Perimenopause Symptoms: A GP’s Checklist for What to Watch For

You might not connect the dots at first. Sleep gets worse. Your period changes — heavier one month, lighter the next, or missing altogether. You feel irritable in a way that doesn’t match what’s happening around you. Concentration slips. Joints ache for no obvious reason. Weight shifts even though nothing else has changed.

These are textbook perimenopause symptoms, but many women spend months — sometimes years — putting them down to stress, age, or just “getting on with it.” At The Lagom Clinic’s menopause clinic in Bristol, we see this pattern regularly. The earlier you recognise it, the sooner you can do something about it.

What Is Perimenopause?

Perimenopause is the transition phase before menopause. It typically starts in your mid-40s, though it can begin earlier. During this time, oestrogen and progesterone levels fluctuate unpredictably rather than declining in a straight line. That fluctuation — not just the decline — is what causes many of the symptoms.

Perimenopause can last anywhere from 2 to 10 years. Menopause itself is defined as 12 consecutive months without a period. Everything before that point is perimenopause.

The Full Perimenopause Symptoms Checklist

Not every woman gets every symptom. But if you’re recognising several of these together, perimenopause is worth discussing with a GP.

Menstrual Changes

• Periods becoming irregular (longer cycles, shorter cycles, skipped months)
• Heavier periods than usual
• Lighter periods than usual
• Spotting between periods

Sleep and Energy

• Difficulty falling asleep or staying asleep
• Waking in the early hours (often with night sweats)
• Persistent fatigue that doesn’t improve with rest
• Feeling exhausted by mid-afternoon

Mood and Cognition

• Increased irritability or shorter temper
• Anxiety — sometimes new, sometimes a return of old anxiety
• Low mood or feelings of sadness without clear cause
• Difficulty concentrating (“brain fog”)
• Forgetting words or losing your train of thought

Physical Symptoms

• Hot flushes (sudden waves of heat, usually face and chest)
• Night sweats
• Joint pain or stiffness, especially in the morning
• Headaches or migraines, sometimes worse around your period
• Heart palpitations
• Dry skin, dry eyes, or changes in skin texture
• Weight gain, particularly around the abdomen
• Bloating

Urogenital Symptoms

• Vaginal dryness or discomfort
• Reduced libido
• Painful sex
• Urinary urgency or recurrent UTIs

Less Commonly Discussed

• Tinnitus (ringing in the ears)
• Changes in body odour
• Burning mouth or altered taste
• Itchy or crawling skin sensations (formication)
• Electric shock sensations

When Do Perimenopause Symptoms Start?

The average age for perimenopause to begin is 45-47, but it can start as early as the late 30s. If your mother went through menopause early, you may too — there’s a genetic component.

Perimenopause before age 40 is considered premature and warrants investigation. If you’re under 40 and experiencing several of the symptoms above, speak to a GP sooner rather than later.

Can a Blood Test Confirm Perimenopause?

This is one of the most common questions we’re asked. The short answer: not reliably on its own.

FSH (follicle-stimulating hormone) levels fluctuate significantly during perimenopause. A single blood test can come back “normal” even when you’re clearly in perimenopause. For this reason, NICE guidelines recommend that perimenopause in women over 45 is diagnosed based on symptoms, not blood tests.

That said, blood tests can be useful for:

• Ruling out other causes of your symptoms (thyroid problems, iron deficiency, diabetes)
• Establishing a baseline before starting HRT
• Investigating premature perimenopause (under 40)
• Monitoring hormone levels over time alongside symptoms

At The Lagom Clinic, we offer perimenopause blood panels that include FSH, LH, oestradiol, testosterone, thyroid function, and full blood count — giving a broader picture than FSH alone.

What Can Help?

Perimenopause is not something you simply have to endure. The right combination of medical support and lifestyle adjustments can make a significant difference.

HRT (Hormone Replacement Therapy)

HRT replaces the hormones your body is producing less of. For many women, it’s the most effective treatment for hot flushes, night sweats, mood changes, and bone protection. Modern HRT has a well-established safety profile — the risks are well-understood and, for most women under 60, are outweighed by the benefits.

HRT should be discussed individually with a doctor who understands your medical history, risks, and preferences. At The Lagom Clinic, we prescribe HRT where clinically appropriate, with ongoing monitoring and adjustments.

Lifestyle Factors

• Exercise — regular weight-bearing and cardiovascular exercise improves mood, sleep, bone density, and metabolic health during perimenopause
• Diet — adequate calcium, vitamin D, and protein; reducing alcohol and caffeine can help with flushes and sleep
• Sleep hygiene — consistent routine, cool bedroom, limiting screens before bed
• Stress management — cortisol and hormonal balance are closely connected; managing stress supports hormonal stability

Cognitive Behavioural Therapy (CBT)

NICE recommends CBT specifically for menopause-related low mood and anxiety. It can be effective whether or not you’re also taking HRT.

When to See a GP About Perimenopause

You don’t need to wait until symptoms are severe. If perimenopause is affecting your sleep, mood, relationships, or ability to function at work, that’s reason enough to have a conversation.

See a GP promptly if:

• You’re under 40 and experiencing these symptoms
• You have very heavy bleeding (soaking through pads/tampons hourly)
• You’re bleeding after sex
• You’re having suicidal thoughts or severe depression
• You’ve started HRT and aren’t sure it’s working or are experiencing side effects

FAQs

What age does perimenopause start?

Typically between 45 and 47, but it can begin in the late 30s or early 40s. If your periods are changing and you’re recognising the symptoms above, it’s worth discussing with a GP regardless of your exact age.

How long does perimenopause last?

On average 4-8 years, though the range is 2-10 years. The duration and severity vary widely between individuals.

Can I get pregnant during perimenopause?

Yes. Until you’ve had 12 consecutive months without a period (menopause), pregnancy is still possible. Contraception should be discussed with your GP.

Is perimenopause the same as menopause?

No. Perimenopause is the transition period before menopause. Menopause is the point at which you’ve had 12 months without a period. Postmenopause is everything after that. Many of the symptoms people call “menopause symptoms” actually begin during perimenopause.

Should I ask for HRT during perimenopause?

If your symptoms are affecting your quality of life, HRT is a reasonable conversation to have with your GP. NICE guidelines support offering HRT to women with troublesome perimenopausal symptoms. It’s not right for everyone, but for many women it’s the most effective option.

Private Menopause and Perimenopause Support in Bristol

At The Lagom Clinic’s menopause clinic, we offer 30-minute dedicated appointments for perimenopause and menopause assessment. We prescribe HRT where appropriate, run hormone and health blood panels, and take a lifestyle-led approach that looks at the full picture — not just your hormones.

No referral needed. Same-week appointments usually available.

Book online, call 0117 987 2075, or email info@thelagom.co.uk.