How Do I Know If I'm in Perimenopause? Signs, Symptoms & Diagnosis

Perimenopause can begin before periods stop completely. For many people, the first clue is a change in their menstrual cycle alongside symptoms such as hot flushes, night sweats, sleep problems, mood changes, anxiety, brain fog, palpitations, joint or muscle aches, vaginal dryness or changes in sexual wellbeing.

There is no single experience of perimenopause. Symptoms vary considerably between people and can change over time.

Visit our Perimenopause & Menopause Support Hub for our complete menopause information pathway.

What is perimenopause?

Perimenopause is the time leading up to menopause, when hormone levels fluctuate and symptoms can develop even though periods may still be happening. Menopause is reached when you have not had a period for 12 months, provided there is no other cause for the periods stopping.

Common signs of perimenopause

Symptoms can include:

• changes in the pattern of periods
• hot flushes and night sweats
• difficulty sleeping
• low mood, anxiety or mood changes
• problems with memory or concentration ('brain fog')
• palpitations
• headaches or migraines that are worse than usual
• muscle aches and joint pains
• changes in body shape or weight
• vaginal dryness, discomfort or urinary symptoms
• reduced interest in sex

You do not need to have every symptom, and having one of these symptoms does not automatically mean perimenopause is the cause.

Do I need a blood test to diagnose perimenopause?

Often, no. NICE guidance says that in otherwise healthy people aged 45 or over with typical menopause-associated symptoms, perimenopause and menopause can usually be identified without laboratory tests. Blood testing may be considered in some younger people or when the clinical picture is less clear. A healthcare professional should decide whether testing is appropriate for your circumstances.

What else can cause similar symptoms?

Symptoms such as tiredness, mood changes, poor sleep, palpitations or changes in periods can have other causes. Pregnancy, thyroid problems, anaemia, medication effects and mental or physical health conditions are among the possibilities a clinician may consider depending on your symptoms.

When should I seek medical advice?

Seek appropriate medical advice if symptoms are affecting your quality of life, you are under 45 and think you may be experiencing menopause-related changes, your bleeding pattern is concerning, or you have symptoms that could indicate another health problem.

Unexpected bleeding after menopause should be medically assessed. Severe symptoms, chest pain, fainting, severe shortness of breath or other emergency symptoms need urgent medical help.

What support is available?

Support depends on your symptoms, medical history and preferences. Options may include lifestyle measures, menopause-specific cognitive behavioural therapy for some symptoms, and hormone replacement therapy (HRT) where clinically appropriate. Treatment decisions should be individualised.

Read our HRT guide, hot flushes and night sweats guide, or menopause and sleep guide.

Perimenopause information in Rochdale & Greater Manchester

Longeva Wellness provides women's health and wellness services from Rochdale. Our menopause information is designed to help people understand symptoms, know when assessment may be appropriate and find the right service pathway.

Explore our Menopause Support Hub, visit Women's Health, or book an appropriate Longeva consultation where the concern falls within our service scope.

This article provides general information and does not diagnose perimenopause or menopause. New, severe or concerning symptoms should be assessed appropriately.