What to know about perimenopause

Periods may become less predictable, while hot flushes, night sweats, sleep disturbance, vaginal dryness, mood changes or reduced sexual desire can appear. Experiences vary, and pregnancy remains possible while ovulation still occurs.

Hormone levels fluctuate as the ovaries gradually change their activity. Bleeding can become heavier or lighter, and cycles may shorten, lengthen or be missed. Symptoms can also shift over time rather than following a fixed sequence.

There is no single test that explains every experience. A clinician often considers your cycle pattern, symptoms, medicines, contraception, pregnancy possibility and other health conditions before deciding whether tests are useful.

Record bleeding days, flow changes, hot flushes, sleep, mood and any vaginal or urinary discomfort. This can reveal patterns and make a consultation more focused. Regular movement, a consistent sleep routine and reducing personal flush triggers may help some symptoms.

Discuss treatment when symptoms disrupt work, relationships, rest or daily activities. Options depend on which problems matter most and may include hormone therapy, non-hormonal medicines, vaginal treatments, contraception adjustments or targeted support for sleep and mood.

Arrange medical review for bleeding that is much heavier than your usual pattern, bleeding between periods, bleeding after sex, new pelvic pain, or symptoms of anaemia such as breathlessness, marked weakness or dizziness. Perimenopause can change bleeding, but it should not automatically be assumed to explain every change.

Take a pregnancy test and seek advice if a period is missed and pregnancy is possible. Any bleeding after menopause needs assessment. Obtain urgent care for extremely heavy bleeding, fainting, severe chest pain, breathing difficulty or thoughts of harming yourself.

Ask whether your bleeding pattern needs investigation, how contraception fits with symptom treatment, and which options suit your medical history. Mention migraines, clotting problems, breast or womb conditions, pregnancy plans, and every medicine or supplement you use.