All the symptoms of perimenopause

The pattern differs from person to person: symptoms may come and go, change in intensity, or overlap. A new symptom should not automatically be attributed to perimenopause because thyroid problems, pregnancy, medicines and other conditions can produce similar changes.

Periods may become closer together or farther apart, and the flow may be heavier or lighter. A skipped period can occur, but pregnancy remains possible while ovulation is still happening.

Temperature symptoms include sudden heat in the face, neck or chest, sweating, chills and night sweats. Poor sleep can then contribute to daytime tiredness, irritability, headaches, forgetfulness and difficulty concentrating. Some people notice anxiety, low mood, mood swings or a more noticeable heartbeat.

Physical changes may include vaginal dryness, discomfort during sex, reduced sexual desire, urinary urgency, joint or muscle aches, dry or itchy skin, hair changes and migraine changes. Having some of these symptoms does not mean that every symptom will develop.

Keep a simple diary of bleeding, sleep, flushes, mood, headaches and medicines. Record what interferes with work, exercise, relationships or rest; this gives a clinician a clearer picture than a list remembered during an appointment.

For comfort, use light layers and a cool sleeping space, maintain regular sleep and movement routines, and use a vaginal moisturiser or compatible lubricant if dryness is troublesome. Discuss contraception if pregnancy is possible. Treatment can be matched to the symptoms that matter most and may include hormonal or non-hormonal options after reviewing your health history.

Arrange a medical assessment for bleeding between periods, bleeding after sex, very heavy bleeding, or any vaginal bleeding after menopause. Seek urgent help if bleeding is accompanied by fainting, marked weakness, severe pelvic pain, chest pain or trouble breathing.

Contact a clinician if low mood, anxiety, poor sleep, palpitations, urinary symptoms or pain are persistent or affecting daily life. Get urgent mental health support if you feel unsafe or have thoughts of harming yourself.

Useful questions include: Could another condition or medicine explain my changes? Do I need a pregnancy test or an assessment of this bleeding? Which treatments fit my main symptoms and medical history? How could treatment interact with contraception? What changes should prompt another appointment?