What should you know about symptoms before menopause?

The transition before menopause can bring cycles that become shorter, longer, heavier or lighter. Some people notice hot flushes or night sweats, disturbed sleep, headaches, breast tenderness, lower mood, irritability or difficulty concentrating. Vaginal dryness, discomfort with sex and lower sexual desire can also occur. Symptoms may come and go, and one symptom alone does not establish the cause.

Similar changes can happen with pregnancy, thyroid problems, anaemia, medication effects or other gynaecological conditions. Pelvic pressure or a bulge is not a typical menopause symptom and may need assessment for another cause, including pelvic organ prolapse.

Keep a simple record of cycle dates, bleeding changes, flushes, sleep, mood and vaginal symptoms. Note medicines, contraception and any chance of pregnancy. Regular meals, hydration, layers of clothing and a cool bedroom may make flushes or night sweats easier to manage. Vaginal moisturisers or lubricants can help some people with dryness; a clinician can discuss other options based on your health history.

Arrange an appointment if symptoms interfere with work, sleep, relationships or daily activities. Assessment may include a symptom history and examination, with tests chosen according to age, bleeding pattern and other findings.

Seek prompt care for very heavy bleeding, bleeding after sex, bleeding after twelve months without periods, severe pelvic pain, fainting or new neurological symptoms. Contact a clinician for persistent low mood, distressing anxiety or sleep loss, especially if you feel unsafe. Sudden chest pain or breathing difficulty needs emergency help.

Could these changes be perimenopause or another condition? Do my bleeding pattern and medicines need review? Which options could help flushes, sleep or vaginal dryness? Do I need contraception or pregnancy testing? What bleeding symptoms should I report?