Perimenopause: the signs, and what helps

Why it is often missed

Because periods continue, many people don’t connect new symptoms with their hormones. Anxiety or low mood can be treated as depression on its own, poor sleep as stress, and blood tests can look normal because hormone levels swing from day to day.

Common early signs

• Changes to your cycle: shorter, longer, heavier, lighter or less predictable periods
• Worse premenstrual symptoms than before
• Night sweats or hot flushes, sometimes only before a period
• Waking in the early hours and struggling to get back to sleep
• Anxiety, irritability or low mood that feels out of character
• Brain fog, poor concentration or losing words
• Joint aches, headaches or tiredness

Is there a test?

If you are over 45 with typical symptoms, usually not. NICE guidance recommends diagnosing perimenopause from your symptoms, because hormone tests change so much from day to day that they rarely help. Tests can be useful if you are under 45 or your symptoms are unusual.

You can still get pregnant

Contraception is still needed during perimenopause: until two years after your last period if you are under 50, or one year after if you are over 50. HRT is not a contraceptive, though some options, such as the hormonal coil, can do both jobs.

What helps

Options include HRT, non-hormonal treatments, cognitive behavioural therapy (CBT) and lifestyle changes. HRT can be started during perimenopause, while you are still having periods. The right choice depends on your symptoms, your health and your preferences, which is what a consultation is for.

Read about HRT or non-hormonal options.