Perimenopause is the phase before your periods stop for good, when your hormone levels start to change and become less predictable. It can begin in your late 30s or early 40s, often several years before your last period (Women's Health Concern, the patient arm of the British Menopause Society). The most common first sign is a change in your periods, alongside symptoms such as hot flushes, disturbed sleep, low mood and brain fog.
If you're in your mid-40s or older and your periods are changing, a GP can usually recognise perimenopause from your symptoms alone, with no blood test needed. This guide explains the signs, what to expect, and when it's worth getting checked.
Not sure if it's perimenopause? Tick your symptoms with our free perimenopause symptom checklist, then print it for your GP appointment.
Key takeaways
- Perimenopause is the years of hormonal change before your final period. Menopause itself is the point when you've had no period for 12 months (NHS).
- If you're 45 or over with typical symptoms, NICE says you usually don't need a blood test to identify it (NICE NG23).
- Symptoms usually last about 7 to 9 years, sometimes longer, and change over time (NHS).
- In a UK survey of women aged 40–60, 73% had experienced menopause-related symptoms (CIPD, 2023).
- Any bleeding after menopause (12+ months with no period) should always be checked by a GP (NHS).
What is perimenopause?
Perimenopause means "around menopause". It's the transition when your ovaries gradually make less oestrogen, your cycles become irregular, and menopausal symptoms often begin. You're still having periods during perimenopause, but their timing and flow may change.
The terms are worth getting straight (NHS):
| Term | What it means |
|---|---|
| Perimenopause | The phase before menopause, when periods become irregular and symptoms can start |
| Menopause | The point when you've had no period for 12 months (and aren't using hormonal contraception) |
| Postmenopause | The time after that point |
Menopause usually happens between the ages of 45 and 55, with a UK average of around 51 (NHS Highland guideline). Perimenopause can start several years earlier.
The menopause transition
The signs of perimenopause
The NHS groups perimenopause and menopause symptoms into changes to your periods, and physical and emotional symptoms (NHS symptoms page). Not everyone gets all of them, and severity varies a lot.
Changes to your periods
Often the first sign. Periods may come more or less often than usual, and be heavier or lighter than you're used to.
Physical symptoms
- hot flushes (short, sudden feelings of heat)
- night sweats
- difficulty sleeping
- palpitations (heartbeats that suddenly become more noticeable)
- headaches and migraines that are worse than usual
- muscle aches and joint pains
- changed body shape and weight gain
- skin changes, including dry and itchy skin
- reduced sex drive
- vaginal dryness, and pain, itching or discomfort during sex
- recurrent urinary tract infections (UTIs)
- sensitive teeth, painful gums or other mouth problems
Emotional and cognitive symptoms
- changes to mood, such as low mood, anxiety, or mood swings
- problems with memory or concentration ("brain fog")
Because these symptoms are so varied, many women don't connect them to perimenopause at first. In a UK survey of 2,185 employed women aged 40–60, of those with symptoms, 67% reported psychological symptoms, 66% hot flushes, 66% sleep problems and 64% muscle or joint problems (CIPD, 2023).
Most common symptoms among symptomatic women
A perimenopause symptom checklist
Use this as a prompt for a conversation with your GP, not as a diagnosis. Note which symptoms you have, how long you've had them, and how much they affect your daily life.
| Area | Possible signs | Have you noticed this? |
|---|---|---|
| Periods | More or less frequent, heavier or lighter, more irregular | ☐ |
| Temperature | Hot flushes, night sweats | ☐ |
| Sleep | Trouble falling or staying asleep, tiredness | ☐ |
| Mood | Low mood, anxiety, irritability, mood swings | ☐ |
| Thinking | Poor concentration, forgetfulness, brain fog | ☐ |
| Body | Joint and muscle aches, headaches, palpitations | ☐ |
| Skin and hair | Dry or itchy skin, thinning hair | ☐ |
| Sex and urinary | Vaginal dryness, discomfort during sex, lower sex drive, repeated UTIs | ☐ |
For a printable version, see our perimenopause symptom checklist.
Do you need a blood test?
Usually not, if you're 45 or over. NICE guidance (NG23) says a healthy woman aged 45 or over with typical symptoms can be identified as perimenopausal from her symptoms alone, without laboratory tests (NICE NG23). In perimenopause, that means recent-onset hot flushes or night sweats together with a change in your menstrual cycle.
