What are the first signs of menopause?

Menopause is reached when periods have stopped for twelve months; the earlier transition is called perimenopause. During that transition, cycles may become shorter, longer, lighter, or heavier. Symptoms can come and go rather than arriving in a predictable order.

You may notice [Hot Flushes](/symptoms/hot-flushes/), [Night Sweats](/symptoms/night-sweats/), reduced concentration, irritability, low mood, sleep difficulty, lower sexual desire, or dryness. Other health conditions and medicines can cause similar changes, so the overall pattern matters.

Record period dates, bleeding changes, sleep, temperature episodes, mood, and vaginal or urinary symptoms. Wear easily removable layers, keep the bedroom cool, and protect sleep routines. Arrange a review if symptoms affect work, relationships, or wellbeing. Discuss options suited to your health history and preferences, including support for [Vaginal Dryness](/symptoms/vaginal-dryness/).

Seek medical advice for very heavy, prolonged, or unusually painful bleeding, bleeding between periods, or any bleeding after menopause. Arrange earlier assessment if menopause-like symptoms begin at an unexpectedly young age, are severe, or follow a new medicine. Urgent help is needed for fainting, severe weakness, chest pain, or sudden neurological symptoms.

Do my symptoms fit perimenopause, or should we check another cause? Which treatments are suitable with my medical history? How can we manage sleep, mood, sexual symptoms, and bleeding changes together?