Awareness has increased about perimenopause, especially via social media, but how is it really defined? When does it happen and what will it be like for me?
In this guide, we address the most commonly asked questions about this key transition in every woman’s life and offer plenty of practical advice to help you along the way.
This guide is for women entering perimenopause naturally. If you are under 40 years, you may also wish to read our guide on Early Menopause and POI. If you have had medical treatment or interventions that induced menopause, please read our guide on Surgical Menopause.
When does perimenopause begin?
To explain this, it’s useful to know what menopause is. Menopause is defined as the point in time when you haven’t had a period for 12 consecutive months. In the UK, women are on average 51 years when this happens.
Hormones start to change a long time before this though, usually many years before periods stop altogether. Firstly, progesterone levels fall and then estrogen follows suit and these hormone changes bring noticeable differences for most women – physically, psychologically and emotionally. Alongside this, testosterone levels decline gradually over time and stabilise around the age of 60.
Perimenopause describes the years leading up to menopause when these changes (symptoms) are happening. For some women, this may even be up to 10 years before the menopause.
It’s not uncommon therefore, for women to start perimenopause in their late 30s or early 40s. Menopause related hormone changes are not something women are usually thinking about at this age, so it can often go unrecognised (and misdiagnosed) for years.
Common perimenopause symptoms
Symptoms are different for each woman, with huge variation in what happens first, how long it lasts for and how severe symptoms are. Some symptoms may only occur during perimenopause and others may stick around, lasting into menopause and beyond.
Here are the most common changes women notice in perimenopause, you can click on the ones in bold for more information:
Changes to periods
This is often the first sign. Periods can become lighter or heavier – you may get a lot more bleeding than you’re used to – your cycle can shorten or lengthen; you might have months without a period and then get one out of the blue. Finally, at some point, they’ll stop for good.
If you don’t have periods because of the type of contraceptive you use, you won’t have this as a clue that your hormones are starting to change.
Low mood and other emotional changes
You may feel worse than usual before you get your period or it might extend to feeling low and/or irritable more consistently. You may feel your moods change more easily and frequently, with extremes of rage or tearfulness, and these changes can really impact relationships at home and at work.
Read our Mood and Emotions guide to learn more.
Anxiety
This can be a big one in perimenopause and often one of the earlier symptoms to emerge.
It might look like increased worries about work performance, relationships, being a more nervous driver or passenger, or an increased tendency to ruminate over your health or the health of loved ones. Increased anxiety can negatively affect your confidence and self-esteem in all aspects of life.
Read our Anxiety guide to learn more.
Brain fog
This term describes a set of cognitive symptoms including poor concentration and recall, difficulty with finding the right word, forgetting names and problems with remembering information or plans. It can be significant and have a negative impact to the extent that many women wonder if they have early onset dementia.
Read our Brain fog guide to learn more.
Hot flushes and night sweats
These affect around 75% of women. Night sweats can lead to disturbed sleep which may already be a problem, further exacerbating levels of tiredness.
Read our Hot Flushes, Night Sweats, and Palpitations guide to learn more.
Palpitations
This is an awareness of your heartbeat that might feel like racing, irregular or skipped beats and it’s often associated with hot flushes and night sweats.
Read our Hot Flushes, Night Sweats, and Palpitations guide to learn more.
Muscle and joint aches and pains
As estrogen is anti-inflammatory, when levels fall in the body, joints can start to ache more and recovery time from muscle exertion or injury can increase.
Read our Aches and Pains guide to learn more.
Worsening headaches or migraine attacks
These can become more severe or more frequent if you already had them, or they may start for the first time at perimenopause.
Read our Migraine guide to learn more.
Loss of libido
Many women become less interested in sex around this time. Falling levels of estrogen and testosterone can negatively affect sexual arousal, receptiveness and level of pleasure experienced. This can cause distress for both parties and affect relationships.
You might want to have your loved one read our Guide for Partners, and whatever your relationship status, Revitalising Your Sex Life is full of useful information and advice.
Vaginal dryness
Estrogen plays a vital role in keeping the vagina well-lubricated and stretchy. As levels fall, the vaginal tissues become thinner, dryer and less able to expand. This can result in discomfort, soreness, and make intercourse more painful if left untreated.
