Menopause and Perimenopause: Symptoms, Timeline, and When to See a Doctor

Menopause and perimenopause can affect anyone who has periods, and common symptoms include hot flushes, low mood, sleep problems and memory problems [1]. Perimenopause and menopause are different for everyone. You may get symptoms that have a big impact on your daily life, including relationships, social life, family life and work, or you may hardly have any symptoms at all [2].

Perimenopause, Menopause and Postmenopause Explained

Menopause is when your periods stop altogether [1], and it is reached when you have not had a period for 12 months; after this, it's called postmenopause [2]. Menopause is caused by a fall in hormone levels and usually affects women between the ages of 45 and 55, but it can happen earlier [1]. It is one point in a continuum of life stages for women and marks the end of their reproductive years [3].

Perimenopause happens when your periods become irregular [1]. It is when you have symptoms of menopause but your periods have not stopped [4], and it ends when you reach menopause [2].

Using hormonal contraception can make it harder to tell if you've reached perimenopause or menopause, because hormonal contraception can affect your periods [2].

When Does Menopause Usually Happen?

Most women have their menopause between the ages of 45 and 55 [3][5]. Women reach menopause at different ages [6]. The average age is 51 years in the UK [5] and 52 in the United States [6]. In women from African and Asian countries, the average age of menopause tends to be lower than the UK average: 46 to 47 years in India and Pakistan, and 49 years in Africa and the Caribbean [5].

It is not possible to predict when an individual woman will experience menopause, although there are associations between the age at menopause and certain demographic, health and genetic factors [3].

Early and Premature Menopause

Two different age cut-offs are used for menopause that comes sooner than usual. The NHS says early menopause or premature ovarian insufficiency can happen before the age of 45 [1], while the World Health Organization (WHO) and the Royal College of Obstetricians and Gynaecologists (RCOG) describe menopause before the age of 40 as premature menopause, which the RCOG also calls premature ovarian insufficiency [3][5].

Early menopause can be caused by surgery to remove the ovaries (oophorectomy), and sometimes the reason is unknown [1]. When menopause happens before 40, there is usually no cause. Some causes are surgery on the ovaries, chemotherapy, or radiotherapy to the pelvis, and less common causes include genetic conditions and some autoimmune diseases [5].

Common Symptoms of Perimenopause and Menopause

Symptoms can happen during perimenopause and menopause, and they can also happen after your menopause has ended [2]. Around half of all women notice physical and/or emotional symptoms during perimenopause [5].

Changes to Your Periods

A change to your periods is usually one of the first signs of perimenopause [2], and it might be what you notice first [6]. Periods may happen more often or less often, and bleeding may get heavier or lighter [2]. Periods may also be shorter or last longer [6]. Eventually, you stop having periods altogether [2].

Hot Flushes and Night Sweats

Hot flushes, called hot flashes in the US, and night sweats are among the most common symptoms of menopause [5][6].

During a hot flush, your face, neck and chest suddenly feel very hot or cold. It can make you sweat a lot, cause palpitations or anxiety, or make you feel dizzy, and it can happen during the day or night (night sweats) [2]. Estimates of how long each one lasts differ: the NHS says several minutes [2], while the US National Institute on Aging (NIA) says most hot flashes last between 30 seconds and 10 minutes [6]. Hot flashes can happen several times an hour, a few times a day, or just once or twice a week, and for many women they last for many years after menopause [6].

Sleep, Mood, Memory and Concentration

Not being able to get to sleep or stay asleep can affect your daily life and make you feel irritable, stressed and anxious, and sleep problems may be worse if you also have night sweats [2]. Night sweats or a need to urinate might wake you up [6].

You may have mood swings, low mood or depression [2][3][5], or feel anxious [3][5], and you may notice problems with your memory or concentration, sometimes called brain fog [2][5]. These symptoms may feel worse if you have sleep problems and feel very tired [2].

You might feel moodier or more irritable around the time of menopause, and scientists don't know why this happens. It's possible that stress, family responsibilities such as supporting growing children or caring for aging parents, depression, or feeling extra tired could be causing these mood changes [6]. Talk with your primary care provider or a mental health professional about what you're experiencing. There are treatments available to help [6].

Vaginal, Sexual and Urinary Changes

You may get dryness, a burning feeling, irritation or itching in and around the vagina [2], and the vagina may become dry and thin [7]. These changes can make sex painful [2][7]. A reduced sex drive (loss of libido), or loss of interest in having sex, is another symptom [2][5].

During menopause, many women develop bladder or urinary problems [6]. You may feel the need to pee more or not be able to control when you pee (urinary incontinence) [2], and you may have a sudden urge to urinate, or urine may leak during exercise, sneezing, or laughing [6]. You may also get more UTIs (urinary tract infections) or symptoms that feel like a UTI [2]. Menopause also increases the risk of developing urinary tract infections [6].

Other Changes You May Notice

Menopause and perimenopause may affect you in other ways, including [2]:

• a faster, slower or more noticeable heartbeat (palpitations)
• headaches and migraines that are worse than usual
• muscle aches and joint pains
• hair thinning or hair loss
• skin changes, including dry and itchy skin
• sensitive teeth, painful gums or other mouth problems

Weight gain during perimenopause and menopause is common, and it often happens around the stomach and upper body [2]. The distribution of fat in the body changes, and women may gain weight more easily [6]. Some of these changes may be part of aging rather than being directly related to menopause [6].

