The short answer: perimenopause symptoms usually start with changes to your periods, along with hot flashes, night sweats, poor sleep, mood changes and vaginal dryness. They happen because your hormone levels rise and fall in the years before periods stop. Many of them can be treated, and some kinds of bleeding should always be checked by a doctor.
You wake at 3 a.m. with your pajamas damp. Your period turns up ten days early, then not at all. You snap at someone over nothing, and later you wonder who that was.
Each of these can seem like its own small problem. Seeing them together is what often makes it click, and it gives you something clear to take to your doctor.
What is perimenopause?
Perimenopause is the time before menopause when your body is getting ready to stop having periods. Mayo Clinic says estrogen rises and falls during this stage. Once you’ve gone 12 months in a row without a period, you’ve reached menopause and perimenopause is over.
Cleveland Clinic says it usually starts in the mid-40s, but it can start as early as the mid-30s or as late as the mid-50s. It lasts about four years on average and can last up to eight, though some people have it for only a few months.
The main perimenopause symptoms
| Symptom | What you might notice |
|---|---|
| Period changes | Shorter or longer gaps, lighter or heavier flow, skipped periods |
| Hot flashes and night sweats | Sudden heat in your face, neck and chest, sometimes with heavy sweating or a racing heart |
| Sleep problems | Trouble falling or staying asleep, with or without night sweats |
| Mood changes | Mood swings, irritability, anxiety or low mood |
| Memory and focus | Forgetting words, trouble concentrating, brain fog |
| Vaginal and bladder changes | Dryness, pain during sex, burning when you pee, needing to go more often, more urinary infections |
| Body changes | Weight gain around the stomach, muscle aches, joint pain, headaches, thinning hair, dry skin |
| Lower sex drive | Less interest in sex than before |
This list draws on the NHS, Mayo Clinic and Cleveland Clinic. You won’t necessarily have all of these, and symptoms can change over time. The NHS says women from a Black ethnic background are more likely to have hot flashes that are severe and last longer.
Going through menopause?
The Menopause Meal Plan
4 weeks of high-protein meals with grocery lists and prep plans. Only $12.
Mayo Clinic gives two useful markers for periods. If your cycle length keeps changing by seven days or more, you may be in early perimenopause. If you go 60 days or more between periods, you’re likely in late perimenopause.
These symptoms can have other causes too. Tiredness in particular has many, so it may help to read why you might always feel tired before you see your doctor.
Bleeding: what’s normal and what needs a doctor
Irregular periods are common in perimenopause. Mayo Clinic says most of the time they’re nothing to be concerned about. But some patterns should be checked.
See your doctor if, during perimenopause:
- Bleeding is very heavy, or you pass large clots
- You’re changing pads or tampons every one to two hours
- Bleeding lasts longer than seven days, or several days longer than usual
- You bleed or spot between periods
- You bleed after sex
- Your periods are less than 21 days apart
Get checked promptly if you’ve gone 12 months without a period and then have any bleeding. The NHS says this counts even if it’s light, spotting or happens only once. We’d include pink or brown discharge too. It’s usually not serious, but it can occasionally be a sign of cancer, which is easier to treat when found early.
When else to see a doctor
You don’t need to wait until things feel unbearable. The NHS says to see a doctor if you think you have symptoms and want to know your options. Go too if you have palpitations.
Cleveland Clinic adds that you should see a provider if symptoms are disrupting your daily life, or if you skip periods before age 45.
Most of the time, you won’t need a blood test. Cleveland Clinic says a provider can often diagnose perimenopause from your symptoms, age and history. Hormone levels change so much that tests can mislead. Before your visit, write down your period dates and your main symptoms for a month or two. It gives your doctor something real to work with.
What treatment options are there?
Nothing stops perimenopause, but symptoms can be treated. No option suits everyone, so talk through these with your doctor.