Read our Vaginal Dryness guide to learn more.
Urinary changes and infection
Estrogen is important to maintain normal bladder control and flow of urine. When estrogen levels fall, changes to the structures of the bladder and urinary tract can cause you to need to wee more often (urinary frequency), and more desperately (urgency). You may also experience recurrent urinary tract infections or cystitis. You may need to get up to pass urine in the night and this can contribute to daytime tiredness and poor concentration.
Read our Genitourinary Syndrome of Menopause guide to learn more.
This list is not exhaustive. In fact, there’s around 40 symptoms linked with perimenopause and menopause. Hormone receptors exist throughout the body so when levels drop, it can lead to a wide range of symptoms including skin and hair changes, dry eyes and burning mouth, for example. You can read more about these in our 3 Surprising Menopause Symptoms You Might Not Know About blog.
How do I know I am in perimenopause?
If you are 45 or more, you have noticed a change in your periods and have one or more of the symptoms listed above, you are likely to be perimenopausal.
Tracking your symptoms can be a useful way of seeing how many you have and how things change over time. You can do this by using our Menopause Symptom Checker. This checker, along with your story, will enable a healthcare professional to diagnose perimenopause without the need for any tests.
If you are age 40-45 years, the same holds true. However, a healthcare professional may want to carry out some blood tests to exclude other causes for your symptoms such as anaemia and/or an underactive thyroid gland.
Tests to check the Follicle Stimulating Hormone (FSH) level are rarely helpful. A blood test is a single snapshot in time, levels fluctuate in perimenopause from day-to-day or even hour-to-hour so cannot be relied on for making a diagnosis.
If you are under 40, you may have Premature Ovarian Insufficiency. It is important to investigate a lack of periods in under 40-year-olds (usually done by blood tests), because a diagnosis of POI has implications for future health as well as fertility. Read our Early Menopause and POI guide for more information on this.
What can I do to help myself during perimenopause?
Perimenopause is a really good opportunity to reflect on your lifestyle habits and consider how they will shape your future health. What can seem like small decisions day-to-day about diet and activity levels, for example, make a big difference to your quality of life in your postmenopausal years.
We have a wealth of information available on these key areas of lifestyle.
Eat well
Our top tip is to keep it colourful and natural, with foods rich in protein, fibre, calcium and add in a vitamin D supplement. Read our Healthy Eating Strategies for Perimenopause and Menopause guide to learn more.
If your body shape is changing in ways you don’t want, read our Understanding Weight Change guide to understand more weight changes in perimenopause.
Keep moving
Keep it fun and frequent, combining activities that get the heart rate up and ones that make your muscles and joints work. This will lift your mood too.
Read The Importance of Exercise During Perimenopause and Menopause guide to learn more.
Manage worry and stress
Don’t let it build up – relax, reflect and reset regularly. Reconnect with yourself and others. Read our Anxiety guide to learn more.
If you’re struggling with other emotions, read our Mood and Emotions booklet.
Sleep well
One of the best things you can do for mind and body is give yourself a decent night’s sleep. Every night.
Read our Managing Sleep Disturbances During Menopause guide to learn more.
Connect
Meaningful relationships with others improves our wellbeing. Invest in your close connections and find support. Meaningful relationships with others improves our wellbeing. Invest in your close connections and find support with friends. If your relationships are suffering, take a look at our blog 5 Ways Perimenopause Can Affect Your Relationship.
You may wish to reconsider your intake of alcohol as it is a depressant, it can disrupt sleep and you may not feel you can tolerate it in the same way as you used to. And have a think about giving up if you smoke or vape. Alcohol and nicotine can exacerbate symptoms such as hot flushes and bring additional risks to your future health. Read How Kindness Can Help During Menopause blog to learn more.
What if I’m struggling to do all this?
We can all aspire to achieve lifestyle change but it can be a challenge when you do not feel at your best. This is not failure but an acknowledgement you need help.
If you have symptoms that are reducing your quality of life and impacting on home life, work life or relationships, speak to a healthcare professional to get tailored advice about what might work for you.