NICE specifically advises against using tests such as anti-Müllerian hormone (AMH), oestradiol or an ovarian ultrasound to diagnose perimenopause in this group, because they don't reliably add anything.
A blood test for follicle-stimulating hormone (FSH) may be considered in some situations (NICE NG23; NHS):
| Your situation | What UK guidance suggests |
|---|---|
| 45 or over, typical symptoms | Identified from symptoms; no blood test needed |
| Aged 40–45 with symptoms including a change in your cycle | An FSH test may be considered |
| Under 40 with symptoms | An FSH test is considered, because menopause this early (premature ovarian insufficiency) needs proper assessment |
| On combined hormonal contraception or high-dose progestogen | FSH is not used to identify menopause, because the hormones affect the result |
Premature ovarian insufficiency (menopause before 40) is more common than many people realise: pooled international studies put it at around 3.5% of women (ESHRE 2024 guideline). If you're under 40 and have menopausal symptoms, see a GP.
Related: Perimenopause test: do you actually need one?
When does perimenopause start, and how long does it last?
Perimenopause can begin in your late 30s or early 40s (Women's Health Concern). There's no single UK figure for how long it lasts, but symptoms overall usually last about 7 to 9 years, and sometimes longer (NHS).
How long symptoms last depends partly on when they start. In a large study that followed 1,449 women with frequent hot flushes, the flushes lasted a median of 7.4 years in total — but over 11.8 years for women whose symptoms began before or early in perimenopause, and about 3.4 years for those whose symptoms only started after their final period (Avis et al., JAMA Internal Medicine, 2015).
The worst and the least expected symptoms
Two questions come up constantly and neither gets a straight answer very often: which symptoms are the hardest to live with, and which ones nobody warns you about.
On severity, the symptoms women most often describe as genuinely disruptive are not the ones in the leaflets. Hot flushes are the cultural shorthand, but sleep disruption, mood changes, anxiety and brain fog are the ones that tend to affect work and relationships most. Night sweats matter largely because of what they do to sleep, and sleep deprivation then amplifies everything else — which is why a symptom that looks mild on a list can be the one that tips someone over.
The less expected ones are real and frequently dismissed:
- Joint and muscle aches — common enough that it is sometimes the first thing noticed, and often attributed to age or exercise instead.
- Itchy or crawling skin, and a feeling of dryness that moisturiser does not fix.
- Tinnitus, dizziness and heart palpitations — unsettling, and worth mentioning to a GP so that other causes get ruled out rather than assumed.
- Burning mouth, altered taste, or a metallic taste.
- Changes in body odour, and new sensitivities to smell.
- Recurrent urinary or vaginal symptoms, including thrush that keeps returning — falling oestrogen changes the tissue and the local environment, so infections that were occasional can become repetitive.
- Worsening of existing conditions — migraine, IBS, eczema and asthma can all become less predictable.
Being told a symptom is "just menopause" is not the same as it being investigated. New palpitations, unexplained weight loss, or bleeding that is unusual for you all deserve proper assessment rather than attribution.
Ovulation, periods and what is still happening
A common misconception is that perimenopause means ovulation has stopped. It has not — it has become irregular. You may still ovulate in some cycles and not others, which is why periods become unpredictable in length, timing and heaviness, and why pregnancy is still possible during perimenopause. Contraception is still needed: the usual guidance is to continue until two years after your last period if you are under 50, or one year if you are over 50.
Some women notice ovulation more during perimenopause than before — mid-cycle twinges, breast tenderness or a day or two of mood change — because hormone swings become larger and less smooth.
After menopause: what stops and what does not
Menopause itself is a single point in time: twelve months after your last period. Everything after that is postmenopause, and the symptom picture changes rather than simply ending.
Usually settle with time: hot flushes and night sweats for most women, though they can persist for years and for a minority continue into their sixties. Mood and sleep often improve as hormone levels stop fluctuating and settle at a lower level — it is the fluctuation, not the low level, that drives much of the difficulty.
Tend to continue or appear later: vaginal dryness, discomfort during sex and urinary symptoms, which are caused by sustained low oestrogen and usually do not resolve on their own. Joint aches and skin changes often continue too.
So "when do menopause symptoms stop?" has no single answer. The vasomotor symptoms — flushes and sweats — typically ease over several years. The genitourinary ones generally do not, and are very treatable, which is worth knowing because they are also the ones women are least likely to raise.
