Early perimenopause

During perimenopause, ovarian hormone production fluctuates rather than changing in a steady line. Periods may come closer together, further apart, become heavier or be missed. Hot flushes, night sweats, sleep disruption, vaginal dryness, lower sexual desire and mood changes may also occur. Similar symptoms can come from pregnancy, thyroid problems, anaemia, medicines or other health conditions, so symptoms alone do not establish the cause. Earlier changes deserve a clinical conversation, particularly if they affect fertility, bones, sleep or emotional wellbeing.

Keep a record of bleeding dates, flow changes, hot flushes, sleep, mood, medicines and contraception. A clinician may review your history, examine you and order tests when another cause needs consideration. Discuss contraception because ovulation can continue during the transition. Treatment choices depend on symptoms, age, medical history and pregnancy plans; options may include lifestyle measures, local treatments or hormone-based treatment when appropriate. Regular movement, adequate nourishment, sleep routines and reducing smoking can support general health.

Arrange medical review for bleeding that is very heavy, prolonged, happens after sex, or returns after a long gap. Seek urgent help for soaking bleeding with dizziness, fainting, severe pain or marked weakness. New chest pain, sudden breathlessness, or one-sided weakness also needs emergency care and should not be attributed to perimenopause.

Ask which causes should be ruled out, whether testing is useful, how to protect bone and heart health, and which symptom treatments suit your medical history.