What to know about the time before menopause

This transition is called perimenopause. Symptoms may begin while periods are still happening, and their pattern can shift over time. Some people have few changes, while others find that sleep disruption, bleeding changes, or hot flushes affect daily life.

Menopause is reached after twelve consecutive months without a menstrual period when there is no other cause. Until then, cycle length and flow may become less predictable. Pregnancy can still occur during perimenopause, so contraception remains relevant until a clinician confirms when it can be stopped.

Hot flushes, night sweats, lower sexual desire, mood changes, vaginal dryness, headaches, joint discomfort, and difficulty concentrating can occur. These experiences can also have other causes, including thyroid problems, pregnancy, medicine effects, anaemia, or a mental health condition, so a new or disruptive symptom deserves an individual assessment.

Keep a simple record of period dates, bleeding pattern, hot flushes, sleep, mood, and medicines. Note what interferes with work, exercise, intimacy, or rest; this helps a clinician discuss options based on your priorities rather than on a single symptom.

Regular movement, consistent sleep routines, breathable layers, and limiting personal triggers such as alcohol or spicy food may ease some symptoms. Vaginal moisturisers can support ongoing dryness, while lubricants can reduce friction during sex. A clinician can explain hormonal and non-hormonal treatments, including which choices fit your health history.

Arrange medical care for very heavy bleeding, bleeding between periods, bleeding after sex, or any vaginal bleeding after menopause. Seek urgent help for chest pain, difficulty breathing, fainting, sudden weakness, or thoughts of harming yourself. Urgency comes from the symptom itself, not from whether it is typical of perimenopause.

Book a routine appointment when symptoms repeatedly disturb sleep, mood, relationships, or everyday activities. Pelvic pressure, a vaginal bulge, urinary leakage, or trouble emptying the bladder also merits assessment because pelvic floor conditions can coexist with midlife changes.

Ask whether your symptom pattern fits perimenopause or needs another explanation, whether any examination or test would change management, and which treatment options target your most troublesome concern. Also discuss contraception, bone and heart health, vaginal or urinary symptoms, migraine, family history, and any previous breast cancer or blood clot before choosing hormone treatment.