Bone and Heart Health After Menopause

Loss of bone density at menopause is a significant contributor to higher rates of osteoporosis and fractures [3].

After menopause, women are also more vulnerable to certain health conditions, including heart disease and stroke [6].

How Long Do Menopause Symptoms Last?

Perimenopause can last from a few months to several years [5]. How long symptoms last differs between UK and US estimates:

• In the UK, symptoms usually last for 7 to 9 years, sometimes longer, and during this time they can change [2].
• In the US, symptoms related to menopause can last for between two and eight years, though the timing and symptoms are highly variable among women [6].

You may get hot flushes and night sweats for a while, but they may improve and be replaced by other symptoms such as low mood and anxiety. You may also get symptoms that continue after menopause, such as joint pain and vaginal dryness [2].

Ethnic Background and Smoking

Ethnic background can sometimes affect symptoms of perimenopause and menopause, how severe they are and how long they last. For example, women from a Black ethnic background are more likely to have hot flushes that are severe and continue longer [2].

Compared with White women, Black women are more likely to have an early onset of menopause, experience more menopausal symptoms, and have symptoms for longer, while Asian women are less likely to suffer from menopausal symptoms [6]. Smoking is associated with an early onset of menopause and more severe menopausal symptoms [6].

How Menopause Is Diagnosed

There's no routine test for perimenopause and menopause, and a doctor may diagnose it based on your age and symptoms [1].

It may be difficult for you and your doctor to tell whether you are in the menopausal transition. If you are having symptoms like hot flashes, irregular periods, or trouble sleeping, your doctor may ask questions about your age, symptoms, and family history to determine if the menopausal transition is a likely cause [6]. In the UK, if you have symptoms of menopause and are over 45 years of age, you will not usually need any hormone tests to diagnose menopause [5].

Blood tests are used in some situations. In some cases, for example if a woman's periods stopped at an early age, a doctor may suggest a blood test to check hormone levels [6]. In the UK, for possible menopause before 40, you will be offered blood tests to measure your hormone levels to help diagnose premature menopause [5].

Can You Get Pregnant During Perimenopause?

Yes. It's possible to get pregnant during perimenopause, and in the UK you still need contraception [2]:

• for 1 year after your final period, if you're 50 or over
• for 2 years after your final period, if you're aged 40 to 49 years old

WHO recommends contraception to avoid unintended pregnancy until after 12 consecutive months without menstruation [3]. In the US, a woman who does not want to get pregnant should continue to use birth control for at least a full 12 months after her last period [6]. Speak with your health care provider about when it is safe for you to stop using birth control [7].

When to See a Doctor

In the UK, the NHS gives this as non-urgent advice. Contact your GP if [2]:

• you think you have symptoms of menopause or perimenopause and want to know what your options are
• you have symptoms like a fast heartbeat (palpitations)
• you still have periods but your bleeding pattern has changed and you're bleeding more, not less, than before
• you have not had a period for 12 months or more, and you have any vaginal bleeding

Early advice can help reduce the effects of menopause and perimenopause on your health, relationships and work [2].

In the US, the NIA says period changes can be normal, but to make sure there isn't a problem, see your doctor if [6]:

• Your periods happen very close together.
• You have heavy bleeding.
• You have bleeding or spotting after sex or between periods.
• Your periods last more than a week.
• You start bleeding or spotting again after not having a period for more than a year.

The US Food and Drug Administration (FDA) advises speaking with your health care provider about any changes in your periods or bleeding [7].

The RCOG says that if your periods come less often or stop before the age of 40 years and/or you experience menopausal symptoms, you should see your healthcare professional [5].

Bleeding After Menopause

The NHS says that if you have not had a period for more than 12 months and you get any vaginal bleeding (postmenopausal bleeding), this needs to be checked, and its non-urgent advice is to see a GP if you have postmenopausal bleeding, even if [2]:

• it's only happened once
• there's only a small amount of blood, spotting, or pink or brown discharge
• you do not have any other symptoms
• you're not sure if it's blood

Postmenopausal bleeding is not usually serious but can be a sign of cancer, and cancer may be easier to treat if it's found early [2].

In the US, the FDA says: "Always tell your health care provider if you have any vaginal bleeding after menopause. This may be a sign of an urgent medical problem." [7]

Getting Help With Symptoms

Many women find that they do not need treatment for their menopause symptoms, and many women have mild symptoms that can be managed with lifestyle changes, such as avoiding caffeine, dressing in layers, or carrying a portable fan [6]. If your menopause symptoms are interfering with your usual activities or get worse, speak with your health care provider to discuss whether treatment is right for you [7]. Symptoms that impact on health and well-being should be discussed with a health-care provider to identify available management options, with consideration of medical history, values, and preferences [3].

Conclusion

Noting how your periods are changing and which symptoms affect you most can help you get more out of a conversation with a GP or doctor, whether you want reassurance or want to talk about next steps.

Medical Disclaimer

This article is for general information and does not replace advice from a qualified health professional. If you think you need urgent medical care, get emergency help straight away.