If your body or mood has started to feel different in your 40s, you may be wondering whether these are perimenopause symptoms. This guide covers the first signs, the full range of symptoms, how common they are, how they differ from PMS, what else can cause similar complaints and when to see your GP.
The short answer: most women notice something. According to the HSE, about 8 in 10 women have symptoms before and after their periods stop, and these can begin 7 to 10 years before your last period. The NHS says a change in your periods is usually one of the first signs.
What perimenopause is
Perimenopause is the time before your last period, when your hormone levels start to fluctuate and your cycle changes. It ends 12 months after your final period. The terms, and what happens to oestrogen and progesterone, are explained in What is menopause?.
The Australasian Menopause Society describes perimenopause as a time of fluctuating hormones, oestrogen in particular. Some symptoms are linked to periods of low oestrogen, others to periods of relatively high oestrogen. That helps explain why symptoms can come and go, and why they can vary from month to month.
First signs of perimenopause
For most women the first sign is a change in the cycle. Clinically, perimenopause starts when the length of your cycles keeps varying by seven days or more from one cycle to the next. Your periods may also become heavier or lighter.
Other early signs many women notice are hot flushes or night sweats, sleeping less well and changes in mood. The UK guideline NICE advises that in otherwise healthy women over 45, perimenopause can be diagnosed based on hot flushes or sweats together with irregular periods, without a blood test.
Perimenopause symptoms in full
No woman has all of these, and the mix differs from person to person. The NHS notes that ethnic background can affect which symptoms you have, how severe they are and how long they last.
Your cycle and periods
Cycles can get shorter or longer, periods can be lighter or heavier, and skipped periods are common. The HSE notes that periods can become very heavy in the year before menopause. Read more in Periods in perimenopause.
Hot flushes and night sweats
The Dutch GP guideline (NHG) reports that about 80% of women have hot flushes to some degree. A flush is a sudden feeling of heat in your face, neck and chest, sometimes with sweating and a racing heart. See Hot flushes and night sweats.
Mood, sleep and thinking
- Low mood, anxiety, irritability, mood swings and lower self-esteem (HSE).
- Difficulty concentrating and forgetfulness, often called brain fog. The Dutch occupational health guideline (NVAB, 2026) says about 60% of women in midlife report memory problems.
- Trouble falling asleep or waking often, partly because of night sweats.
The NVAB guideline states that the risk of clinical depression is 2 to 5 times higher in perimenopause and early postmenopause. Thuisarts notes that a previous depression raises the chance of another one during this time. Low mood that lasts is worth discussing with your GP, whatever the cause.
Body
- Joint and muscle aches: up to half of women report them, according to the NVAB guideline.
- Headaches and migraine, which often get worse in perimenopause and gradually improve after a natural menopause.
- Heart palpitations.
- Sore or tender breasts, which the Australasian Menopause Society links to higher oestrogen phases.
- Dry or itchy skin and thinning hair.
- Weight gain, often around the middle. More in Weight and menopause.
Some symptoms are less well known, such as sensitive teeth, gum problems or a lower sex drive. We cover these in Lesser-known menopause symptoms.
Vagina and bladder
Lower oestrogen can make the vaginal tissue thinner and drier. This can cause itching, burning and pain during sex. Some women get urinary tract infections more often, or need to pee more often, including at night. The NVAB guideline puts vaginal symptoms at about 15% of women in perimenopause and 30% after menopause, so they often appear or increase later.
How common they are and how long they last
According to the HSE, about 8 in 10 women have symptoms. Most symptoms last around 4 years after the last period, but about 1 in 10 women have them for up to 12 years. The NHS says symptoms usually last 7 to 9 years, sometimes longer, and notes that symptoms can change over time: hot flushes may ease while low mood or anxiety becomes more noticeable. For the full picture, read How long does perimenopause last?.
Worse PMS, or perimenopause?
Many women notice that their premenstrual symptoms get worse in their 40s. PMS means physical or emotional symptoms in the second half of your cycle that ease once your period starts. The Dutch gynaecologists' guideline on PMS estimates that about 5% of women aged 15 to 45 have PMS, in the sense of symptoms that get in the way of daily life.
In perimenopause, oestrogen can rise higher and fall lower than before. The Australasian Menopause Society notes that mood problems become more common in this phase, especially in women who have had hormone-related mood symptoms before. A 2021 review in Current Psychiatry Reports concluded that the hormonal changes of the early transition may worsen existing premenstrual mood disorders, while noting that more research is needed.
A practical difference: PMS follows a pattern, starting after ovulation and lifting when your period begins. Perimenopause symptoms such as hot flushes or poor sleep can turn up at any point in the month, and the cycle itself starts to change. Noting your symptoms alongside your period dates for a few months usually shows which pattern you have.
What else can cause similar symptoms
Tiredness, low mood, weight gain and irregular periods are not specific to perimenopause. Your GP will think about other causes, especially if your symptoms are unusual for your age.
- Thyroid problems. An underactive thyroid can cause tiredness, weight gain, low mood, dry skin, hair loss and irregular or heavy periods, according to the NHS. An overactive thyroid can cause sweating and palpitations; the NVAB guideline lists it as a condition to rule out.
- Iron deficiency. The HSE lists tiredness, lack of energy, shortness of breath, palpitations and pale skin as common symptoms of iron deficiency anaemia. Heavy periods are a very common cause.
- Depression or anxiety. These can occur on their own or alongside perimenopause. The NVAB guideline lists anxiety and panic disorder, and problem drinking, as conditions that can resemble menopause symptoms.
- Medicines. Some medicines, including tamoxifen, aromatase inhibitors and some antidepressants, can cause hot flushes (NVAB).
- Pregnancy. If your periods are irregular and you have had sex without contraception, the HSE advises checking whether you are pregnant.
Hormonal contraception can also mask perimenopause, because it changes or stops your periods. A hormone test usually doesn't settle the question over 45, because levels change from day to day; a blood test can still be useful to rule out other causes. More in Menopause tests.
When to see your GP
The HSE advises contacting your GP if:
- your symptoms are worrying you or affecting your daily life;
- your symptoms start before you are 45;
- your periods have stopped for a year or more before you are 45.
The NHS adds palpitations, and periods that are getting heavier rather than lighter. Any vaginal bleeding after 12 months without a period should always be checked. In Ireland your GP can assess and treat menopause symptoms, and can refer you to a specialist menopause clinic if treatment doesn't help, you can't take HRT, or your medical history is complex.
Keep track before your appointment
A few weeks of notes make a GP appointment more useful: your period dates and flow, hot flushes, sleep, mood and anything else you notice. Our free symptom diary is designed for this, and you can print it to take with you. The menopause guide gives an overview of the stages.
Sources
- HSE. Symptoms of menopause and perimenopause; Menopause; Iron deficiency anaemia.
- NHS. Symptoms of menopause and perimenopause; Underactive thyroid: symptoms.
- NICE. Menopause: identification and management (NG23).
- Australasian Menopause Society. Perimenopause information sheet.
- NVAB. Richtlijn Overgang en werk (2026).
- NHG. Summary of the NHG-Standaard De overgang, Huisarts en Wetenschap (2022).
- Thuisarts.nl. Ik ben in de overgang.
- NVOG. Richtlijn Premenstrueel syndroom.
- Sander B, Gordon JL. Premenstrual mood symptoms in the perimenopause. Current Psychiatry Reports, 2021;23:73.
