Perimenopause is the transition time before menopause, when hormone levels fluctuate and periods become irregular. It usually starts in a woman’s 40s and lasts on average about 4 years, though it can be shorter or much longer. Menopause itself is confirmed after 12 months with no period. Symptoms can affect sleep, mood, work and relationships, and effective treatments are available.
15 common signs of perimenopause
- Irregular periods: shorter, longer, heavier or lighter
- Hot flushes
- Night sweats
- Sleep problems
- Mood swings, irritability, anxiety or low mood
- Brain fog and forgetfulness
- Tiredness
- Vaginal dryness and discomfort during sex
- Lower sex drive
- Needing to urinate more often or recurrent UTIs
- Joint and muscle aches
- Headaches or worse migraines
- Heart palpitations
- Weight gain around the middle
- Dry skin, hair thinning
Is it perimenopause or something else?
Thyroid problems, anaemia, depression and pregnancy can cause similar symptoms. In women over 45 with typical symptoms, diagnosis is usually based on symptoms; blood tests are mainly used in younger women. Very heavy bleeding, bleeding between periods or after sex, or any bleeding after menopause should always be checked.
What helps
Hormone replacement therapy (HRT)
HRT is the most effective treatment for hot flushes and night sweats and can help mood, sleep and joint pain. For most women under 60, benefits usually outweigh risks. Women with a womb need progestogen as well as oestrogen. Discuss your personal risks with a healthcare provider.
Vaginal oestrogen
Low-dose creams, tablets or rings for dryness and urinary symptoms; very little is absorbed into the body.
Non-hormonal options
- Some antidepressants and other medicines can reduce hot flushes
- Cognitive behavioural therapy (CBT) for hot flushes, sleep and mood
- Regular exercise, including strength training for bone health
- Reducing alcohol, caffeine and spicy food if they trigger flushes
- Layered clothing and a cool bedroom
- Calcium and vitamin D for bone health
Contraception in perimenopause
You can still get pregnant. Use contraception until you have had no periods for 12 months if over 50, or 2 years if under 50, or follow your healthcare provider’s advice.
For nurses going through perimenopause at work
- Ask occupational health about reasonable adjustments: cooler uniforms, access to water, flexible breaks
- Night shifts can worsen sleep problems; discuss rota options
Frequently asked questions
At what age does perimenopause start?
Usually in the 40s, sometimes in the late 30s.
Can perimenopause cause anxiety?
Yes. Fluctuating hormones can trigger new or worse anxiety and low mood.
Related reading: Menopause symptoms and HRT · Insomnia tips
Checked against NHS guidance on menopause and perimenopause. Updated 5 November 2026.
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