Is this perimenopause? Signs to notice and how to talk to your doctor

Maybe it started with your period arriving a week early. Then you were waking up at 3am for no clear reason. Then there was the afternoon you walked into a room and had no idea why you were there.

None of these things on its own is a big deal. Together, they can leave you wondering: is this perimenopause?

This post won't tell you whether it is. Only a healthcare professional who knows your history can do that. What it can do is explain what perimenopause is, what reputable health organizations say about the signs, and how to have a useful conversation with your doctor.

What perimenopause actually is

Perimenopause is the stretch of time before menopause, when your body is getting ready to stop having periods. Mayo Clinic describes it as the time when estrogen "rises and falls," which is why things can feel unpredictable from month to month (Mayo Clinic).

Menopause itself is one specific point: when you've gone 12 months in a row without a period. Perimenopause is everything leading up to it (Mayo Clinic; ACOG).

It doesn't start at the same age for everyone. Mayo Clinic notes many women notice signs in their 40s, but some notice changes in their 30s or as late as their 50s. Cleveland Clinic says it usually starts in your mid-40s and can last anywhere from a few months to several years (Cleveland Clinic).

Signs health organizations describe

Every body is different. Some women notice very little, and others notice a lot (ACOG; NHS). These are the changes that come up again and again in reputable sources:

• Changes to your periods. The NHS calls this "usually" one of the first signs. Periods may come more or less often, and bleeding may get heavier or lighter (NHS).
• Hot flashes and night sweats. A sudden feeling of heat in the face, neck and chest. When it happens at night, it's often called night sweats (NHS; ACOG).
• Sleep problems. Trouble falling asleep, or waking long before your usual time. Mayo Clinic notes sleep can change even without hot flashes or night sweats (Mayo Clinic).
• Mood changes. Irritability, mood swings, low mood or anxiety (Cleveland Clinic; ACOG).
• Memory, focus and "brain fog." The NHS lists problems with memory or concentration, and notes they can feel worse when you're short on sleep (NHS).
• Vaginal and bladder changes. Dryness, discomfort during sex, needing to pee more often, or more UTIs (Mayo Clinic; NHS).
• Other changes the NHS mentions include palpitations, headaches that are worse than usual, muscle aches and joint pains, and dry or itchy skin (NHS).

Why it's so hard to tell on your own

Here's the honest part: a lot of these signs overlap with other things. Stress, thyroid problems, medicines, poor sleep and mental health conditions can all cause some of the same changes. Cleveland Clinic points out that because perimenopause symptoms resemble other conditions, it's a good idea to talk to your healthcare provider so they can rule other causes out (Cleveland Clinic).

There also isn't a simple at-home answer. Cleveland Clinic explains that hormone testing isn't necessary to diagnose perimenopause, and that hormone levels go up and down so much that tests aren't always reliable. A provider usually looks at your symptoms, age and history instead (Cleveland Clinic). The National Institute on Aging says much the same: your doctor may ask about your age, symptoms and family history (NIA).

And if you use hormonal contraception, it can be harder still. The NHS notes that some types can make periods irregular or stop them, which hides one of the usual clues (NHS).

When to call sooner rather than later

Some changes are worth getting checked promptly instead of waiting and watching. Reputable sources list:

• Very heavy bleeding, or bleeding that lasts longer than seven days
• Bleeding between periods or after sex
• Periods that come less than 21 days apart
• Any bleeding after you've gone 12 months without a period

(Mayo Clinic; Cleveland Clinic; NHS)

The NHS also suggests contacting your GP if you have palpitations, or simply if you think you have symptoms and want to know your options (NHS). And Mayo Clinic puts it simply: if any symptoms bother you, see your healthcare professional (Mayo Clinic).

One more thing many women don't realize: pregnancy is still possible in perimenopause. Mayo Clinic advises continuing birth control until you've gone 12 months without a period, and the NHS says it can be longer if you're under 50, so ask your doctor when it's safe to stop (Mayo Clinic; NHS).

How to make your appointment count

Appointments go fast. Walking in with notes makes a real difference. Cleveland Clinic suggests keeping a journal of your cycles, including when they start and stop and how heavy they are (Cleveland Clinic). You might also jot down:

• Which changes you've noticed, and roughly when they started
• How often they happen, and what they get in the way of (sleep, work, relationships)
• Any medicines or supplements you take
• Whether your mom or sisters went through menopause early, if you know

Cleveland Clinic also offers a few questions you could bring along:

• Are these symptoms of perimenopause?
• What can I do to relieve my symptoms?
• How long do you think I will have these symptoms?
• Are there any tests that should be done?

(Cleveland Clinic)

The bottom line

If you're asking "is this perimenopause?", you're not imagining things, and you're not alone in asking. Perimenopause is a normal life stage, but that doesn't mean you have to just put up with changes that are wearing you down. Noticing what's going on, writing it down and talking it through with your doctor is a good first step.