What should you know about physical symptoms of perimenopause?

Perimenopause is the stage when ovarian hormone patterns become less predictable before periods stop. Bleeding may arrive earlier or later, last longer or become lighter; some cycles may be missed. Temperature changes can cause flushing or sweating at night, while sleep loss may leave you tired during the day. Vaginal dryness, discomfort during sex, urinary changes, headaches, joint aches and lower sexual desire can also occur.

Mood changes can accompany these physical symptoms, but new or severe symptoms should not automatically be attributed to hormones. Pregnancy, thyroid conditions, anaemia, medicines and other health problems can also affect bleeding, sleep or energy.

Track bleeding, flushes, sleep and triggers so you can describe patterns at an appointment. Keep the bedroom cool, use breathable layers and consider a fan for night sweats. Regular movement, steady meals and a consistent sleep routine may support wellbeing. Water-based lubricant or vaginal moisturiser can help dryness. A clinician can discuss menopause treatment and check whether a hormonal or non-hormonal option fits your health history.

Arrange medical review for bleeding between periods, after sex, or after periods have stopped; very heavy bleeding; dizziness or breathlessness; new pelvic pain; or symptoms that interfere with daily life. Seek urgent help for soaking through protection repeatedly, fainting, severe pain or sudden neurological symptoms. A clinician can assess heavy periods or irregular cycles instead of assuming they are part of perimenopause.

Could another condition explain my bleeding or fatigue? Which treatments could help flushes, sleep or vaginal symptoms? What monitoring do I need?