What are the first signs of perimenopause?

Perimenopause is the transition before menopause, when ovarian hormone patterns become less predictable. Periods may arrive earlier or later, last a different length of time, or change in flow. Some people notice temperature surges, night sweats, lighter sleep, irritability, low mood, reduced concentration, headaches, or vaginal dryness. These symptoms can vary from month to month, and a missed period does not by itself confirm perimenopause because pregnancy, stress, illness, and contraception can also alter bleeding.

Track bleeding, sleep, temperature symptoms, mood, and vaginal discomfort for several weeks. Use breathable layers, keep the bedroom cool, and consider a vaginal moisturiser or lubricant for dryness. Arrange a clinical review if symptoms affect work, relationships, or sleep. Your clinician can discuss contraception, a hormonal coil, hormone replacement therapy, or non-hormonal menopause treatment based on your health and preferences.

Seek prompt advice for very heavy bleeding, bleeding after sex, bleeding after menopause, persistent pelvic pain, or symptoms that begin unexpectedly and feel severe. If pregnancy is possible, take a pregnancy test rather than assuming a missed period is part of the menopause transition.

Ask whether your pattern fits perimenopause, whether another condition or medicine could explain it, and whether you still need contraception. Discuss the benefits and cautions of hormone replacement therapy, and what non-hormonal options may help particular symptoms.