Perimenopause

Perimenopause is the hormone transition before menopause, causing changing periods and symptoms such as hot flushes, sleep disruption and mood changes.

Perimenopause is the phase before menopause, when ovarian hormone production becomes less predictable. Periods may become closer together, further apart, heavier, lighter or occasionally absent. Menopause is reached after twelve months without a period, provided another cause has not been found.

Perimenopause is a normal life stage, but symptoms can affect sleep, work, relationships and sexual comfort. The experience varies: some people notice mostly cycle changes, while others have hot flushes, night sweats, vaginal dryness or concentration difficulties.

Very common presentations include [Irregular Periods](/symptoms/irregular-periods/), hot flushes, night sweats, mood changes and menopausal brain fog. Lower oestrogen can also contribute to vaginal dryness and reduced sexual desire. Heavy bleeding or a missed period can occur, although bleeding changes should still be assessed when they are new, severe or disruptive.

The ovaries gradually release eggs less consistently and produce fluctuating amounts of oestrogen and progesterone. These shifts affect the uterine lining, brain temperature regulation, sleep, vaginal tissues and menstrual timing. Perimenopause can also begin earlier after some operations or medical treatments that affect ovarian function.

Symptoms may come and go, and one month can feel different from the next. Periods often become less predictable before stopping. A symptom diary can record bleeding, hot flushes, sleep, mood and medicines, making patterns easier to discuss during an appointment.

Timing is influenced by family history and individual health. Smoking, some cancer treatments, surgery involving the ovaries and certain autoimmune conditions may be associated with an earlier or more abrupt transition. These factors do not determine exactly when symptoms will begin.

For many people over forty-five, a clinician can recognise perimenopause from age, symptoms and changing periods without a hormone test. Examination and blood tests may be considered when symptoms are unusual, periods stop unexpectedly, pregnancy is possible, or another condition needs checking. New heavy bleeding may need assessment of the cervix, womb lining or blood count.

Treatment is guided by symptoms, medical history and personal preferences. Hormone Replacement Therapy can relieve several menopause-related symptoms when suitable. Non-Hormonal Menopause Treatment may help when hormones are unsuitable or not wanted. A Hormonal Coil can reduce heavy bleeding and may provide contraception; it can sometimes be used alongside other treatment. Vaginal moisturisers, lubricants, regular movement, layered clothing and a cool bedroom may also help.

Keep a simple symptom record and use practical changes that match your triggers. Protect sleep with a regular routine, limit bedroom heat and consider discussing intimacy concerns early. Contraception may still be needed while periods continue, because ovulation can occur unpredictably.

Seek prompt assessment for bleeding after twelve months without periods, bleeding between periods, bleeding after sex, or flow that causes dizziness or rapid soaking of protection. Severe low mood, thoughts of self-harm, chest pain or sudden breathlessness require urgent help. These symptoms should not be assumed to be perimenopause.

Perimenopause cannot be prevented, but health habits can support bones, heart health, sleep and mood. Avoid smoking, stay physically active, eat a varied diet and address blood pressure or other long-term conditions with a clinician.

A family doctor, gynaecologist or menopause-focused clinician can review changing periods, screen for other causes and discuss treatment. Bring your symptom record and mention migraine, clotting history, breast or womb conditions, liver disease, medicines and pregnancy plans.