When does perimenopause start?

During perimenopause, ovarian hormone levels fluctuate rather than changing in a steady pattern. Periods may become closer together, farther apart, heavier, or lighter; some cycles may be missed. Hot flushes, night sweats, sleep disruption, mood changes, vaginal dryness, or lower sexual desire can also occur. Symptoms differ widely, and a change in bleeding can have causes unrelated to perimenopause.

Track bleeding dates, flow changes, sleep, temperature symptoms, and mood for several weeks. This record can help a clinician assess the pattern. Use breathable layers for heat symptoms, protect sleep routines, and discuss contraception if pregnancy is possible because ovulation may continue during the transition. A clinician can also review medicines and health conditions that may affect bleeding.

Arrange medical advice for bleeding between periods, bleeding after sex, very heavy flow, bleeding that continues unusually long, or symptoms that interfere with daily life. Seek urgent care for bleeding that makes you faint, feel markedly weak, or rapidly soak through protection. Any bleeding after menopause needs assessment.

Could another condition explain my bleeding pattern? Which treatments could help my sleep, flushes, mood, or vaginal symptoms? Do I still need contraception, and what warning signs should prompt an urgent review?