Any bleeding after menopause needs checking, however light and whatever you assume the cause to be. Our guide to bleeding after menopause explains why it is always investigated. For how the phases fit together, see the stages of menopause.
Could it be something else?
Several conditions cause symptoms that overlap with perimenopause, which is one reason a GP visit is worth it rather than assuming. Your GP decides which tests, if any, you need.
| Condition | Overlapping symptoms |
|---|---|
| Underactive thyroid | Tiredness, low mood, weight gain, poor concentration, heavier or irregular periods (NHS) |
| Overactive thyroid | Anxiety, poor sleep, feeling hot, palpitations, itchy skin (NHS) |
| Iron-deficiency anaemia | Tiredness, palpitations, headaches; often caused by heavy periods (NHS) |
| Depression or anxiety | Low mood, poor sleep, poor concentration |
If your symptoms could point to your thyroid, our guide to thyroid blood test results explains what those tests show. These conditions can also exist alongside perimenopause.
What can help
There are effective options, and the right choice depends on your symptoms, health and preferences. A clinician should talk you through the benefits and risks of each (NICE NG23).
Wondering about supplements? Our guide to menopause supplements and what the evidence shows goes through black cohosh, red clover and the rest.
Lifestyle steps the NHS suggests (NHS):
- keep a regular sleep routine, and eat a healthy diet with enough calcium
- do regular weight-bearing and strengthening exercise (aim for around 150 minutes of activity a week, including strength work — Women's Health Concern)
- try relaxation approaches such as yoga, tai chi or meditation
- for hot flushes, keep cool with light clothing and a fan, and cut common triggers such as spicy food, caffeine, alcohol and smoking
- for vaginal dryness, moisturisers and lubricants can help
Talking therapy. NICE recommends menopause-specific cognitive behavioural therapy (CBT) as an option for hot flushes and night sweats, for the sleep problems they cause, and for low mood (NICE NG23).
Hormone replacement therapy (HRT). For many women, HRT is an effective treatment for menopausal symptoms, and NICE says the decision should be based on an individual discussion of the benefits and risks (NICE NG23). Overall, NICE notes that HRT is unlikely to affect your life expectancy. Whether it's suitable, and which type, is a conversation to have with a clinician who knows your history.
Renvo can help. Our menopause consultations start with a free conversation with a GP who specialises in this area — no forms to fill in first — to talk through your symptoms and the options that fit you. Book a free consultation
When to see a GP urgently
Most perimenopause symptoms aren't an emergency, but some bleeding patterns always need checking. See a GP if (NHS; NHS postmenopausal bleeding):
- you have any vaginal bleeding after menopause (12 or more months since your last period) — even if it's only once, and even though it's usually not serious, it needs to be checked
- your periods become much heavier, or you bleed between periods or after sex
- you have symptoms and you're under 45
- your symptoms are hard to cope with, or affecting your daily life or mental health
If you ever feel unable to keep yourself safe, call 999 or go to A&E. For urgent mental health support, call NHS 111 and choose the mental health option, or call Samaritans free on 116 123 (NHS).
Remember that pregnancy is still possible during perimenopause. Guidance is to keep using contraception until you've had no period for 2 years if you're under 50, or 1 year if you're 50 or over (Women's Health Concern).
If treatment is on the table, our guide to HRT side effects covers what to expect in the first few months.
Honest FAQs
What are the first signs of perimenopause?
Often the first sign is a change in your periods — they become more or less frequent, or heavier or lighter. Hot flushes, night sweats, disturbed sleep and mood changes commonly appear around the same time (NHS).
Can perimenopause start at 40, or in your late 30s?
Yes. Perimenopause can begin in your late 30s or early 40s (Women's Health Concern). If menopausal symptoms start before 40, see a GP, as this needs assessment.
Can a blood test tell if I'm perimenopausal?
If you're 45 or over with typical symptoms, NICE says no test is needed — it's identified from your symptoms. Between 40 and 45, or under 40, an FSH blood test may be considered (NICE NG23).
Does perimenopause make you tired all the time?
Tiredness is common, often driven by disturbed sleep and night sweats. In a UK survey, sleep problems were among the most common symptoms reported (CIPD, 2023). Because tiredness also has other causes, such as thyroid problems or anaemia, it's worth discussing with a GP.
How long does perimenopause last?
There's no single figure, but menopausal symptoms overall usually last about 7 to 9 years, and sometimes longer (NHS).
This article is general information, not medical advice. Always speak to a qualified clinician about your own symptoms and treatment.
