Perimenopause can be difficult to recognise because it does not follow one predictable pattern. Some women notice changes to their periods first, while others become aware of sleep problems, anxiety, brain fog, hot flushes or unexplained changes in their mood. It's therefore completely possible to experience several symptoms without immediately connecting them to hormonal changes.
Perimenopause usually occurs during 'midlife', although it can begin earlier. Periods may become irregular, heavier, lighter or more widely spaced. Symptoms can change over time, and not everyone experiences hot flushes despite how much it's talked about. The NHS guide to perimenopause symptoms lists a wide range of possible other effects including headaches, joint pain, vaginal dryness, palpitations and difficulties with concentration.
"Women, like men, should try to do the impossible. And when they fail, their failure should be but a challenge to others." - Amelia Earhart
One common misconception is that a woman must be in her late 40s or 50s before perimenopause can be considered. Menopause does usually occur between 45 and 55, but earlier menopause is possible. If symptoms begin before 45, it is particularly important to discuss them with a healthcare professional because other investigations or treatment considerations may apply.
There is no single routine test that confirms perimenopause in every woman though. For otherwise healthy women aged 45 or over, NICE recommends identifying the condition through symptoms and menstrual changes rather than routinely relying on blood tests. Hormonal contraception can make this more complicated because it may alter or stop periods, so hopefully you have a clinician who can consider the wider picture.
Keeping a record can make any medical consultation more useful. Note changes in bleeding, sleep, mood, temperature sensitivity, pain, concentration and any effect symptoms have on work or relationships. Then, rather than simply saying "I don't feel like myself", you can clearly explain when the problem began, all the symptoms you're experiencing, how frequently they occur, and so on. Unfortunately, "I don't feel like myself" is one of the most common things said to a doctor. But it is pretty much useless as a diagnostic indicator.
You will see and hear about a lot of women who simply put up with symptoms. That doesn't mean you have to as well. Depending on personal circumstances, a clinician may discuss hormone replacement therapy, menopause-specific cognitive behavioural therapy or other approaches. HRT is not suitable for everyone and the benefits, risks, and alternatives should be considered individually.
At the very least, perimenopause should not be used as an explanation for every new symptom without appropriate consideration. Persistent, severe, or unusual problems deserve medical attention even when hormonal changes seem a likely cause. The practical goal is not to obtain a label and then dismiss issues as simply being a part of later life.
Please note: our help articles are not a substitute for professional advice. We provide general information to boost knowledge prior to speaking to a qualified provider and links to useful resources. Articles in this section are by our team, but we do include submitted guest posts in other marked ares.
