What are the signs of perimenopause?

Perimenopause is the time before your periods stop, when your hormone levels are changing and symptoms begin. The most common signs are changes to your periods, hot flushes and night sweats, trouble sleeping, mood changes such as anxiety or low mood, and problems with memory or concentration, often called brain fog. According to the HSE, symptoms can start 7 to 10 years before your periods stop, so they can begin well before your periods actually stop.

Perimenopause and menopause: what’s the difference?

The terms get mixed up a lot, so here’s how the HSE and NHS use them:

• Perimenopause is when you have symptoms but your periods haven’t stopped completely.
• Menopause is reached when you haven’t had a period for 12 months. The HSE says this usually happens between 45 and 55, and the average age in Ireland is 51.
• Postmenopause is the time after that.

It happens because your ovaries make less oestrogen and stop releasing an egg each month. Symptoms don’t always stop when your periods do: the HSE says most last around 4 years from your last period, while around 1 in 10 people have them for up to 12 years. The NHS says symptoms usually last 7 to 9 years, sometimes longer. Both agree it’s different for everyone.

Changes to your periods

Often the first thing women notice is that their periods change. The HSE and NHS describe:

• cycles getting shorter or longer
• periods that are lighter or heavier than usual
• periods lasting more or fewer days
• skipped periods, which the HSE says are common

Physical signs

Between them, the HSE and NHS list a wide range of physical symptoms, including:

• hot flushes and night sweats: sudden heat in the face, neck and chest, sometimes with a racing heart, anxiety or dizziness
• trouble sleeping
• headaches, and migraines that are worse than usual
• heart palpitations, where your heartbeat feels faster, slower or more noticeable
• joint aches, muscle pains and loss of muscle
• weight gain, which the NHS says often happens around the stomach and upper body
• vaginal dryness, itching or discomfort, and pain during sex
• lower sex drive
• urine infections (UTIs) that keep coming back, and needing to pee more often
• thinning hair, dry or itchy skin
• sensitive teeth or sore gums

Lower oestrogen also affects your bones: both services note a higher risk of osteoporosis (weak bones) after menopause.

Mood and mind

These signs are easy to put down to stress or a busy life. The HSE lists low mood, anxiety, mood swings, low self-esteem and irritability, as well as problems with memory and concentration. The NHS also mentions depression and brain fog.

If your mood has dropped a lot or you’re finding it hard to cope, please don’t wait it out. Talk to your GP.

How is perimenopause diagnosed?

There isn’t one single test. The HSE says your GP can usually confirm it based on your symptoms, and may suggest a blood test to check your hormone levels.

The NHS adds two useful points. Hormonal contraception can make it hard to tell whether you’ve reached perimenopause or menopause. And you can still get pregnant during perimenopause, so the NHS advises using contraception until 1 year after your last period if you’re 50 or over, or 2 years after if you’re aged 40 to 49.

When to see your GP

The HSE suggests contacting your GP if:

• your symptoms are worrying you or affecting your daily life
• you’re having symptoms before the age of 45
• your periods have stopped for a year or more before 45

Around 1 in 100 women reach menopause before 40, which is called premature ovarian insufficiency. Early menopause can also follow surgery to remove the ovaries or some cancer treatments, and symptoms can be stronger when it happens suddenly.

The NHS also suggests seeing your GP if you have palpitations, or if your bleeding pattern has changed and you’re bleeding more rather than less.

Bleeding after menopause always needs checking. If you haven’t had a period for 12 months or more and then have any vaginal bleeding, contact your GP, even if it’s only once, only spotting, or pink or brown discharge. The NHS says it’s not usually serious, but it can be a sign of cancer, which is easier to treat if found early.

What to do next

• Keep a note of your symptoms for a few weeks: what you notice, when, and how it affects your day, along with your period dates. It makes a GP appointment far more useful.
• Book a GP appointment if your symptoms are getting in the way of work, sleep or relationships, or if you’re under 45. Bring your notes and ask directly whether this could be perimenopause and what your options are.
• Don’t ignore bleeding after menopause, or periods that are getting much heavier. Ring your GP.
• Read up on the treatment options before your appointment so you can ask good questions, and remember that your GP or pharmacist is the right person to advise on what suits you.