Hormone therapy (HRT). The NHS says HRT relieves most menopause symptoms and helps prevent osteoporosis. It also says that for most people, the benefits usually outweigh the risks, though your age, symptoms and personal risk factors all matter. Some of the risks it lists:
- Breast cancer: combined HRT slightly raises the risk, by about 5 extra cases per 1,000 women after 5 years. The risk rises with time on HRT and falls after stopping.
- Blood clots and stroke: tablets increase these risks a little, though the NHS says the risk stays very low, and that patches, gels and sprays do not raise it.
HRT may not suit you if you’ve had breast, ovarian or womb cancer, or have had blood clots, untreated high blood pressure or liver disease. If you still have your womb, you’ll usually need a progestogen as well.
Vaginal estrogen. A low-dose cream or pessary can treat dryness and soreness. The NHS says it doesn’t carry the usual risks of HRT and doesn’t increase your risk of breast cancer.
Non-hormonal options. The NHS lists cognitive behavioral therapy (CBT) and certain medicines for hot flashes. Cleveland Clinic also mentions gabapentin, oxybutynin, fezolinetant and elinzanetant, depending on your symptoms and health.
Herbal remedies. The NHS says remedies like red clover and black cohosh have very little evidence of benefit or safety, and may cause serious side effects with other medicines. Check with your doctor before trying them.
What you can do yourself
- Keep your bedroom cool and wear light layers. The NHS also suggests regular sleep routines.
- Notice your triggers. The NHS suggests limiting spicy food, caffeine and hot drinks, and not drinking above the recommended alcohol limit.
- Lift something. The NHS recommends weight-bearing activity and strength training to help protect your bones. Our guide on how to keep muscle as you age shows you how to start.
- Eat for your bones. Read what to eat during menopause for a simple way to plan your meals.
These habits are low risk, but they aren’t proven treatments. In 2023, The Menopause Society did not recommend avoiding triggers, cooling techniques or exercise as treatments for hot flashes. Exercise has other good reasons behind it, and if a trigger clearly affects you, avoiding it costs little.
Your next step
This week, start a simple note on your phone: the date, your period, and your worst symptom of the day. If anything in the bleeding section applies to you, call your doctor now, without waiting for the note.
Going through menopause?
The Menopause Meal Plan
4 weeks of high-protein meals with grocery lists and prep plans, so you can stop guessing what to eat. Only $12.
Quick questions
What are the first signs of perimenopause?
The NHS says one of the first signs is usually a change to your periods. They may come more or less often, and bleeding may get heavier or lighter.
How long does perimenopause last?
Cleveland Clinic says it lasts about four years on average and can last up to eight, though some people have it for only a few months. The NHS says menopause and perimenopause symptoms usually last 7 to 9 years, sometimes longer.
Do I need a blood test to diagnose perimenopause?
Usually not. Cleveland Clinic says a provider can often diagnose it from your symptoms, age and medical history, and hormone testing isn’t necessary because levels change too much to be reliable.
Can you get pregnant during perimenopause?
Yes. Cleveland Clinic says pregnancy is less likely but still possible as long as you have periods, so keep using birth control if you don’t want to become pregnant.
When should I worry about bleeding?
See a doctor about very heavy bleeding, bleeding that lasts longer than seven days, bleeding between periods or after sex, or periods less than 21 days apart. Get any bleeding checked if you’ve gone 12 months without a period, even if it’s only spotting or happens once.
This article is general information, not medical advice. If you’re worried about your symptoms or any bleeding, please talk to your doctor.
Sources
- NHS. Symptoms of menopause and perimenopause, Things you can do and Treatment.
- NHS. Post-menopausal bleeding.
- NHS. About HRT and Types of HRT.
- NHS. Benefits and risks of hormone replacement therapy (HRT).
- Mayo Clinic. Perimenopause: Symptoms and causes.
- Cleveland Clinic. Perimenopause and Menopause.
- The North American Menopause Society, now The Menopause Society. 2023 Nonhormone Therapy Position Statement release.