What should you know about hormonal changes during perimenopause?

Oestrogen and progesterone may rise and fall unpredictably as ovulation becomes less consistent. Periods may arrive earlier or later, last a different length or become heavier. Irregular periods and missed periods can occur, but pregnancy remains possible until menopause is established.

Hormone shifts can also bring hot flushes, night sweats, sleep disturbance, headaches, lower sex drive or menopausal mood changes. Symptoms may be present in one cycle and absent in another. A symptom does not by itself diagnose perimenopause; thyroid problems, pregnancy, anaemia, medicines and other conditions can overlap.

Keep a simple record of bleeding, headaches, sleep, hot flushes, medicines and contraception. Regular meals, hydration, movement, relaxation practice and a cooler sleeping environment can support day-to-day wellbeing. If symptoms interfere with work, relationships or rest, a clinician can discuss hormonal and non-hormonal treatments.

Use contraception if pregnancy is not wanted, because ovulation can still occur during the transition. Ask for advice before using hormones if you have migraine with aura, a history of clots, liver disease or hormone-sensitive cancer. Heavy bleeding may require assessment for iron deficiency and other causes.

Arrange a clinical review for heavy periods, bleeding between periods, bleeding after sex, persistent pelvic pain or a new change that is difficult to manage. Seek advice for a missed period when pregnancy is possible, or when symptoms suggest another illness.

Get urgent help for bleeding that makes you faint or weak, sudden severe headache, new weakness or trouble speaking, chest pain, severe breathlessness or one-sided leg swelling. These warning signs should not be explained away as hormone changes.

Ask whether your pattern fits perimenopause, whether tests are needed to exclude another cause, and which treatment suits your bleeding and headache history. Discuss contraception, fertility, mood, sleep and when to review symptoms.