What perimenopause is and how to tell

Perimenopause is the stretch of time before your periods stop for good. Your ovaries do not switch off overnight: hormone levels rise and fall unevenly, sometimes for several years. It usually begins in your 40s, though for some women it comes earlier or later.

The first sign is often a change in your cycle. Periods may come closer together or further apart, get heavier or lighter, or skip a month. Alongside that you might notice:

• hot flushes or night sweats
• poor sleep
• mood swings, irritability or low mood
• trouble concentrating, or losing words mid-sentence
• vaginal dryness
• aching joints

Few women get all of these, and for some the symptoms stay mild.

If you are over 45, a doctor can usually recognise perimenopause from your symptoms and your cycle. Hormone levels swing from day to day, so a single blood test says very little. Tests may be used if you are younger, or to rule out other causes such as thyroid problems or anaemia.

You can get pregnant during perimenopause, even with irregular periods. Keep using contraception until a doctor tells you it is safe to stop. A simple note of your periods and symptoms over a few months gives that appointment something concrete to work with.