Perimenopause symptoms: every sign, with a checklist

Short answer: perimenopause usually starts between 40 and 50. The first signs are often a cycle that gets shorter, longer or more irregular, poorer sleep and mood swings. Hot flushes and night sweats often come later. If you recognise several signs from the checklist below and you are over 40, it is worth talking to your GP.

What is perimenopause exactly?

Perimenopause is the time when your ovaries slowly make fewer hormones and your periods eventually stop. The years before your last period are the perimenopause. The last period itself is the menopause; you only know it afterwards, once you have had no period for 12 months. On average that is around 51. Also read the difference between perimenopause and menopause.

The symptoms at a glance

Your cycle changes

Often the first sign. Your cycles get shorter or longer, you skip a month, or you suddenly bleed much more heavily or for longer than you are used to.

Hot flushes and night sweats

A sudden wave of heat in your face, neck and chest, sometimes with sweating and palpitations. At night it is called night sweats. Read what happens in a hot flush and what helps.

Poor sleep

Trouble falling asleep, waking often or lying wide awake at four. Sometimes because of night sweats, sometimes without a clear reason.

Mood and irritability

Getting irritated faster, feeling low or anxious, or furious about something small. Many women briefly do not recognise themselves.

Forgetfulness and poor concentration

Words that will not come, losing track of what you were doing. Often called brain fog.

Joints and muscles

Stiff or aching joints and muscles, without doing anything differently.

Vagina, bladder and sex drive

Vaginal dryness, pain during sex, a lower sex drive, needing to pee more often or getting cystitis more easily.

Palpitations, headaches and skin

Palpitations, more headaches or migraines, dry or itchy skin and thinner hair are also among the symptoms many women mention.

Checklist: does this sound familiar?

• You are over 40.
• Your cycle has clearly changed in recent months.
• You have hot flushes or sweat at night.
• You sleep worse than a year ago.
• Your mood swings all over the place.
• You forget words or appointments more often.
• Your joints or muscles ache more often.
• Your vagina is drier or your sex drive is lower.

Recognise three or more? Then it fits perimenopause. It is not a diagnosis: the same symptoms can have another cause, such as your thyroid, low iron or stress. That is why a talk with your GP makes sense.

When to see your GP

• When symptoms seriously affect your daily life, work or sleep.
• When you are under 40 and your periods stop.
• Always for bleeding after 12 months without periods, very heavy or long bleeding, or bleeding after sex.

If you are over 45, a blood test is usually not needed: your GP looks at your age, your cycle and your symptoms. Read how to prepare for your GP appointment.

Tracking your symptoms helps

Perimenopause symptoms come and go, and in a ten minute appointment you forget half of it. Logging when hot flushes come, how you sleep and how your cycle changes shows patterns and makes the conversation concrete. In PERIOD. meno you log a hot flush in one tap, track your symptoms and HRT, and make a report for your GP.

Sources: NHS, Perimenopause and Menopause symptoms; NICE NG23; Thuisarts.nl (NHG), Overgang. This article is general information, not medical advice.

Frequently asked questions

What are the first signs of perimenopause?

Often a changing cycle: shorter, longer, more irregular or heavier. Poor sleep, mood swings and hot flushes often follow.

How long does perimenopause last?

Usually several years. Symptoms often start years before the last period and can continue for a while afterwards.

Is there a test for perimenopause?

Over 45 it is usually not needed: your GP looks at your age, cycle and symptoms. Hormone levels swing a lot in these years, so a single test says little. A checklist like the one above does help you put your symptoms in order.

Can you get pregnant during perimenopause?

Yes. As long as you still have periods, or your last period was less than a year ago, you can get pregnant. Talk to your GP about contraception.

Want a clear overview of your perimenopause? Download PERIOD. on the App Store or Google Play.