Could these changes be perimenopause, and when should I seek help?

What is perimenopause?

Perimenopause begins when hormonal changes start affecting periods or causing symptoms. It may last for several years. Menopause is usually recognised after 12 consecutive months without a period when there is no other explanation.

The experience varies widely. Some people notice few changes, while others find that symptoms affect sleep, work, relationships or daily comfort. Menopause is a normal life stage, but symptoms do not have to be endured without support.

Which symptoms can occur?

Possible changes include:

• periods becoming less predictable, closer together or further apart;
• heavier or lighter bleeding;
• hot flushes or night sweats;
• difficulty sleeping;
• low mood, anxiety, irritability or problems with concentration;
• vaginal dryness, discomfort during sex or urinary symptoms;
• reduced sexual desire;
• joint or muscle discomfort.

These symptoms are not specific to perimenopause. Pregnancy, thyroid disorders, anaemia, medication effects, stress and some gynaecological conditions can produce overlapping symptoms. Assessment should therefore consider your age, cycle pattern, medical history and the symptoms causing concern.

Do I need hormone tests?

If you are aged 45 or older and have typical symptoms with a changing menstrual pattern, hormone blood tests are often unnecessary. Hormone levels can fluctuate considerably during perimenopause, so a single result may be misleading.

Testing may be considered when symptoms begin before 45, periods stop before 40, the diagnosis is uncertain, or another condition needs to be excluded. A pregnancy test, blood count, thyroid testing or other investigations may be appropriate depending on the history. The same test panel is not required for everyone. NICE and RCOG both advise that typical menopause symptoms after 45 can usually be assessed without routine hormone testing.

Which bleeding changes need assessment?

Some irregularity is common during perimenopause, but do not assume every bleeding change is hormonal. Arrange an assessment if:

• bleeding is unusually heavy or prolonged;
• periods occur very frequently;
• bleeding happens between periods or after sex;
• the change persists or causes concern;
• you feel tired, breathless, dizzy or may be anaemic;
• bleeding occurs after 12 months without a period.

Bleeding after menopause should always be evaluated, even when it is only light spotting. The existing guides on irregular or heavy periods and bleeding after menopause explain these warning signs in more detail.

What can help with symptoms?

Treatment depends on which symptoms matter most, their effect on daily life and your medical history.

Regular activity, adequate sleep, stopping smoking and moderating alcohol or caffeine may help some people. Weight-bearing exercise also supports bone health. Vaginal moisturisers and lubricants can help dryness or discomfort.

Hormone replacement therapy, often called HRT or menopausal hormone therapy, is an effective option for symptoms such as hot flushes and night sweats. It is not suitable in exactly the same form for everyone. If you have a uterus, systemic oestrogen generally needs suitable progestogen protection. Personal factors, including bleeding history, migraine, blood-clot risk, cardiovascular health and breast-health history, should be considered before treatment.

Non-hormonal options may also be appropriate. A healthcare professional should explain the expected benefits, possible risks and reasonable alternatives so that the choice reflects your priorities.

Can vaginal or urinary symptoms be treated separately?

Yes. Vaginal dryness, burning, discomfort during sex and some urinary symptoms can occur as oestrogen levels change.

Vaginal moisturisers and lubricants may help. Low-dose vaginal oestrogen is another option for appropriate patients and differs from systemic hormone treatment because absorption into the rest of the body is low. Your personal history still matters, particularly if you have had breast cancer or unexplained bleeding.

Do I still need contraception?

Pregnancy remains possible during perimenopause, and HRT does not work as contraception. The appropriate duration and method depend on your age, menstrual pattern, health history and current treatment. Discuss contraception before stopping it rather than relying on symptoms or an isolated hormone test.

What should I ask at my consultation?

• Could another condition explain my symptoms?
• Do I need blood tests, an examination or an ultrasound?
• Which treatment options fit my symptoms and medical history?
• What are the likely benefits and risks of hormone and non-hormone treatments for me?
• Do I still need contraception?
• When should my symptoms or treatment be reviewed?

Frequently asked questions

Related care: General gynaecology and menopause consultations.