Everyone is different and no two women have the same experience of perimenopause. Get clued up about the different treatments available and then talk about the pros and cons of possible options with a trained clinician.
HRT for perimenopause symptoms
In perimenopause, the ovaries are no longer producing stable, consistent and adequate levels of hormones. Hormone Replacement Therapy or HRT refers to the replacement of one or more of the hormones estrogen, progesterone and testosterone:
- Estrogen can be given as a patch, gel or spray delivered across the skin, or as a tablet taken orally.
- Progestogen is needed if you take estrogen and you still have a womb. You can swallow it as a capsule or have a device inserted into your uterus that releases this hormone. There are also patches or tablets with estrogen and progestogen combined in one.
- Testosterone is mostly for women with low sex drive if HRT alone has not improved this. It is available in a cream or a gel.
- Local Vaginal Estrogen can be used alone or in combination with HRT for symptoms affecting the vulva, vagina and urinary function. Vaginal estrogen can be prescribed as a pessary, cream, gel or a ring that’s inserted into the vagina
Alternatives to HRT
Cognitive behavioural therapy
This talking therapy is recommended as an option for the management of anxiety and low mood and there’s even evidence that it can help hot flushes.
Prescription medications
HRT would be most woman’s first line choice for treating symptoms but for women who cannot take HRT or choose not to, there are various prescription medications that may help some perimenopausal symptoms. These include antidepressants such as Venlafaxine and Citalopram which show some benefit in reducing hot flushes. Other medications such as Clonidine and Gabapentin can be considered but are frequently associated with side effects. Newer medications such as fezolinetant can also be considered for helping hot sweats or flushes.
Herbal remedies
Some women find herbal remedies help some symptoms, however there is little good evidence that they help any more than a placebo would. You may wish to investigate helpful supplements to support perimenopause. Take a look at our HRT and Supplements blog to learn more.
What can I expect from taking HRT?
Relief of your symptoms
Often the dose needs some adjustment, but generally hot flushes and night sweats are relieved within a few weeks of starting. Low mood, anxiety and sleep disturbance take longer to settle but have usually improved within 3 months. Symptoms of vaginal dryness can take longer to settle and, in some women, can take up to a year.
Reduced risk of osteoporosis
In late perimenopause and early menopause, there is a period of rapid bone loss leading to weakness and increased risk of fracture. HRT reduces this bone loss resulting in reduced risk of the disease osteoporosis and less chance of breaking a bone in the future.
Reduced risk of cardiovascular disease
There is evidence that HRT started within 10 years of the menopause or below the age of 60 gives you a reduced risk of cardiovascular disease – the second most common cause of death in postmenopausal women.
If you’re going to start taking HRT for the first time, read our Guide to Starting Hormone Replacement Therapy (HRT)
Are there any risks from taking HRT?
Taking HRT is a very personal decision and you can discuss this with your doctor considering your symptoms and how they are impacting your life, your personal and medical history, any pre-existing medical conditions, your family history and whether or not you still have a womb (uterus).
Historically, there have been two risks associated with older types of HRT:
Breast cancer
This appears to be the most common worry for women when thinking about taking HRT but the reality is your personal breast cancer risk depends on many factors including age, family history, your weight, if you smoke, how much alcohol you drink and whether you exercise regularly.
Studies have shown that women who take estrogen-only HRT do not have any increased risk of breast cancer.
Women who take HRT containing estrogen and progestogen, may have a very small increased risk of breast cancer, but this risk can be minimised further by using micronised progesterone (e.g. Utrogestan).
Blood clots
HRT taken orally as a tablet is associated with a small increased risk of a blood clot so it is generally not prescribed often these days. HRT taken across the skin as an estrogen patch, gel or spray does not increase the risk of a blood clot.
There are many lifestyle factors that do increase your risk of blood clot however, such as smoking, obesity and prolonged periods of inactivity, so efforts should be made to minimise these wherever possible to avoid a clot developing.
HRT is safe for most women but it is always best to make a well-informed decision that reflects your own concerns and priorities and in discussion with your doctor.
Last updated: June 2026
