Most women recognise perimenopause not from one symptom but from a list.
That is the usual account: reading through something like this and realising that a dozen unrelated things you had explained away separately are one thing.
Cycle and bleeding
- Cycles getting shorter — periods arriving more often
- Cycles varying by seven days or more between one and the next
- Heavier bleeding, sometimes with clots
- Longer periods
- Skipped months, then a return
- Worse premenstrual symptoms than you used to get
Cycle change is the most common first sign and the one most often missed, because people expect periods to space out rather than bunch up.
See heavy and irregular periods.
Temperature
- Hot flushes during the day
- Night sweats, sometimes needing a change of bedding
- Feeling cold and clammy after a flush
- Sudden flushing in the face, neck or chest
About three in four women experience these. One in four does not, and their absence rules nothing out.
Sleep
- Waking in the early hours, often between 2am and 4am
- Difficulty getting back to sleep
- Difficulty falling asleep
- Waking unrefreshed despite enough hours
- Lighter sleep, waking at noises that never registered before
See sleep problems and insomnia.
Mood
- Anxiety, often without an identifiable trigger
- Low mood or a flatness that feels out of character
- Irritability, or sudden anger disproportionate to the cause
- Tearfulness
- Loss of confidence
- Loss of interest in things you used to enjoy
- Panic attacks
See anxiety, low mood and rage and irritability.
Thinking and memory
- Word-finding difficulty mid-sentence
- Walking into a room and losing the reason
- Reading the same paragraph repeatedly
- Difficulty holding several things in mind
- Feeling slower, as though thinking takes effort it did not
See brain fog.
Body
- Joint aches and morning stiffness
- Muscle pains
- Headaches or migraines changing in pattern
- Heart racing or pounding
- Dizziness
- Tingling or numbness in hands or feet
- Fatigue that rest does not fix
- Weight settling differently, particularly around the middle
- Hair thinning; drier skin and nails
- Itchy or crawling skin
- Changes in body odour
- Dry or gritty eyes
- Bloating and digestive changes
- Sore or tender breasts
Genital, urinary and sexual
- Vaginal dryness or irritation
- Discomfort or pain during sex
- Reduced interest in sex
- Difficulty reaching orgasm
- Needing to pass urine more often or urgently
- Leaking with coughing, sneezing or exercise
- Recurrent urinary tract infections
This group is the least reported and, unlike most of the others, does not improve on its own. See vaginal dryness and urinary symptoms.
What a long list does and does not mean
It does not mean you have perimenopause. Thyroid problems, iron deficiency, sleep apnoea, vitamin B12 or D deficiency and depression all produce overlapping symptoms. All are common in this age group. All are treatable, and all get missed when everything is attributed to hormones.
It does mean you have something worth investigating, and that you now have specifics rather than a vague sense that things are off.
What to do with it
A list is only useful if it becomes a record.
- Note which apply, and roughly when each started
- Track your cycle for two or three months
- Write down the impact — what you have stopped doing
- Book a long appointment, and say it is to discuss perimenopause
Our symptom check does the first and third in about two minutes, and produces a summary you can print or email. It is based on a symptom questionnaire used in menopause research, and it groups your answers the way a doctor will want to hear them.
It does not diagnose anything. That is the point — it makes the conversation that follows a better one.