficiency (POI), which means the ovaries stop working normally before age 40.
When to seek urgent help
Call 999 or go to A&E if you currently have palpitations that do not stop, or palpitations with chest pain, shortness of breath, feeling faint or fainting. If those symptoms have stopped, request an urgent GP appointment or use NHS 111. See NHS guidance on heart palpitations.
For urgent mental-health help, ask for an urgent GP appointment or use NHS 111 and select the mental-health option. Call 999 or go to A&E if someone’s life is at risk or you do not feel able to keep yourself or somebody else safe. See NHS urgent mental-health guidance.
Sources
- NICE NG23: Menopause, recommendations
- NHS: Symptoms of menopause and perimenopause
- NHS: Heart palpitations
- NHS: Heavy periods
- NHS: Where to get urgent help for mental health
This information is general and does not replace an individual clinical assessment.