What perimenopause means
In perimenopause, periods change and eventually stop because hormone levels fall. Menopause usually affects women between 45 and 55, but it can come earlier. Symptoms usually last seven to nine years, sometimes longer, and change during this time.
Signs you might not connect straight away
Besides changing periods and hot flushes, the NHS lists among others:
- sleep problems and night sweats
- mood swings, low mood, problems with memory and concentration
- vaginal dryness, burning, more frequent urinary tract infections
- palpitations, joint and muscle pain, headaches
- reduced interest in sex
- thinning hair and skin changes
According to the European Society of Endocrinology's 2025 guideline, about one in four women has debilitating symptoms.
Contraception is still relevant
It is still possible to get pregnant during perimenopause. The NHS advises continuing contraception: from 50, until one year after the last period; between 40 and 49, until two years after. Hormonal contraception can mask the signs because it changes your bleeding. The NHS no longer recommends the combined pill from age 50.
For Rhythmus this also means: as cycles become more irregular, the phase calculation becomes less accurate. The calculated ovulation is not a method of contraception in any case.
When to see a doctor
- Your bleeding gets heavier rather than lighter.
- You haven't had a period for twelve months or more and you bleed again. It is usually not serious, but it needs to be checked because it can occasionally be a sign of cancer.
- You are under 45 and have menopause symptoms, or your periods stop. If menopause starts this early, the NHS advises replacing the missing hormones because bones and heart are otherwise at greater risk.
What can help
The Lancet's 2024 series on menopause argues for not treating this time merely as a list of symptoms, but for supporting women through it with knowledge and a say in decisions. The European guideline describes treatment options with and without hormones in detail; which one fits is a medical decision.
What happens after the last period is covered in the article menopause and postmenopause; for treatment with and without hormones, see hormone therapy and hot flushes without hormones.